For many years, a decline in estrogen at the time of menopause was associated  with an increased risk of depression, anxiety and other mood disturbances. Current evidence reveals that this is not consistent with how the majority of women experience their menopausal years. Although women experience more depression than men, it generally occurs earlier and is most frequent in 20- to 30-year-olds. Women who have experienced a major depressive episode in the past may be at an increased risk of a recurrence at the time of menopause. Many women seek help for disruptions in their moods during the perimenopausal years and beyond. In addition to depression and anxiety-related symptoms, frequent complaints include irritability and a decreased sense of well-being.

There are many possible reasons why a woman may experience symptoms such as these at mid-life and beyond. Fluctuating hormone levels can affect the level of neurotransmitters (chemical substances in the brain) known to regulate moods in the brain. Additionally, disruption of normal sleep patterns associated with estrogen decline can lead to chronic sleep deprivation and mood symptomatology. Psycho-social factors can play an integral role as well. Menopause can be a time of great change for women in both their internal and external environment. Psycho-social circumstances can be a time of great joy or great distress. Just the process of change associated with growing older can be stressful at times. In addition, physical illness can affect psychological well-being. There is a complex interplay of all these factors in creating or influencing the psychological function or make up of a woman during menopause.

How to resolve it?

Women should not anticipate a time of upheaval during their menopause transition.They should critically evaluate the contribution of each factor (hormonal, psycho-social and physical) to psychological symptoms experienced at this time.It is important to recognize the signs of clinical depression and seek appropriate help. Major depression is best managed with current anti-depressive medications on the market with or without psychotherapy. St. John's Wort is an herbal alternative thought to be effective in the management of mild depression.

One may want to consider hormone replacement therapy for the management of symptoms related to sleep disturbances and a decreased sense of well-being.

One may also want to consider low dose oral contraceptives for similar symptom management during the perimenopausal years prior to the cessation of menses.

It is beneficial to exercise regularly, at least three times a week.

It is advantageous to adopt a healthy stress-coping mechanism in one's life.

It is helpful to read, pray or meditate on a daily basis.

It is recommended to find a hobby or a pleasurable activity.

Women should practice deep breathing.

It is necessary to eat a balanced diet and not to miss meals.