More than a Mood Swing - Depression + Menopause

October 23, 2013

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More than a Mood Swing - Depression + Menopause
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More than a Mood Swing - Depression + Menopause

Most women are well aware of the signs and symptoms of menopause. As they approach their forties and fifties they watch and wait for them.

Women may experience some of the signs and symptoms for several years before their periods stop altogether, during what is known as the perimenopause. As women get closer to menopause, irregular or very heavy periods, night sweats, hot flashes, mood swings, sleep disturbances, fatigue, weight gain, and lowered sex drive are all daunting prospects to be facing.

The good news is that for most women, their experience of these signs and symptoms is mild and short term; some fortunate women sail through menopause only noticing that their periods have stopped.

Depression is not often on the list of possible signs of menopause; it is thought to affect only about 1 in 8 women at any time of their lives.  It can be very difficult for a woman to know the difference between normal mood swings associated with menopause and mild depression. According to Dr. Shaila Misri, one of the leading reproductive psychiatrists in North America, depression can range from mild to severe presentation. If a woman is experiencing moderate to severe depression, treatment is advisable.

What is the difference between regular mood swings in menopause and serious depression?

“Women talk freely about mood changes they experience during the years of perimenopause and menopause,” Dr. Misri points out “but the dilemma is how to recognize the difference between “normal” menopausal mood swings and severe or clinical depression, especially if a woman is experiencing depression for the first time. It may take years for a woman to get help if she doesn’t understand that she has an illness in addition to menopause”.

Symptoms of Severe Depression:
  • Feelings of guilt, helplessness, hopelessness, worthlessness
  • Sleep disturbances (sleeping more, or less than usual)
  • Lack of energy, and fatigue
  • Appetite and weight changes
  • Difficulty concentrating
  • Suicidal thoughts

“What differentiates between a clinical depression that needs treatment and mood swings associated with menopause is the intensity and the duration of mood change”, says Dr. Misri, “In a clinical depression, the low, sad, and hopeless mood is persistent for every day for most of the day for at least two weeks, or longer”.

Risk Factors:

Risk factors do not cause diseases, but they do increase the chances of getting a particular condition. Having one or more risk factors does not mean that a person will develop the disease or condition, only that she has a higher than normal risk.

Previous Mental Health Challenges

Women who have had depression before, particularly in pregnancy or after childbirth, are more likely to encounter it again at this time in their lives. Those who experience severe premenstrual mood swings may find that these increase during menopause. Women who have had problems with their reproductive systems such as cancer, endometriosis, infertility, pregnancy losses, or have had a hysterectomy are at a higher risk of suffering from depression around the menopausal transition. Finally, a family history of depression- particularly in a mother or sister constitutes an additional risk factor. 

A Stressful Social Environment

For many women the period of their lives often referred to as “mid-life” coincides with challenging changes in family dynamics. For example a woman may be required to juggle the demands of teenaged children (who often have mood swings of their own), the needs of aging parents, complications arising in her relationship with an aging partner, or, as is often sadly the case, the loss of a long-term relationship. If she works outside of the home, she will be dealing with the demands of a career in addition to being the “family manager”. Or, in a different situation, a woman who has devoted her life to her family and works within her home may feel some anxiety as children become ready to leave home and go out on their own (also known as “empty nest syndrome”).  However, assuming the role of a grandparent is often a protective factor. The transition through menopause can be a stressful time also for a woman who has had issues with fertility or who has decided not to be a parent.

Physical Health and Self-Image Issues

Because we live in a “youth-oriented” culture in which the usual signs of aging are seen in a negative light, the impact of physical changes and health challenges of mid life can be much more consequential than they need to be. The first appearance of inevitable wrinkles and thickening of the waistline can be very distressing if a woman’s self-esteem is connected to her appearance. If health issues such as high blood pressure, headaches, sleep problems, back pain, or joint pain, and loss of sex drive also arise at this time, the risk of depression becomes much greater.

What is the Treatment for Clinical Depression?


