Hello all. This may feel like an oddly specific topic for someone in their early 20’s to be writing about however my Masters dissertation this year was focused on establishing whether hormone replacement therapy (HRT) was an effective treatment for depression and low mood in the menopause. My research has since sparked a passion for sharing the reality of the effects that the menopause can have on mental health. There is so little understanding out there about the menopause in relation to mental health and I feel it is about time that people really start talking about it.
I will write about what I found in my dissertation in relation to the potential benefits or drawbacks of HRT in another blog post, but I thought I would begin by shedding some light over where the research is at in its understanding of menopausal depression.
I would like to preface this post by emphasising that the menopause is not necessarily a female-specific phenomenon. Trans men and non-binary people can also experience the menopause. Where I use the terms women/woman/female I am usually trying to talk about the influence of biological sex rather than chosen gender however I apologise if I misuse the terms.
A Brief Overview of the Menopause
The menopause is where the menstrual cycle comes to an end due to naturally declining levels of hormones. It typically begins around the ages of 45-50 and lasts for an average of 4-5 years however the age of onset and duration is unique for each person going through it. The menopause itself is actually split into different transitory stages, beginning in the perimenopause where the cyclical nature of menstruation becomes irregular, and ending in the postmenopausal period which is signposted by the experience of no bleeding (amenorrhoea) for 12 consecutive months.
While some will experience little to no difficulty during this time there are many unwelcome symptoms that can accompany the menopausal transition such as hot flushes/flashes, night sweats, insomnia, vaginal dryness and itching, sexual dysfunction, anxiety and depression.
Across the world, prevalence studies have reported that depression is experienced by 28-40% of menopausal woman  . When split into the transitory stages, the prevalence is the lowest in the premenopausal period and is relatively similar across the perimenopause and the postmenopausal period   . Sadly, there is very little research surrounding menopausal depression even though it can be a common symptom of the menopause and can be debilitating for those who experience it.
What is the cause?
Unfortunately, there is no one established cause of menopausal depression at the moment. There is however research attempting to explain and understand how depression emerges during this period of time.
It is well established in scientific research and literature that, between the sexes, women are far more likely to suffer from depressive illnesses than men  . One proposed reason for this is the presence of the oestrogen, progesterone and other female-associated hormones  . Most of the evidence for this comes from cases of premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD), or from intervention studies where depressed women are given hormones to help with the depression    . It is also well known that oestrogen is closely linked with the functions of serotonin (the hormone otherwise known as the ‘happy hormone’). Unfortunately, due to a general lack of research, the evidence for hormones inducing depression isn’t strong however many medical professionals are hopeful that with more research, hormones could be established in the aetiology behind menopausal depression.
Other factors that have been suggested to be involved in the emergence of depression during the menopause include a difficulty to cope with the stressors of mid-life, difficulty with a partner, age, employment status and struggling with the other menopausal symptoms such as hot flushes or the insomnia      .
After all of my research so far, I truly believe that the cause for depression in the menopause will be unique for everyone who comes to experience it and that there is no one cause of menopausal depression, instead that it is a combination of factors coming together to create a very difficult menopausal transition.
So, what can be done about it?
As the research out there is lacking, there is no established or perfect treatment for menopausal depression. There is research to suggest that hormone replacement therapy (HRT) is both good and bad for treating menopausal depression. I hope to write a more in-depth blog post later on about the use of HRT to treat menopausal depression but for the purposes of this blog post I can’t say that HRT is the solution, even though I know many medical professionals hope it will be. There is research also supporting and refuting the use of antidepressants and talking therapies. The only promising research is where there is a combination of antidepressants and HRT however there still isn’t enough research out there to suggest that this is a be-all-end-all treatment or that it works for everyone.
If you or someone you know is struggling with menopausal depression, I would suggest seeking advice from a GP as well as a medical professional who specialises in areas such as the menopause or female health. It is important to talk through the symptoms you experience, your history, your lifestyle and all the options available to you. The treatment you receive may not be perfect first-time round, but there will be something that works for you.
Dealing with depression during the menopause can be extremely tough and isolating. It is important to remember that you are not alone in what you are experiencing and there is help out there.
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