Your mind is a vacation, a warehouse, a garden, your home. It can be your private, no-judgements, heavily argued court room, yet it can also be your blissful paradise. It is your personal place to mentally work through any pros and cons of the thoughts of the moment.
Is the S or the C silent in ‘scent’?
Who knew what time it was when the first clock was invented?
Your mind is your place to control. Most of the time.
We all know perimenopause marks a time of change. It is the period of time directly prior to menopause, and it is the time that your hormones are most unpredictable. Many changes are felt or seen during this time, and many are aware of the visually evident hot flushes, weight gain or ageing changes. Invisible symptoms, like perimenopausal depression, is a thoroughly under-recognised, underestimated and almost taboo symptom that many either refuse to recognise, or identify as a confirmation of failure.
Blame it on your hormones.
Perimenopausal depression is difficult to diagnose. However Australian statistics show that the highest age-specific rate for suicide for females is 45-49 years old. The second highest rate of suicide in women is 50-54 years. Mental health can have a devastating impact on women as they approach menopause. Fortunately, this should be seen as a ‘phase’ or a vulnerable time period – not a burden or struggle for the rest of your life.
That is an important difference to distinguish.
Mental illness is very prevalent in women in the perimenopausal transition. Like I mentioned earlier, your mind is a private place, and as such, we can hide our emotions, address our emotions or let our emotions fester and grow until they are uncontrollable. We strongly recommend that you recognise your emotions, be aware of your reactions, check your reactions (honestly) and be educated on how to calm down, reassess and thrive.
Being aware is the key.
Be aware that there is a high prevalence of mental illness during the months or years of perimenopause. Be aware that you (yes you) may be one of the many that are challenged by this mental vulnerability. And be aware of the mood lifting, anxiety shaking or perspective drawing tools that you have.
If you’re unsure of your coping mechanisms, don’t worry, I’ll give you a few to test out soon.
Perimenopausal depression can start as early as your mid-40s. It can be hard to identify or hard to admit as it often presents much sooner than the physical and often typical symptoms of perimenopause. Hot flushes or night sweats can start up to 5 years after the perimenopausal depression has set in or disturbed your life.
And let’s face it, its not just your life that is affected by perimenopausal depression.
Women are often strong influences in families, communities and workplaces. Please be aware of the possibility of mental issues in your picture. We don’t want you to burn any bridges during perimenopause. Remember, perimenopause is a transition, it’s not a destination. While we want you to embrace your fierce womanhood, we want you to be happy with your reactions and your journey into menopause.
Symptoms of perimenopausal depression include:
- Low energy
- Paranoid thinking
- Irritability or hostility
- Decreased self-esteem
- Somatic symptoms (hot flushes, night sweats, vaginal dryness etc.)
- Sleep disturbances
- Weight gain
- Decreased sexual interest
- Problems with memory or concentration
If you notice these symptoms creeping into your life in your mid-40s, or if you notice your previously well controlled depression exacerbating in your mid-40s, speak with a medical professional. We encourage you to get yourself checked out for thyroid disorders, autoimmune disorders or other factors that may be affecting you. Once these factors are ruled out, perimenopausal depression can be evaluated.
There are two main pathways to consider when supporting perimenopausal depression treatment; psychosocial treatments and biological treatments.
Psychosocial treatments include the proactive, personal and empowering techniques aimed at redirecting you. This includes:
- Deep breathing
- Fresh air
- Dietary changes
Basically, whatever takes you out of the moment and lets you relax and have some ‘me-time’.
Prioritise your me-time and enjoy your me-time, regularly.
Biological treatments are a little less private and require a level of self-recognition. Biological options include:
- Hormone therapy
- Antidepressant medication
- A combination of both
Most women with perimenopausal depression respond to treatment. It is important to be aware of the potential, the symptoms and the serious nature of perimenopausal depression. Whilst perimenopause is a transition time, it is not encouraged to down-play, or deem this type of depression as minor. The menopause transition can go for several years during which your quality of life or that of your family’s can deteriorate irreparably. Life is too short to be sad for too long.
Speak with the Australian Menopause Centre doctors if you are interested in discussing bio-identical hormones, or the Naturopaths and Nutritionists if you are interested in discussing the psychosocial treatment options.
 Australian Bureau of Statistics. 3303.0 – Causes of Death, Australia, 2015. Canberra: Australian Bureau of Statistics; 2016 Sep 28. www.abs.gov.au/AUSSTATS/abs@.nsf/ allprimarymainfeatures/2ABFC8DC5C3C53A9CA25 81A7001599A3?opendocument# [cited 2019 May 10]
 Burt, V. K. and V. Quezada (2009). “Mood disorders in women: focus on reproductive psychiatry in the 21st century–Motherisk update 2008.” Can J Clin Pharmacol 16(1): e6-e14.
 Clayton, A. H. and P. T. Ninan (2010). “Depression or menopause? Presentation and management of major depressive disorder in perimenopausal and postmenopausal women.” Prim Care Companion J Clin Psychiatry 12(1): PCC.08r00747.
 Kulkarni, J. (2018). “Perimenopausal depression – an under-recognised entity.” Aust Prescr 41(6): 183-185.