I knew from having close friends a few years older that sometime around my mid- to late-40s, certain “things” were going to start happening to my body that would be a clear signal of my declining fertility, and subsequent journey into menopause. There were the common “things” that the majority of women begin to experience, like unexpected weight gain and/or a huge drop in metabolism.
I noticed those immediately, as it seemed to just maintain my weight and not gain overnight, I had to keep up a constant level of physical exercise and abide by a restrictive diet — both of which 10 years ago would have made my body shed pounds easily. Keeping extremely active was by no means easy, because a new level of fatigue also began to visit me certain times of the month, and with it, some volatile and angry mood swings, accompanied by crying jags. And then I started to experience the dreaded, “What did I just walk in this room for?” type of short-term forgetfulness, along with the occasional foggy head. These made me question my brain’s cognition, or lack thereof.
There were also a variety of perimenopausal side effects that, ironically enough, mirrored those of adolescent puberty. My breasts grew larger and at times felt achingly swollen and engorged, and my face broke out in cystic acne all along my jawline. Stubborn chin hairs began poking out (making tweezers my new best friend), and for someone who was always a rock-star sleeper, I now found myself eyes wide open at 2 a.m., my agitated mind racing with endless and anxious thoughts that I couldn’t seem to shake.
And speaking of anxious thoughts, they gradually flourished with more frequency and irrationality, and eventually began to feel like depression, something I recognized from having during my postpartum phases of motherhood. Were depressive symptoms another unwelcome dish in this perimenopausal buffet platter I was now forced to consume? Or was it a combination of midlife malaise and the instability of hormones that was causing it? Does this happen to all women on their journey to and through menopause, or was this newly arrived depression some serotonin-related chemical imbalance in my brain? And why was it making an appearance NOW?
A changing body I was prepared for, but a changing mind? I was blindsided.
The cycle of a woman’s life lends itself to many mental ups and downs, most of which are, in fact, hormone-related. PMS, postpartum depression (PPD) and the more severe postpartum psychosis are now seen as extremely treatable, and we’ve made great strides in destigmatizing all those forms of depression. But until recently, perimenopausal depression wasn’t something treated as its own specific kind of depression. That changed last year when the North American Menopause Society (NAMS) and the Women and Mood Disorders Task Force of the National Network of Depression Centers released the first guidelines for the evaluation and treatment of perimenopausal depression, now known as PD.
The guidelines make clear that PD is different than depression at other times in a woman’s life, because of both the physical and chemical changes that are happening in her body, as well as the lifestyle ones. Fluctuations in estrogen levels during perimenopause, especially the extreme lows, can trigger depression in some women, but not all. If you’ve experienced PPD and have had depression at other times in your life, the estrogen fluctuations you’re having now may make you more vulnerable to depression at this stage of life.