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Navigating Perimenopause

Despite it affecting half of the population, perimenopause is a topic that many women know very little about. That’s partly due to female hormones being an historically “taboo” topic. Fortunately, it’s time to move forward and have a candid conversation about perimenopause and the profound physical and psychological impact it can have.

When does perimenopause begin?

Perimenopause is the transitional stage prior to menopause where ovarian hormones, estrogen and progesterone, start to fluctuate and eventually decline. The first signs are typically changes in period length and flow and reduced fertility. For some women, perimenopause can begin in their late 30s, but most women can expect symptoms in their late 40s to early 50s.

This stage, while completely natural, can be extremely challenging and comes with a whole range of symptoms that can include: hot flashes, insomnia, period fluctuations, irritability, anxiety, and even depression.

The profound psychological impact of these hormonal changes are often left out of the pop culture commentary that unfortunately seem to focus on hot flashes, and often comically.

While depression doesn’t affect all women during perimenopause, those with a history of mental illness and postpartum depression are at higher risk of receiving a major depression disorder diagnosis. 

Perimenopausal depression is different

Estrogen plays an important role in regulating mood. As these levels fluctuate, your brain chemistry may be affected, leading to depression or anxiety.

Around 20% of women going through perimenopause present with symptoms of depression or anxiety. Symptoms may include sadness, anxiety, irritability, sleep issues, not enjoying activities as much, lacking energy, changes in appetite and feeling tired. It can be severe enough to make you feel hopeless, worthless, and even have thoughts of suicide. If these symptoms are severe and affect your daily life for two weeks or more, please seek medical care as you may be suffering from major depression.

Mental health symptoms during perimenopause can overlap with that of a major depression experienced outside of times of hormonal flux. Symptoms such as hot flashes, night sweats, sexual disturbance, weight changes, and memory issues can mirror a depressive disorder, making it difficult to separate the etiology (the cause of illness).

In addition, the transition to menopause can be a time of great stress as it typically coincides with children leaving home, financial changes, and new caregiver responsibilities for those with elderly parents.

Pay attention to the impact this combination of lifestyle changes and hormonal fluctuations are having on your life and be open with your care provider. We’re here to help and can explore various treatment methods to determine what works best for your unique needs.

Treatment options for perimenopausal depression

We now have more perimenopausal treatment options than ever before that include a more precise focus on women. Women and men have different hormonal pathways in response to emotional events, making it important to connect with a care provider who understands the unique and changing female biology. If you have been sensitive in the past to hormone changes or depression, let your health provider know, as it will influence your treatment.

Treatment of depression during perimenopause typically uses one or more methods. It is important to work with a care team or provider to find the treatment method – or combination of methods – that are personalized to your unique situation. The most current treatment options are:

Antidepressant pharmaceuticals

Antidepressants can be used for major depression but there are also some that can treat hot flashes as well, particularly paroxetine, venlafaxine and escitalopram.


Cognitive behavioural therapy (or CBT) has been found to be effective in reducing symptoms of anxiety, depression and sleep challenges. With or without an antidepressant, CBT can help you deal with the multitude of changes during this time of life.

Estrogen replacement therapy

Although it is not indicated for treating a major depression, estrogen replacement therapy is very effective during the transition to menopause to help improve mood, sleep and well-being. It has not been shown to be effective in the post-menopausal women. Estrogen therapy can also be combined with antidepressants, if needed.

Complementary medicine and exercise

While there is not currently enough evidence to support alternative medicines or herbal supplements to treat depression, it is generally thought that exercise has a great benefit. One study of 289 women in the perimenopausal stage noted a significant improvement in depression and anxiety symptoms following aerobic training. The same women also noticed improved sleep quality. Effects were increasingly noticeable with more frequent exercise.


At Harrison Healthcare, we have considerable experience caring for clients through perimenopause and beyond and we are committed to finding a treatment method that works for you. We pride ourselves on taking a compassionate approach to your care that includes physical well-being, nutrition, exercise, and mental healthcare. We are here to listen and help find a solution for you, so you can get back to living life to the fullest!


Author Dr. Pollie Lumby is a NCMP (NAMS Certified Menopause Practitioner) Physician


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