Hot flashes, night sweats and sexual dysfunction are synonymous with menopause and perimenopause—the three- or four-year period just before menopause. Such symptoms often emerge for the first time as a woman’s hormone levels begin their life-changing decline.

An underrecognized threat: A woman’s risk for depression also increases during perimenopause. Unfortunately, depression in perimenopausal women often falls under the diagnosis radar because these symptoms tend to get lost amidst other menopause-related changes.

Good news: A task force of clinicians and scientists recently published the first-ever guidelines for recognizing and treating perimenopausal depression. The new guidelines have been endorsed by the International Menopause Society.

For many women, perimenopause creates a “perfect storm” of responsibilities and stressors. While undergoing the initial hormonal changes, many women also are juggling child and/or parent care, increasing career demands and/or other significant life changes.

Women who have previously suffered from depression may experience these stressors more intensely when they accompany the hormonal changes of perimenopause. Even women who have no prior history of depression are at increased risk during perimenopause, although the reasons are not entirely clear.

According to the guidelines, perimenopause should be viewed as a “window of vulnerability” for the development of depressive symptoms, and clinicians are encouraged to look for signs of psychological distress in perimenopausal women. Red flags for triggers that can lead to depression include bereavement (women may experience more losses of loved ones during this time than in previous years)…and body changes associated with reproductive aging (such as weight gain and vaginal dryness).

Takeaway: Because each woman experiences perimenopause differently, it’s important to schedule regular doctor’s visits and discuss any symptoms with the physician.

The most appropriate treatment will depend on the woman’s particular distress. For example, if she has low energy due to poor sleep caused by  night sweats, hormone therapy may help. If a woman has a history of depression and perimenopause is making it worse, an antidepressant might be most effective. Cognitive behavioral therapy—with or without medication—may be the best choice if a woman finds herself ruminating over family and career burdens. The new guidelines are intended to customize depression treatment for women during this time of her life.

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