Hormones can mess with our heads
Reproductive depression describes certain times in a woman’s life when hormonal fluctuations can significantly affect her mood.
Premenstrual syndrome (PMS)
Premenstrual dysphoric disorder (PMMD)
Post-natal depression (PND)
Menopausal or Perimenopausal depression (sometimes also called Climacteric depression)
And it’s not just about low mood– there can be other changes like anxiety, irritability, anger and even psychosis. For some women, it is so extreme that they become suicidal.
Women are twice as likely to suffer with depression than men
It has long been known that women have higher rates of depression and there is no one simple answer to explain this.
There are likely many forces at play – the different social stresses and expectations on women, career limitations, less earning potential, more care-giving roles and domestic responsibilities – there have been many theories over the years to try and explain this gender difference.
But all too often, the powerful influence of our hormones is not mentioned.
The highest rates of depression in women occur during the years around menopause
Menopause and perimenopause are vulnerable times.
Even women who’ve never had any mental health issues before, are at increased risk of depressive symptoms when they enter the perimenopause.
The mood changes can come completely out of the blue. Women can suddenly feel worried or anxious over things that never used to bother them – this can include simple things like driving, flying on an aeroplane or talking in a meeting. The anxiety can be so intense that it stops women doing things they normally wouldn’t think twice about.
For women who’ve already been through depression in the past, there is an increased risk of a relapse around menopause and perimenopause.
But it often feels different to the episodes they’ve had before. And the treatments or therapies that worked well in the past – suddenly don’t seem to work anymore.
At least 40% of perimenopausal and menopausal women report depressive symptoms
Feeling depressed or low in mood is a common symptom in perimenopause and menopause. Women often also have a loss of motivation and a loss of confidence.
It can be all too easy to explain these symptoms away as due to the stresses and strains of a busy life. Or they are diagnosed as clinical depression or anxiety.
But in many cases, perimenopause and menopause are being missed.
The mood symptoms of menopause can start up to five years earlier than any of the physical symptoms
There’s lots of reasons why perimenopause is often overlooked. Most of us (doctors included) are waiting for that first hot flush, or the first skipped period.
But long before any of these classic symptoms come along, mood changes are often the first and only sign of the huge hormone shifts happening within our bodies.
There is no way to predict or diagnose reproductive depression with a hormone test
Mood changes don’t happen to every woman.
And there’s no way to predict who will have them and who won’t.
It’s not simply about the hormone levels in our bloodstream. Research has shown that women who suffer with depression during menopause don’t have significantly different or lower blood hormone levels compared to women who don’t.
Our brains are packed with receptors for estrogen – so it’s not surprising that our mood and mind are affected when the hormone levels fluctuate. And we think some women are even more sensitive to these fluctuations than others.
Hormones and the Brain
All three of the hormones our ovaries make - estrogen, progesterone and testosterone – have effects on our brain and neurotransmitters.
There are receptors for all of these hormones throughout our brains.
Estrogen in particular, has been shown to have neuroprotective and anti-depressive effects. There are high numbers of receptors for this hormone in regions known to play a key role in regulating our mood and emotions (such as the prefontal cortex and hippocampus).
Estrogen can also increase serotonin, noradrenaline and dopamine levels and it stimulates something called brain-derived neurotropic factor (BDNF) which also plays an important role in our mood.
How should we treat reproductive depression?
There will never be an easy answer to this question - just like we don’t have one for any other type of depression either.
We are all unique. And what works for one woman, may not work for someone else.
But as for most conditions – be them psychological or physical – the first medicine we turn to should always be our lifestyle.
Exercise and movement are not just good for your body – they are good for your mind.
And it’s the same with food too. The right food can make us happy; and the wrong food can make us unhappy.
Counselling, mindfulness, meditation, psychotherapy and other talking therapies can also help us to heal and improve our mental wellbeing.
Anti-depressants or HRT?
For some women, the mood changes in menopause become so severe that healthy lifestyle alone doesn't work. And they are left struggling.
The question is, if hormones are driving the mood changes – should hormones be part of the solution?
Many specialists are now arguing that our reflex prescription for anti-depressants to treat severe mood changes around perimenopause and menopause does not always serve women well.
If lifestyle changes and psychological therapy are not helping, then it may be better to try HRT before anti-depressants.
Many women report how their mood symptoms in menopause feel different or how their usual treatments aren’t working anymore.
We often intuitively know our bodies and our hormones. And we know when they are out of balance.
In the UK, HRT is now the first line treatment for significant mood symptoms in perimenopause and menopause – not anti-depressants. The UK NICE menopause guidlelines state we must ensure the following:
“…that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for SSRIs or SNRIs to ease low mood in menopausal women who have not been diagnosed with depression”
(SSRIs = "selective serotonin reuptake inhibitors". These are anti-depressant medications and include citalopram, escitalopram, sertraline and paroxetine.
SNRIs = "serotonin and noradrenaline (also called norepinephrine) reuptake inhibitors". These are another type of anti-depressant medication and includes venlafaxine)
How HRT can help mood
There is growing research to show that HRT can help improve mood and relieve anxiety. And these benefits occur regardless of whether the HRT helps with hot flushes and sleep.
At the moment, the research shows that HRT seems to be most helpful for mood changes during perimenopause and early menopause, rather than in late post-menopause.
There’s also studies to show that starting HRT in perimenopause reduces the likelihood of mood symptoms ever occurring in the first place.
So there may be a ‘window of opportunity’ during perimenopause when women are most likely to benefit from HRT in terms of their mood.
So what is the answer?
HRT is not a magic cure.
Just like anti-depressants are not a magic cure either. Mood is complex – and we can’t blame our hormones for everything.
The way we live – eat, move, think and sleep – has a huge impact on our mind and our mood.
And these things should always come first – before any medications.
But it is time to also acknowledge the unique biology of women – and the powerful effects of our hormones.
The fear around HRT and breast cancer, which was all based on a flawed study with exaggerated findings – has meant we have been avoiding HRT for two decades.
Perhaps it’s time for change.
If you currently feel like you need some help or support because of how you are feeling, please reach out and call one of these NZ numbers:
Need to Talk? text or call 1737
Lifeline - 0800 543 354 or free text 4357
Depression Helpline - 0800 111 757
Samaritans - 0800 726 666
Crisis Helpline - 0508 828 865
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