The time leading up to menopause (called perimenopause) is a physical and emotional roller coaster for some women. The so-called “change of life” comes with a host of symptoms triggered by hormonal shifts — hot flashes, insomnia, mood fluctuations and even depression.

When women go through sudden hormonal changes like those that come with perimenopause, puberty, postpartum and even their monthly cycle, they’re at a higher risk for depression say mental health experts. In general, women are twice as likely as men to develop the condition.

How Menopause May Contribute to Depression

Menopause is technically one day in a woman’s life that occurs 12 months after her last period. Afterward, women are considered postmenopausal. Before then, you’re in the perimenopause stage when reproductive hormones are shifting and can make you more vulnerable to major depression.

Hormonal Fluctuations

Most of the time, when people are talking about menopause or going through "the change," they’re actually referring to perimenopause. During this phase, the menstrual cycle becomes irregular — longer, shorter, heavier, lighter, infrequent or closer together.

The same hormones that control your menstrual cycle also influence serotonin, a brain chemical that promotes feelings of well-being and happiness. When hormone levels drop, serotonin levels also fall, which contributes to increased irritability, anxiety and sadness.

Falling estrogen and progesterone levels can trigger mood swings that make you less able to cope with things you’d normally let roll off your back. For some, these hormonal dips can set off a depressive episode, especially for those who’ve gone through major depression in the past.

Sleep Problems

It’s common to experience bouts of insomnia during perimenopause, partly because of nighttime hot flashes. Poor sleep can make you up to 10 times more likely to become depressed.

Life Changes

Perimenopause typically occurs in your 40s. Turbulent hormones aside, this can also be a stress-filled stage of life with events that impact emotional health, such as:

• Aging parents
• Career pressure
• Health problems
• Kids leaving home

These external pressures can make mood swings worse, as well as trigger or increase depression.

If You’ve Been Diagnosed with Depression in the Past

Having a history of depression makes it more likely you’ll experience an episode as you approach menopause. Talk to your doctor if your previous symptoms return or if you have new ones, including:

• Persistent feelings of sadness, hopelessness or irritability
• Low appetite or overeating
• Oversleeping or insomnia
• Overwhelming fatigue and lack of motivation
• Loss of interest in activities previously enjoyed
• Difficulty making decisions and absorbing information
• Thoughts of suicide (Call 911 if these occur.)

Treatment for Menopause-Related Depression

If you’re having frequent mood swings or other symptoms of depression that are affecting your life, it’s important to talk to your primary care doctor or obstetrician-gynecologist.

Many symptoms of perimenopause respond well to hormonal medications. An estrogen patch with progesterone pills or a very low-dose oral contraceptive pill may offer relief.

However, taking hormonal medications for depression may not be a good option if you:

• Smoke
• Have high blood pressure
• Have a history of blood clotting problems
• Are postmenopausal

Antidepressants may be helpful for mood symptoms in those who aren’t candidates for hormonal medications. Studies show antidepressant treatment coupled with cognitive behavioral therapy is the most effective approach to managing depression.

Lifestyle adjustments can also help reduce perimenopause symptoms and promote good postmenopausal health. Healthy habits include eating a nutritious diet, exercising regularly, and limiting caffeine and alcohol consumption.

Reaching menopause can be a relief. Once hormones settle down, mood fluctuations may end. But if you have major depression, it’s hard to predict if you’ll feel better after menopause. Depression is a recurrent illness — sometimes it gets better for long periods and sometimes it gets worse out of the blue.

When to Seek Help

The good news: Mood fluctuations are treatable. If emotional ups and downs during perimenopause impact your normal daily activities (work, school, hobbies) or your relationships, talk to your doctor about your options.