Eating a healthy, well-balanced diet is the first step toward rebalancing your body’s changing hormone levels and metabolism. A recommended diet would be low in carbohydrates, sugar, alcohol and caffeine.


Increased exercise has many health benefits; it can be as simple as walking on a regular basis, working out at a gym, or joining a dance class. Yoga can be helpful as well.


Your pharmacist can recommend a good multivitamin as well as a calcium and Vitamin D supplement, important for prevention of osteoporosis.

Hormone Replacement Therapy (HRT)

For women with no history of cancer, Hormone Replacement Therapy (HRT) may be a good solution for night sweats and hot flashes that may be making life unbearable. However, it is important to discuss the risks and benefits of HRT with your family doctor.

Anti-Depressant medication

“Women who have severe depression”, says Dr. Misri, “respond well to anti-depressant medication, especially when it is combined with supportive therapy”. Dr. Misri finds that with  treatment, women are  able to cope much better with the pressures and demands of their lives. “Everyone benefits”, says Dr. Misri, “women are happy again and so are their families”.

Here are some resources available in the Greater Vancouver region:

The Cross Roads Graceful Vitality Menopause Clinic
“Comprehensive management of health issues related to menopause while focusing on health promotion”
Dr. Unjali Malhotra & Dr. Chui Kin Yuen
Suite 350 – 507 West Broadway, Vancouver B.C., V5Z1E6


Westcoast Women’s Clinic for Hormone Health
“One of the first physician-based clinics in British Columbia to be fully dedicated to hormone health and wellness”
3525 West 4th Avenue, Vancouver, BC V6R 1N9
No referral needed; some services provided are covered by MSP


Lonsdale Women’s Clinic
1777 Lonsdale Avenue, Vancouver, BC V7M2J6

Workshops/Support Groups

Vancouver Women’s Health Collective
“Menopause: A Self-Care Approach”—monthly rotating workshops, of which the menopause workshop is one
29 West Hastings Street Vancouver, BC, V6B 1G4
604-736-5262 ;

Knowledge/Information/Research Centres

North America Menopause Society (NAMS)
Includes resources to find local practitioners, information about menopause, etc

SIGMA Canadian Menopause Society
“An independent, multidisciplinary group of family doctors and specialists interested in menopause and post-menopausal health”

Centre for Menstrual Cycle and Ovulation Research
“An accessible research center with a mandate to distribute information directly to women about changes through the life cycle, from adolescence to menopause”
Dr. Jerilynn C. Prior

HealthLink BC
Answers questions about menopause and peri-menopause and about the usage of hormone therapy.

The safe use of natural health products during menopause
Benefits and risks of hormone replacement therapy (estrogen with or without progestin)


Menopause and U
“Menopause information backed up with research”

BC Women’s Hospital
Menopause and peri-menopause

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Cookbook created for those with Fibromyalgia 

Dr. Alison Bested lends her expertise to helping those with Fibromyalgia improve their condition through lifestyle and nutrition.

It is estimated that nearly half a million Canadians and 5 million Americans suffer from Fibromyalgia. Diet and nutrition can help relieve symptoms and improve quality of life for patients.

The Complete Fibromyalgia Health, Diet Guide & Cookbook by Dr. Louise S. McCrindle and Dr. Alison Bested aim to help patients with lifestyle tips and anti-fibromyalgia foods and recipes.

The Complete Fibromyalgia Health, Diet Guide & Cookbook is published by Robert Rose and is available now in stores and online.

Patient story from BC Women's Complex Chronic Diseases Clinic.


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Featured Donors

Auxiliary to BC Women’s, Blair East, Face The World Foundation, Kim and Jeff McCord, Oppenheimer Group, Monica and Jason Soprovich, TB Vets Charitable Foundation, Talal Yassin, Lingli Zhou, ZLC Foundation

BC Women's Hospital thanks Odlum Brown for 15 years of continuous support.


The content provided in Women’s Health eNews is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.


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