There is a connection between menopause and depression. According to research, about 41{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} of postmenopausal women feel depressed. Among menopausal women of different racial and ethnic groups, depression disproportionately affects Black women.
It is important to know the symptoms of depression to help you seek help and form a treatment plan with your healthcare professional.
In this article, learn more about the connection between menopause and depression and the health disparities related to this biological process.
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What’s the Link Between Menopause and Depression?
Women are 2.5 times more likely than men to experience depression, and research shows this risk is heightened during menopause, the transition period between reproductive and nonreproductive ages.
Women with no history of depression are nearly twice as likely to experience depression during menopause than premenopausal women. Women with risk factors like previous depression, adverse life events, and vasomotor symptoms (like hot flashes or night sweats) are at a 2.5 times greater risk of depression during menopause than premenopausal women.
Menopause, Depression, and Black Women
The heightened risk for depression during menopause is even greater for Black women, who are more likely than White women to experience more than seven recurrent episodes of depression and less likely to receive treatment for depression.
This was reported by the Study of Women’s Health Across the Nation (SWAN), a 25-year multiracial and multiethnic cohort study begun in 1996 that enrolled over 3,300 midlife women and is ongoing.
According to a 2022 analysis of SWAN data between Black and White women, structural racism plays a significant role in the menopausal health inequalities between Black and White women.
What Causes Depression During Menopause?
A large body of research has explored the connection between menopause and depression. Changing hormones, sleep issues, and stress during this life stage, among other factors, may contribute to the greater incidence of depression during menopause.
However, disentangling the various factors that may contribute to a heightened risk of depression during menopause is complicated.
Some risk factors for developing depression during menopause include:
- Vasomotor symptoms (hot flashes and night sweats)
- History of depression (particularly depression related to hormonal changes like pregnancy or the menstrual cycle)
- Surgical menopause (having a hysterectomy)
- Adverse life events
- Negative attitudes toward menopause and aging
Depression and Age of Menopause Onset
Black women are more likely than White women to undergo surgical menopause and, as such, are less likely to undergo natural menopause. This is significant since early-onset menopause increases the risk of depression. Conversely, older age at menopause can reduce the risk of depression in later life.
Hormonal Changes
During menopause, hormones are in flux, contributing to various physical and mental symptoms.
It’s likely that the disruption in estrogen, in particular, during menopause, is closely connected to depression. Estrogen helps boost serotonin, a neurotransmitter indicated in depression. When estrogen levels fall during menopause, serotonin levels may also dip, leading to depression.
One study using rats found that the disruption in estrogen during menopause leads to a dysregulation of brain-derived neurotrophic factor (BDNF) and serotonin (5-HT2A). Combined, this made the brain vulnerable to depression.
Other researchers have theorized about the connection between estrogen, menopause, and depression. Because early-onset menopause is associated with a higher risk of depression while late-onset menopause reduces the risk of depression, researchers theorize that estrogen may have a protective effect against depression.
Sleep Problems
Disruptions in sleep during menopause may also contribute to depression.
There is a close link between sleep problems and depression. While sleep problems are a symptom of depression, poor sleep quality may increase the risk for depression. One 2011 meta-analysis found that people with insomnia had a 2 times’ greater risk of depression than people without sleep problems.
Vasomotor symptoms of menopause, which include hot flashes and night sweats, can lead to insomnia and difficulty sleeping.
During perimenopause, which is the period leading up to menopause in which people experience most symptoms, about 39{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} to 47{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} of people have a sleep disorder. After menopause, this ranges from 35{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} to 60{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e}.
Sleep is another area in which Black women are disproportionately affected. Black women are 50{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} more likely than White women to experience hot flashes. They are also less likely to report problems with sleeping. However, they are more likely to score as having poor sleep quality on objective tests.
Other Menopause Factors
For many people, menopause also occurs during a transition period in which life roles may change. Menopause, which often occurs in the late 40s and through the 50s, may accompany life events like supporting aging parents, children growing up and leaving home, greater responsibility at work, and more. All of these can be mental stressors.
Signs of Depression
Some symptoms of depression overlap with symptoms of menopause, such as trouble sleeping or concentrating and mood swings.
It’s important to be aware of the signs and symptoms unique to depression, so you can be proactive about seeking treatment.
Some symptoms of depression include:
- Low mood
- Feelings of pessimism, hopelessness, worthlessness, helplessness, or guilt
- Loss of interest in things you previously enjoyed
- Sleep problems (sleeping too much or too little)
- Fatigue and low energy levels
- Difficulty concentrating
- Irritability
- Appetite and weight changes
- Thoughts of death or suicide
Black Women Experience More Depressive Symptoms During Menopause
Black women experience elevated depressive symptoms during menopause. According to the SWAN study, 27.4{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} of Black women, compared to 22.3{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} of White women, reported clinically significant depressive symptoms. This occurs because certain risk factors, which raise the risk of depression are more prevalent in Black women.
Treatment for Menopause-Related Depression
Many people experience depression during menopause, and knowing the symptoms can help you seek treatment faster and get back to feeling well.
Treatments for depression during menopause may include:
- Antidepressants
- Psychotherapy (talk therapy)
- Selective estrogen receptor modulators (SERMs)
Hormone therapy is sometimes used to treat depression symptoms that occur alongside other menopause symptoms, like hot flashes.
Disparities in Depression Treatment
According to the SWAN study, Black women are less likely than White women to be treated for depression related to menopause. This includes receiving treatment for emotional problems (43{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} for Black women vs. 65{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} for White women), psychotherapy (20{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} vs. 36{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e}), and prescribed medications (25{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e} vs. 36{fc1509ea675b3874d16a3203a98b9a1bd8da61315181db431b4a7ea1394b614e}).
Lifestyle Changes
You may wish to consider positive lifestyle changes if you’re experiencing depression during menopause.
These include regular exercise, stress and relaxation techniques like yoga and meditation, joining a support group, and more. Specific diets, like a low glycemic index diet (food low in carbohydrates that can raise blood sugar), have also been shown to help with menopausal symptoms like hot flashes.
Consult a trusted healthcare provider before making any significant lifestyle changes. They can advise you on these and other ways to help manage depression.
When to Speak to a Healthcare Provider
If you are in perimenopause, it may be challenging to differentiate between menopausal symptoms and depressive symptoms.
Due to hormonal fluctuations, menopause can lead to mood swings and trouble sleeping; however, if you are in a persistently low mood, with a loss of interest in things you used to enjoy or feelings of guilt or hopelessness. You may have depression, and speaking to a healthcare provider is essential.
Additionally, if menopause symptoms affect your ability to perform your regular duties, tasks, roles, and hobbies, speak to a healthcare provider.
Summary
Depression is more common during menopause and due to socioeconomic factors that disproportionately affect Black women. Black women experience depression during menopause more often than white women but are less likely to receive treatment.
These health disparities reflect the impacts of structural racism on certain communities affecting equal access to public services like education and health care, other goods and services, and opportunities, which all compromise the quality of care received, even when it is accessible.