As women stand on the shores of perimenopause and gaze into the future of menopause and beyond, we often wonder what to expect. We may begin to contemplate ways to avoid or minimize hot flashes and how to ward off extra pounds around our hips, but why doesn’t anyone tell us about the risk of depression and anxiety?

Well, we’re here to tell you about it now. But don’t despair! A little understanding can help you maneuver this psychological glitch.

Depression, anxiety, and hormonal changes

The hormonal changes that begin during perimenopause can cause mental and emotional challenges, including irritability, moodiness, crying for no reason, profound despair, and feelings of sadness. However, for some women, this stage of life also brings with it an elevated risk of depression and anxiety.

About 18 percent of women in early perimenopause and 38 percent of those in late perimenopause have depressive symptoms. In addition, symptoms of anxiety seem to be more common during perimenopause, and that includes panic attacks.

In the Archives of General Psychiatry, researchers reported that perimenopausal women were twice as likely to be diagnosed with a major depressive disorder than their peers who had not yet entered this stage of life. Studies also report that women in the perimenopausal stage of life are four times as likely to develop depressive symptoms than women who had not yet entered this stage.

And there’s more.

According to Jennifer Payne, director of the Women’s Mood Disorders Center at Johns Hopkins University, “Women who have a previous diagnosis of major depression or anxiety disorder are going to be at a greater risk during the perimenopausal time.” This includes women who may have lived with an episode of postpartum depression.

Women who have any history of anxiety or depression should take the higher risk during perimenopause and beyond seriously. Payne added that “if you’re having suicidal thoughts, or you feel completely hopeless, that is a major depressive episode that absolutely needs treatment.”

Why do some women have this greater risk of depression and anxiety? Payne explained that “it’s like that their brain is sensitive to normal, natural hormonal fluctuations,” and that it has nothing to do with any abnormal hormonal changes. Lifestyle changes such as divorce, children leaving home, caring for elderly parents, and other challenges also can put additional stress on women during this period in their lives and thus make depression and anxiety more front and center in their lives.

How to manage and treat depression and anxiety

The good news, however, is that for most women, the mood changes that can accompany perimenopause are manageable. Yes, you may be snappy or edgy or feel sad or sluggish, but these issues can be dealt with in a variety of ways.

If you go to your doctor, however, you may not always get the positive help you’re looking for. One issue is that many doctors, including ob/gyns, don’t know much about perimenopause. You may be told that you’re just “getting older” and should expect some physical and emotional changes as your hormones fluctuate.

However, if you have a history of mental health challenges, it’s important to point this out to your healthcare provider. If you don’t get the attention and respect you’re looking for regarding these concerns, then it’s time to look for another doctor who does.

Women need to take control of any mental health symptoms associated with perimenopause and beyond. Your doctor may want to prescribe antidepressants, which may be a wise choice in some cases. However, it’s important to find healthcare providers who are willing to work with you on using an approach that involves lifestyle and dietary changes, talk therapy, and natural remedies, such as acupuncture and herbal remedies.

One suggestion from psychiatrist Hadine Joffee, leader of the Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital in Boston, is for women to monitor and keep track of their symptoms on paper so they can present the information to their doctors and engage in an informed discussion. So what shouldn’t women do?

Tough it out. “Women are accustomed to having to cope with physical discomforts and life challenges,” Joffee says. And that’s why so many women carry that same course of action over to mental health issues, including depression and anxiety associated with hormone changes. Yet, she says, women don’t need to take that road. They should seek assistance from knowledgeable healthcare providers, family and friends, and support groups. Help is available!

When to see a physician

If you are in perimenopause and you are experiencing feelings of depression and/or anxiety that are affecting your ability to enjoy your life, talk to a knowledgeable healthcare provider. Prior to your visit, write down everything you can about how you feel, when you experience these feelings, and how your mental state is affecting your life. If you have a history of depression and/or anxiety, as well as the use of prescription medications for these conditions, tell your doctor.

Bottom line

Depression and anxiety are a real concern among women in perimenopause and beyond. This is especially true for women who have a history of these mental health concerns. Before you can effectively manage and treat these symptoms, you need to acknowledge and identify them, and then you can devise treatment strategies that fit your lifestyle.