--- title: "Perimenopause Depression" entity: "blog" canonical_url: "https://www.meghanbauer.com/blog/perimenopause-depression" markdown_url: "https://www.meghanbauer.com/llms/blog/perimenopause-depression" lastmod: "2025-04-03T13:28:00.000Z" --- Why are so many women in their 40’s showing up in my office with depression? They’re talking to therapists, often taking SSRI’s, sleeping medications and anxiolytics. They’re scrolling on social media and finding motivation to increase protein, try new supplements, keep walking with a weighted vest. What can we do to help understand and fill the gaps in available care and treatment approaches? Is there a role for Naturopathic Dr.’s in their care? Not all women have changes in mood during perimenopause but 1 in 4 women will go through serious, life altering depression as estrogen declines. (Bromberger et al. 2018) “If you take the time to peruse the annals of any nineteenth century asylum, as I have, you will discover that the ‘cause of admittance’ for all women over forty is listed as ‘change of life’.” said Mary Ruefle in a dark, triggering (suicidal ideation warning) and well written personal essay on menopause for Granta. “Nothing can prepare you for this.” she concludes. The ‘change of life’ is another way to refer to menopause and not that far off. It is a change of life for many and it is definitely a change of biology and chemistry. Luckily, the tides have turned when it comes to hormone replacement therapy, i.e. supporting tanking estrogen and progesterone levels, and we’re finding ways to safely and effectively address this for many but still it isn’t the answer for all. Especially during the perimenopause years when estrogen is up and down in an erratic way. What else can we do to help understand and support women through this transition? Social media will have you eating a 100+g’s of protein, taking anti histamines and lifting a lot of weight. Is there merit to any of it? Have the biological and functional changes been looked at scientifically to build an evidenced based approach to support? Do we even know what’s going on physiologically that leads to mental and emotional changes? Perimenopause + Depression: Behind the scenes of a literature review When you do a literature search on perimenopause + depression pre 2020 you find studies focused on understanding the prevalence of mood changes in perimenopause and menopause. Is this a thing? Are they significantly correlated? It turns out that yes, they are. We had to work through a decade of research to get there but we did and now we know that it’s not just coincidental and women aren’t just crazy. Research efforts from 2020 - 2023 (loosely) shift gears to understanding how to safely and effectively use hormone therapy to help support women through this transition. Estrogen (and progesterone) play a huge role in how we feel mentally and emotionally and having safe hormonal treatment options is a game changer. If you search the studies post 2023 for perimenopause + depression they start to get more holistic and interesting. Not to say that HRT isn’t interesting. It’s phenomenal and extremely helpful for many women. As an ND I can and often do prescribe topical, bio identical hormones and look to other root causes to further support improvements. This is what the studies post 2023 look like (a selection of titles that get me excited): To summarize this list of papers and 100’s of other recent papers and review articles on perimenopause and depression would be to look at the following areas: Brain chemistry - How does estrogen affect our neurobiology? Oxidative stress and antioxidants - Looking at cellular damage and it’s relationship with depression - and with that, ways to support it (flavonoids, resveratrol, pomegranate from the above studies). Microbiology - How does our gut environment and whole body microbial balance affect our mood through peri and menopause. Estrogen seriously affects our chemistry and with it our influence on an optimal microbiome. Inflammation - Looking at the relationship of histamine and quercetin, chronic infections, cholesterol, good and bad and the changes during peri/menopause. Metabolism - How do blood sugar and insulin change and affect our mood through peri/menopause? Stress and other hormones that affect the HPA Axis - Are there changes that affect mood through peri/menopause? Most of these studies are preliminary and a lot of them in rodent models but they paint a picture of what’s to come and help elucidate why a lot of naturopathic treatments help. Also, why a lot (not all) social media trends are helpful. It turns out that a ‘healthy lifestyle’; movement, vegetables, lowered stress, social interactions all help. Working on diet, and lifestyle, exercise, using targeted supplements to improve nutritional status, decrease inflammation, increase antioxidants, working on gut health and microbiome balance, addressing and decreasing stress helps. Improving the functional parameters that estrogen and brain chemistry are interacting with matter in this equation. What’s exciting to me is the validation but also the potential for very targeted, individualized support and better testing and biomarkers for assessment and progress tracking. With this type of thinking and research we start to build out a map for individualized treatment. I argue that social media is moving the boundaries of care and support faster than science can keep up with. It’s a challenge for an evidence based approach. There are endless Dr’s who have positioned themselves as the ones to debunk the social media trends and offer the truth according to science. Often and incorrectly lumping the ND’s in with the non professionals and not evidence based practitioners (more on this in a future post). I agree that we need to understand what is safe and effective in a process that’s without bias and that we can trust but I also think we need to think critically, look at the unfolding literature with an open mind and find a bridge to bring these trends in to focus and with some sort of guidelines. Naturopathic Dr’s have the training and knowledge to help bridge this gap between mainstream medicine and social media mayhem. The ‘Change of Life’ is often hard and brings with it a necessity to change so many things to feel better. Where to start? Check in with your health team; therapists, MD’s, ND’s and physical therapists and look to well informed social media players for motivation and hope that this will pass and you will get through it! The holistic research might lag behind your transitional time frame but at least we’re out of institutions, with safe and effective hormonal options available and surrounded by millions of women talking, and screaming, about a positive and supported direction forward. We’re in this together! Meghan