When I learnt from my academic studies, that 1 in 5 New Zealand women get placed on anti-depressants in their mid-life menopause transition and 2/3 of women in the United Kingdom, Australia and New Zealand are placed on anti-depressants in mid-life, I was quite surprised. But that was before peri-menopause mood swings and melancholy foudn their way to me as well. I was 51 years old and I remember vividly, the day I left my high-intensity spin class at the gym and after walking out to my car, felt like bursting into tears. Where all those exercise-fueled endorphins went at the time is beyond me!
The link between depression and menopause has been known for years.
This is why for so many women, anti-depressants during menopause are an important intervention and if you are feeling down and out, then always seek support from your medical specialist as well. I visited my own GP about my moods and feeling low, but before deciding to go on medication, I wanted to understand the link between depression and menopause more thoroughly. I was curious to understand why I had been so happy, motivated and healthy all my life, but hitting peri-menopause sent my moods and feelings of worthlessness into a tail-spin. So, I spent hours and hours researching how depression manifests in menopause (not clinical depression that is diagnosed differently in younger people).
So, if you are feeling out of sorts and well … down in the dumps with little or no motivation, then here’s what I want to share with you:
- Depression is linked to the build-up of inflammation. And as we age, our body becomes more inflamed, especially when our temperature regulation is affected and our body struggles to cool down. When Hot Flushes are more than 5 an hour, our body overheats and becomes inflamed. This inflammation then exacerbates a decrease in SEROTONIN. This important hormone is your ‘happy hormone’. When oestrogen is lowering in menopause, serotonin follows it on a downward slide. But there’s another factor as well. If you aren’t sleeping and you are feeling stressed, then you may be producing too much of your chronic hormone, Cortisol. This causes more inflammation in your organs, muscles and blood vessels as we biologically age. The accumulation of high levels of cortisol, can disrupt serotonin production more rapidly during menopause.
- Sleeping less than 6 or 7 hours a night, is positively associated with worsening depression. When we aren’t sleeping during menopause, we build up oxidative stress in our heart, muscles, arteries and gut. This is why in both of the MyMT™ symptom reduction programmes, I teach women how to re-balance their sleep hormones using lifestyle strategies specific to their menopause transition.
- Low Vitamin D3, depression and worsening inflammation go hand-in-hand. Vitamin D is often low in menopausal women because it decreases with changes to oestrogen receptors in our skin. (Lerchbaum, 2013). I talk a lot about Vitamin D and this connection with menopause with women, because so many of us work inside and if women have darker skin, then their Vitamin D absorption is lower too. If women are also overweight and carrying more belly fat, then because Vitamin D has an affinity to fat in fat storage areas, then the Vitamin D can go to adipose tissue and not to where it is needed – in muscles, bones, nerves and the heart. [Dregan, Rayner, et al., 2020).
- When Liver inflammation is present in cells and tissues or if women are putting on belly fat and have poor gut health, then B vitamins are not absorbed and metabolised very well. Low Vitamin B6 and B12 increases depressive episodes (Feraj, 2017). This is why, for women who want to improve their moods and motivation during menopause, it’s important to turn around liver health first, especially for women who are overweight.
- The gut-brain connection is also important during menopause. Over decades our gut health has changed and too often women develop Irritable Bowel Syndrome (IBS) or Diverticulitis when they reach their 50’s. With researchers now understanding the powerful connection between our immune system and our gut, this has a profound effect on our mental health if our gut health is impaired as well because inflammation impacts on the absorption of a protein called Tryptophan, which helps to make serotonin.
If we have any inflammation that sits within our gut we experience more brain fog, more lethargy and more depression. It’s so important to turn gut health around in menopause. [My Gut REHAB module is available to you when you come onto the programmes or as a stand-alone module as part of my health restoration series. All the information is easy to put into action and evidenced against lifestyle medicine science].
The great news from so many of the studies that became part of my menopause symptom reduction research, was that many of these came to a similar conclusion to the research by Taylor and Hickey (2014):
Lifestyle factors, such as managing BMI (Body Mass Index) and improving sleep could be used together with nutritional interventions to aid in efforts to prevent or help treat depression in women during the menopause transition. [Menopause and depression: Is there a link? Maturitas Journal]
I also follow the work of American Psychiatrist, Kelly Brogan, MD. She is really pushing the envelope on depression management and her studies confirm my readings as well. As she says:
“Scientific evidence continues to show that depression is a sign of imbalance, not an inherited genetic condition that you are powerless to change. Imbalances can be caused by inflammatory foods, toxins, medications, life events like trauma, and stress – and taking a one-size-fits-all antidepressant is like turning off the smoke alarm and ignoring the fire.” [Kelly Brogan, MD]
But I would also add hormonal changes in peri-menopause and over-exercising to her list of causes of imbalance as well!
So, why am I feeling depressed? That’s the question I asked myself too.
Feeling depressed or experiencing frequent mood swings in peri-menopause and menopause is all about the connection between all of your hormones – not just oestrogen, progesterone and serotonin – and here I share with you my own discoveries from the research, when my moods were all over the place during peri-menopause:
- How rapidly your oestrogen is dropping in menopause compared to progesterone. When oestrogen levels drop sharply, so too do your levels of SEROTONIN – your mood-boosting hormone.
