Leading Psychiatrist & Women’s Health Clinician Answers 12 Significant Questions About Perimenopause & Depression
Dr. Hadine Joffe is Executive Director at the Mary Horrigan Connors Center for Women's Health and Gender Biology and the Founder and Director of the Women’s Hormones and Aging Research Program in the Department of Psychiatry at Brigham and Women’s Hospital in Boston, MA. A psychiatrist and women’s health clinician, she treats women with symptoms related to menopause (hot flashes, sleep, mood, fatigue) and breast cancer therapies.
An international leader in the field of menopause research, Dr. Joffe is devoted to understanding the biology of menopause-related symptoms and advancing their treatment.
Here, Dr. Joffe answers common questions about perimenopause and perimenopausal depression:
1. What is perimenopause?
Perimenopause is a period of time, on average, lasting four years and starting in the mid to late 40s, when a woman’s menstrual cycle pattern changes. So someone who has had predictable monthly cycles will start to have longer or shorter cycles. Eventually, they become less frequent. Once a woman goes 12 months without a menstrual period, she has reached menopause and is officially postmenopausal.
2. What should I know about perimenopause?
All women go through perimenopause, most without a major impact on their well-being. It’s not a disease. It’s not a condition. It’s a reproductive transition, in the same way that puberty is a natural stage of life.
3. What happens in a woman’s body during perimenopause?
The perimenopause signifies that the ovaries are aging, with fewer and fewer follicles that release eggs.
4. What are the symptoms of perimenopause?
The most common symptoms are changes in menstrual cycle patterns, hot flashes, night sweats, changes in sleep or insomnia, mood changes, low energy, and fatigue during the day, as well as vaginal dryness.
5. How do I check to see if I’m perimenopausal?
A woman with a uterus has a menstrual marker indicating changes in her body. But, for a woman without a uterus - it was removed during a hysterectomy, for example - that marker isn’t always present, so a blood test will help us understand whether she’s in perimenopause.
6. What are some treatments for hot flashes?
Hot flashes don’t necessarily need treatment. They’re mild, infrequent, and not bothersome for some women. However, others experience intense and frequent hot flashes that interrupt their sleep and distress them during the day.
Some women decide to treat their hot flashes with non-medical approaches and see how that goes over time. These include lifestyle changes like wearing lighter clothing and layering or using fans to keep the air moving around them.
OTC treatments include soy, acupuncture, hypnosis, and cognitive behavioral therapy (CBT.)
Hormone therapy, the main medication we use to treat hot flashes, is very effective. We use it at low doses, and we try to keep women on it for fewer than four or five years, which is very manageable for most of them. We also use antidepressants called selective serotonin reuptake inhibitors (SSRIs). Although we’re not using them in these cases to treat depression, serotonin interacts with the brain changes that cause hot flashes and can treat them.
7. What is perimenopausal depression?
Depression is sadness that a woman can’t shake, and is linked to hormone changes in her brain and body. Common in perimenopause, this kind of mild depression comes and goes and can last for a long time. It is accompanied by other symptoms, including trouble sleeping, lack of energy, concentration and motivation, and appetite changes. Women with depression may or may not have experienced depression in the past. Perimenopausal depression can be very disruptive for a protracted period of time, which is a reason to seek treatment.
8. What’s the difference between mild mood changes and clinical major depression?
When depression is severe, it comes with hopelessness and even suicidal thoughts. A woman can’t function or maintain relationships. Major depression is not as common in perimenopause, but it’s a period of risk and vulnerability, like postpartum depression.
Depression can last over a number of years because perimenopause can last a long time. We want to monitor a woman with a history of depression or sensitivity to hormonal changes.
It looks like the risk for depression decreases when a woman is postmenopausal. The hormones settle and things quiet down in the brain.
9. What causes perimenopausal depression?
Depression can occur at any stage of life. It can happen when a woman is perimenopausal, but it may not be related at all. A major life stressor could trigger it. It’s important to determine the contributing factors.
10. What are the treatments for perimenopausal depression?
Perimenopausal depression is very treatable, most often with serotonin-based antidepressants. Talk therapy and CBT are critical for some women. It’s important to discuss, understand, and manage your symptoms, whether it’s a lack of concentration or avoiding a social life.
Are you exercising? How much are you drinking? Are you sleeping well? Leaving the house? Getting light exposure? Socializing? Monitor your mood. It’s helpful to tell the doctor what’s happening when you’re low and how often you’re low.
11. Which doctor should I see?
Start with your primary care doctor, who can be knowledgeable about dealing with depression.
12. What steps can a woman take to recognize perimenopausal depression?
Depression can be consuming, even though you can’t see it and it’s nebulous. If you notice you’re not yourself, try to connect with someone else. Understand. Empower. Monitor. Protect. Relieve. These are strategies to help you during this time of life. Your quality of life matters to you and to those around you.
Comments