Women are at increased risk of depression during perimenopausal transition due to hormonal changes in this period so close to menopause. This syndrome is called perimenopausal depressive disorder or PMDD.
Researchers hypothesis that during premenstrual, postpartum, and perimenopausal transition women are particularly sensitive to changes in their bodies hormonal environment . Each of these stages are characterized by large fluctuations in ovarian hormone production that cause similar depressive effects. 45-68% of perimenopausal women have been found to have elevated depressive syndrome.
Women at high risk for PMDD are those with history of antidepressant use, premenstrual depressive symptoms(PMS), anxiety, and social issues such as social isolation and major stressful life events. Added pressure of caring for young children, aging parents, and at the same time managing a career without support increases the risk for PMDD.
The challenge in diagnosing PMDD is separating perimenopausal and psychiatric symptoms. It is also important to recognize physical, social, emotional, and financial stresses creating added pressure on a woman’s condition. Having a low threshold and educating women during perimenopausal transition to recognize and report to a physician the depressive symptoms is crucial in early diagnosis.
The principal components of treatment are aggressive, early treatment, and close follow up.
In my practice treatment begins with educating women during perimenopausal transition to recognize the life stresses and learn to cope with them appropriately and recognize the depressive symptoms. I use exercise, bio-identical hormones, and diet as the first line of therapy in PMDD. Even though life changing this condition can be treated and managed effectively in the majority of cases in this fashion. Close evaluation and follow up may indicate further treatment with anti-anxiety medication and psychotherapy.
If you recognize these symptoms in yourself or any of the women around you at any stage of life, we are here to help.