- The type, timing and amount of your food intake – we are the generation of ‘dieters’, especially low carb diets, but these do not work during menopause when it comes to our moods! When we don’t eat regularly or we don’t eat the right carbohydrates (especially if we are exercising), then this affects your insulin production and blood sugar levels. When blood sugar levels are low, your pancreas secretes a hormone called glucagon to re-set your blood sugar levels. Eat too much and your pancreas releases insulin to help regulate your blood sugar levels. When both glucagon and insulin are un-balanced, our mood swings and feelings of depression are impacted because there is a powerful link between your blood sugar hormones and serotonin production.
- Your sleep patterns and hot flush frequency. Poor sleep means that your adrenal glands (which produce your ‘fight or flight’ hormones) become overwhelmed and this impacts your THYROID function. Low thyroid response results in low energy levels and even more stress on your adrenals. When we are feeling stressed or we have oxidative stress from inflammation in our tissues, our sleep suffers, we get more hot flushes and our mood swings become worse.
- Your Vitamin D levels. I’ve already mentioned Vitamin D in this article, so this is a reminder, that this vital vitamin (and exposure to natural sunlight) helps in the conversion and transmission of your mood-boosting hormone, SEROTONIN. This is why, during winter months, many of you may need to get your levels checked and/or take a supplement. They don’t call it the ‘Winter Blues’ for nothing!
- Your stress levels and gut health (again, as I’ve mentioned above).
- Whether you are doing too much or not enough aerobic exercise – this type of exercise of low to moderate intensity, is well evidenced to alleviate symptoms of mild depression. This differs from high intensity anaerobic exercise, which is all the rage in the fitness industry, e.g. cross-fit and high intensity interval training [HIIT] routines. Conversely, if you aren’t doing enough aerobic exercise, then you need to start getting this into your day if you are feeling a bit low. Aerobic exercise boosts serotonin production and how to achieve improved fitness and strength specific to your menopause transition and your body-type is in my exercise programme for women in menopause, called ‘Re-Build My Fitness‘. Many women do this programme after the foundation programmes – Transform Me (weight loss) or Circuit Breaker (for thinner/ leaner women).
I’m always reminding women that our body does not work in isolation. All of our organs in the body are connected via chemical messengers, called hormones. They work synergistically together. The role they play inside your body is to maintain the body in ‘homeostasis’. This is a term that physiologists and endocrinologists refer to as ‘maintaining the body in a state of equilibrium’. So when one hormone is low, there are chemical and neurological messages sent to other hormones to counteract the environment changes that the low hormone is causing.
In the two to eight year period that is known as ‘peri-menopause’, the production of oestrogen is declining. Because oestrogen is a hormone, when levels are lowered it affects the function of not only progesterone, but other hormones in the body as well, including your mood hormone, serotonin. When serotonin levels are low, this impacts on other hormones produced by your thyroid, adrenal and more importantly, your pituitary glands where serotonin production occurs.
Are there lifestyle solutions to help my moods and motivation during menopause?
I’m shouting, absolutely YES! If you are experiencing mild to moderate depression or frequent mood swings in menopause, then you can reverse this. You need to follow a specific regime for sleeping, eating, moving and boosting Vitamin D production as well as reducing any inflammation and managing menopause weight gain. You also need to focus on your gut and liver health, your hormonal health and your nutrition and sleep, before launching into any vigorous exercise programmes. When you aren’t sleeping, then too much exercise can worsen hot flushes, moods and send you into adrenal fatigue.
Reducing all of your menopause symptoms naturally and giving you your life back is what MyMT™ helps you with. Whilst I don’t interfere with any medications you are on, because this is between you and your Doctor, what I do have for you, are scientifically evidenced lifestyle solutions to help you feel motivated and healthy again. You can beat symptoms of hot flushes, night sweats, mood swings, low motivation and weight gain in menopause when you reverse the inflammation that’s been building up for decades and adjust aspects of your day-to-day life so that your body adjusts to the different hormonal environment it is trying to achieve as we age. I also promise you that, like Andrea from Australia below, who worked through my 12 week online Circuit-Breaker programme when she was struggling with mood swings, anxiety and low motivation, I will be with you every step of the way. Andrea had no energy or motivation for doing her paintings before coming onto the programme, but then using the strategies, she turned around her sleep first, and her energy levels. I love how she is sitting outside her painting studio in this photo. You can read her story here…
- Dregan, A., Rayner, L., Davis, K., Bakolis, I., Arias de la Torre, J., Das-Munshi, J., Hatch, S. L., Stewart, R., & Hotopf, M. (2020). Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study: A Mediation Analysis. JAMA psychiatry, 77(6), 1–9. Advance online publication. https://doi.org/10.1001/jamapsychiatry.2019.4712
- Feraj, J. (2017). Micro-nutrients, depression and inflammation among women of reproductive age. Doctoral Dissertation 993, University of Massachusetts.
- Lerchbaum, E. (2014). Vitamin D and menopause – A narrative review. Maturitas Journal, 79, 3-7
- Ministry of Health Public Health Report 43 (2007). Patterns of Antidepressant Drug Prescribing and Intentional Self-harm Outcomes in New Zealand: An ecological study.
- Vivian-Taylor & Hickey, M. (2014). Menopause and depression: Is there a link? Maturitas Journal, 79, 142-146