Ladies, is your body changing? It's sooner than you think

Menopause doesn’t happen overnight. It unfolds gradually in three phases: perimenopause, menopause and post-menopause. Each phase brings different changes.

• Perimenopause: The adjustment period before menopause. It often begins in your 40s. During this time, your ovarian function begins to decline. You may notice changes in your menstrual cycle, such as periods that are heavier, lighter, longer or shorter. Hot flashes, mood changes, night sweats, weight gain, thinning hair and trouble sleeping can also begin during this phase.
• Menopause: Occurs when you have not had a menstrual period for 12 consecutive months. Most women reach this point in their early 50s, though it can happen earlier or later. Hot flashes, mood changes and other symptoms may continue. At this point, your body adjusts to lower hormone levels and you may need extra care to manage symptoms.
• Post-Menopause: After menopause, your body continues to change. While some symptoms may ease, your risk increases for health conditions like heart disease, osteoporosis and urinary incontinence. Ongoing care can help you stay healthy and manage these long-term changes.

Perimenopause and Mood

Perimenopause is the time before menopause when a woman's hormone levels change. During this phase, periods can become irregular. Other symptoms such as hot flashes, night sweats, vaginal dryness, sleep problems, and changes in urination can happen. Depression is more common during this time. Existing mental health conditions such as anxiety and PTSD may get worse. Perimenopause usually lasts between 4 and 8 years. It ends when a woman has gone 12 months without a period, which is called menopause.

Why does perimenopause affect mood?

During perimenopause, your hormone levels don't just go down—they go up and down unpredictably. These hormone swings can affect your brain chemistry. This can make you more likely to feel depressed or anxious.

Research shows that women going through perimenopause have about a 40% higher chance of depression compared to women who haven't started this transition yet. Not all women have depression during this time. Only a minority of women develop significant mood problems.

You may be more likely to have depression in perimenopause if you: 

• Have had depression before.
• Have a history of mood changes related to your menstrual cycle or after childbirth.
• Have other perimenopausal symptoms that may impact mood. For example, hot flashes can wake you up from sleep. Not getting enough sleep can lead to more depression.
• Are dealing with stresses and losses common in midlife. These can include retiring, losing loved ones, children moving out, taking care of elderly parents, and dealing with medical problems. This can also lead to less social support.
• Have sexual health issues common in perimenopause. For example, vaginal dryness can make sex painful. This might cause tension with a partner.
• Have negative feelings about aging. These can come from other people and messages in the media. 

Managing the stages of menopause

No other health care system understands your experience as a Veteran better than VA. We recognize your unique needs and tailor our services to you. You may be eligible for services, including:

• Medication: Medications, including hormonal and non-hormonal options, can reduce symptoms and restore balance.
• Sleep support: VA offers tools and treatments to help you sleep better, which supports your overall well-being.
• Whole Health: A variety of additional options for managing symptoms are offered through Whole Health, including acupuncture.
• Mental health support: VA offers counseling, medication and peer support to help with mood changes, stress or emotional shifts.
• Lifestyle counseling: VA helps you build healthy habits around diet/weight, exercise and stress management through various therapies and medications.
• Bone density testing: VA monitors bone density to detect early signs of bone loss and personalizes plans to prevent or manage osteoporosis.
• Vaginal therapies: VA offers therapies for vaginal and urinary symptoms, including topical medications and pelvic floor physical therapy. 

Need help with symptoms you're concerned about?

Contact your primary care team or the Sheridan VA Health Care System women's health team at .

Content for this article taken from "Perimenopause and Mood" in the Veterans Health Library, and "Navigating Menopause with VA" by the Office of Women's Health.