Is It Menopause or Depression? How to Recognize the Differences and Find Relief

Hot flashes. Night sweats. Vaginal dryness. We hear a lot about the physical symptoms of menopause, largely caused by fluctuating hormone levels. But those same hormonal swings can also change your mood.

“A lot of times, people don’t realize the mood changes could be related to [menopause], especially if they don’t have hot flashes or vaginal dryness, which are the two most known symptoms,” says Kelli Burroughs, MD, an obstetrician-gynecologist (ob-gyn) at UTHealth Houston. “They recognize something has changed, but they’re not sure why, because they feel like they can’t pinpoint any triggers.”

Whether your mood changes are temporary or linger longer than usual, there are things you can do to feel better.

These emotional changes can also be more unpredictable during this time, largely because, “As menstrual cycles become irregular, shifts in hormones like estradiol and progesterone become more erratic,” says Liisa Hantsoo, PhD, a psychologist at Johns Hopkins in Baltimore.

Complicating matters, many women find themselves in some sort of life transition around the time of menopause. Children might be going off to college, or there may be changes in career or marital status. “It’s almost like the perfect storm,” says Dr. Burroughs.

• A lack of interest in once-enjoyable activities
• Eating more or less than usual
• Feeling frustrated, irritable, or restless
• Feeling sad or anxious often or all the time
• Having trouble concentrating
• Trouble falling asleep or staying asleep — or sleeping too much

And even if you’re getting enough shut-eye, having hot flashes during the day might be provoke anxiety. “If a woman has a hot flash at the table … and thinks everyone’s noticing, that may make them want to withdraw socially,” says Marla F. Wald, MD, a psychiatrist at Duke Health in Durham, North Carolina.

“High-functioning women, or those who are in demanding jobs — who are used to multitasking — can [become emotionally] distraught when they’re unable to maintain a certain level of focus that they’re used to,” says Burroughs.

If one bad day is turning into two, three, four, and then a period of several weeks, you might want to seek support from a doctor, especially if your mood is affecting your daily life, says Burroughs.

“Ask yourself if your feelings are directly impacting your ability to function or the dynamics of a family relationship,” says Burroughs. “If your day-to-day routine, whether it’s at work or home, is being impacted, that’s a reason to see a physician.”

Start with your primary care doctor or even your ob-gyn. You may also benefit from seeing an endocrinologist or a psychologist or psychiatrist.

“Mental health providers can give you tools to manage some of the mood shifts, including cognitive behavioral therapy (CBT) or mindfulness-based tools,” says Hantsoo. For some, antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), or hormone-based treatments can be helpful in mitigating menopausal mood symptoms.

Other treatments include complementary therapies, such as yoga or acupuncture, which have been shown to help people manage hot flashes, says Dr. Wald. “There are other interventions that aren’t just medicine,” she says.

Sometimes, treating the mood changes during perimenopause can also take some trial and error. “For many patients, if they do meet certain criteria for treatment, we don’t know what they’ll respond to best until we try it,” says Burroughs. “But it’s important that once they start treatment, they receive follow-up care to make sure the treatment is effective.”