Is it Depression or Perimenopause? Or Both?

Let’s welcome back Christy, who we met in last week’s blog.  As you remember, Christy was suffering from symptoms of depression and was feeling “lost”.  She turned to me, a board-certified Ob/Gyn, to help clarify what was going on with her and recommend possible treatment.

When Christy returned for her lab follow-up, I asked a few more questions regarding her menstrual cycles.  Were they still regular?  Any skipped periods?  Any symptoms of hot flashes and night sweats?

She stated that her cycles were still very regular, every 26-28 days, lasting 4-5 days.  She did notice that her sleep had been more disrupted with waking up at night 2-3 times/night for the past few months.  This was not due to night sweats she said, but rather due to anxiety with feeling a sense of doom.  She feared waking up knowing she would have a difficult time falling back asleep and this only heightened her anxiety. 

We then reviewed Christy’s labs.

LABs – complete blood count showed a borderline hemoglobin and hematocrit (signs of mild anemia), comprehensive metabolic panel with normal glucose levels, normal liver function tests and normal kidney function.  Her thyroid panel (TSH, free T3, free T4) was normal but her Vitamin B12 and Vitamin D levels were low.  I recommended a multivitamin that includes a B-Complex and Vitamin D, along with micronutrients to help her immune system stay strong during these stressful times. It’s called Phytomulti by Metagenics.  Since Christy was still having her menstrual cycles (perimenopausal), I recommended the Phytomulti with Iron to help build up her blood levels. 

When evaluating patients, it is important to understand the whole picture – a holistic approach to how the body is functioning.  For Christy, her most significant symptoms were that of anxiety and depression – having a history of postpartum depression in the past, as well as being perimenopausal, which can increase symptoms of depression due to fluctuating hormone levels. Christy reiterated that she only was experiencing a few night sweats, with no daytime hot flashes, vaginal dryness or brain fog.  After offering varying options for treatment, including possible medication for her anxiety/depression, she decided to wait a few more months and see how things progressed.  I agreed with her decision and offered her a list of resources to help – especially with the overlying stress imposed by the COVID pandemic.

Click here for the link to resources. 

I also shared with her one of my favorite sayings/prayers regarding how we need to let go of things we can’t control.  I used this prayer during my breast cancer diagnosis and it really helped me get through the very stressful days of surgery/radiation and beyond.

Serenity Prayer – written by American theologian Reinhold Niebuhr, 1951

“God, grant me the serenity to accept the things I cannot change,

Courage to change the things I can, and

Wisdom to know the difference.”

I will be seeing Christy back in 6-8 weeks to evaluate her status.  If she’s still feeling depressed, we will readdress the possibility of starting an antidepressant.  If symptoms such as more severe night sweats and daytime hot flashes begin occurring, we will consider hormone therapy either in a low-dose birth control pill or bio-identical hormone supplementation.  

As you can see, there is no “cookie-cutter” approach to this.  Every woman is unique and requires a specialist in women’s health with knowledge of perimenopause, as well as anxiety/depression.

I hope this clinical case brings to light the need to have an honest conversation and consultation with your healthcare provider.  If he/she should dismiss your symptoms, I would advise finding a new provider.  There are ways to make these times more manageable – Amazing Over 40 is here to help and educate you!

Please share this blog with your friends who might benefit from these words of wisdom.  We are all in this together- and together we will emerge even stronger.

In health and happiness,

Dr. Diana