Early Menopause and Depressive Mood Disorder

September is Menopause Awareness Month. In the past, Dr. Patricia Allen has written about Lichen Planus and making choices that ensure a manageable menopause. This week she explores the connections between menopause and depression.


Dear Dr. Pat,

It is 4 a.m. and I just did an internet search for menopause and depression, which led me to this  site. I notice that you answer questions so I am reaching out. I’m only 40 years old but I haven’t had a period for a year. I saw my gynecologist last week and he did hormone tests and a pelvic ultrasound. He told me that everything was normal but that I was in menopause. I was really surprised since I am much younger than anyone I know who has gone through menopause. The usual menopausal symptoms I expected haven’t really bothered me. I don’t have any hot flashes to speak of but my mood has really taken a turn for the worse. I was generally an optimistic person, but lately everything has felt overwhelming. Some days, I don’t want to get out of bed. At work, I am having trouble concentrating, but that may be in part because I have such fatigue. I think the fatigue is due to the change in my sleep habits. I wake up at 4 a.m. every morning and can’t fall back to sleep because I am worrying that I won’t get back to sleep, will wake up tired and not be able to function at work. I eventually get out of bed and begin the day starting off already tired. It is all so overwhelming. I always had bad PMS but my symptoms now feel like PMS every day. The gynecologist felt that I should start taking hormone therapy but I couldn’t tolerate the birth control pill. I don’t really want to take hormones for this unless I have to. Is this depression or menopause?



Dear Carolyn,

Your final question, “Is this depression or menopause?” is one asked by many patients. Each woman experiences menopause in a unique way. Many have minimal or manageable symptoms, while others are overwhelmed primarily by physical symptoms and report many of the symptoms affecting mood that you describe.

Certainly, beginning hormone therapy without an evaluation of other causes of early onset of menopause, for example, fatigue and low mood, is premature. Schedule a consultation with your gynecologist for a more thorough evaluation of causes of early menopause and see your GP for evaluation of the causes of fatigue and sleep disruption. There are effective treatments for sleep disorders that could certainly improve your sleep and energy during the day.  If no other diagnoses are found to explain your symptoms, a mood disorder should be considered.

For over a century,  an association between menopause and depressed mood has been identified. Research suggests that up to 1 in 5 women experience depression at some point during menopause. A study released by the Centers for Disease Control and Prevention showed that you are in a particularly high-risk age group — women between the ages of 40 and 59 had the highest rates of depression of those surveyed.  Many suffering from depression don’t seek the help they deserve. Only about 1 in 5 individuals with moderate depression report seeing a mental health professional in the past year.

We have asked Dr. Megan Riddle, the psychiatry chief resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program, to respond to your concerns about depressed mood in women who go through menopause at an early age.  You have already taken a valuable first step: you have asked for information and for help.

Dr. Pat

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