What Causes Depression in Perimenopause?

by Magnolia on March 4, 2013

Depression in perimenopause is the blogging topic for March here at The Perimenopause Blog.

I hope my writing extensively on these topics for an entire month is helpful for you. As I’ve said previously, the typical 500-600 word blog post just doesn’t lend itself to a thorough discussion on a particular topic in my view. Hence, my decision to blog on only one specific topic for an entire month during 2013.

I’m also going to devote one of those blog posts per month giving you specific suggestions on what you can actually do about these symptoms as well.

It’s one thing to talk about perimenopause symptoms, explain what they are, and what causes them. But, quite another to actually offer some actual guidance and help. So watch for those posts as well.

For this month’s topic, I asked BodyLogicMD – a regular sponsor of The Perimenopause Blog – what they could offer to the discussion on depression in perimenopause.  I received one very clinical answer from Dr. Kenneth Orbeck.  I’m going to give you his answer in its entirety, then I’m going to break it down and decipher it for you, so that you can actually understand what it means.


Dr. Orbeck, a lot of women suffer from mood swings and depression during perimenopause.  What causes this exactly?

Dr. Orbeck¹

The transition into menopause is associated with multiple hormonal imbalances and decline. It has been well documented that steroidogenic hormones (sex hormones) are closely related to neurotransmitter balance and function. The lack of progesterone often results in estrogen irritability (dominance) because of poor GABA stimulation. Estrogen decline has an effect on acetylcholine which is the speed of thought and memory.

The integration of neurotransmitters is very important in neural behavioral disorders. When this integration becomes imbalanced, neurotransmitter imbalance occurs as well. This imbalance can involve the monoamine neurotransmitters. These include serotonin, dopamine, norepinephrine, and epinephrine. Changes in steroidogenic hormones often result in neurotransmitter imbalance and secondary neurobehavioral decline. If left uncorrected, the use of amino acids often become necessary with hormonal optimization and cognitive recovery.


Following is a segment on neurotransmitters from another post I wrote a while back on perimenopause depression.  I thought I would reprint it here to help explain in layman’s terms what Dr. Orbeck’s answer actually means:

The neurotransmitters serotonin, norepinephrine, and dopamine, work in synergy in our brain to modulate and regulate our mood. When all things are chemically balanced between these mood power players, we experience a general state of calm and well being. Serotonin, norepinephrine and dopamine can also reduce anxiety, improve sleep,  and generally take us to a happy place.If there is  disruption in the ability of serotonin, norepinephrine, and dopamine to act effectively as neurotransmitters, the result will usually be a difficult time with moods, depression, anxiety and insomnia.

We also have these things called receptors in the brain.  I like to refer to them as the “keepers of the biological gate.”  There are many different types of receptors throughout our body, which are like biological traffic cops, receiving, directing, and modulating chemical transmissions carried out by neurotransmitters, including the aforementioned serotonin, norepinephrine and dopamine.

Estrogen receptors are heavily concentrated in the cortex and limbic system part of a woman’s brain.  This limbic system is the major regulating center for mood, memory, sleep, sex drive, appetite and pain.   If the receptors are having a bad day (like, say, your progesterone and estrogen levels are fluctuating due to perimenopause) then there could be all kinds of biological road rage and chemical smash-ups, aka, mood swings and depression.

Dr. Elizabeth Vliet, author of the book Screaming to be Heard: Hormonal Connections Women Suspect, and Doctors Still Ignore explains it this way: (emphasis mine)

There are multiple connections between the limbic system and all the other parts of the brain….which carries messages to all parts of the body.  The rise and fall of estrogen alters serotonin, which affects pathways in the limbic system, which then produces changes in mood, sleep, memory, pain appetite and many other mind-body functions.  Changes in hormone levels, in turn, affect the amount of neurotransmitters produced as well as the sensitivity of the neurotransmitter receptors to the chemical messengers. No wonder changing hormone levels at puberty, in pregnancy, after delivery and at menopause can produce such a wide variety of physical and emotional changes!

I’m glad that I will have an entire month to discussion depression in perimenopause.  It is an important topic and there is a lot that can be said about exactly what causes it, and what can be done to help.  If this post is a little too clinical for you, I understand.  I’ll try to break things down a little more simply for you through out the month.


¹Dr. Kenneth Orbeck practices anti-aging and preventive medicine at BodyLogicMD of Greenville, helping women and men suffering from menopause, andropause and other hormone imbalances achieve a longer, better life. Using individual, customized wellness programs tailored to address each patient’s specific, personal needs, Dr. Orbeck combines customized nutrition and fitness regimens, pharmaceutical-grade supplements, stress reduction techniques and natural bioidentical hormone replacement therapy to ensure his patients enjoy restored energy, improved mental clarity and the highest quality of life possible.

Dr. Orbeck stresses the importance of treating the whole patient by finding the root of the issue, instead of simply using a one-size-fits-all treatment approach for individual symptoms.  His practice emphasizes the prevention of disease and encouraging optimal overall health, rather than tackling illness once it has already occurred. Dr. Orbeck is passionate about sharing his knowledge and experience to ensure each and every patient can enjoy living life to the fullest.

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