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"My experiences in perimenopause have impacted me so strongly that I want to help other women navigate this phase of life better," says Annunziata Schnurbein.
January 7, 2025
Marianne von Waldenfels
- Women's Health
- Health
Depression during perimenopause and menopause
Annunziata Schnurbein, founder of Perihub, a platform that focuses on (peri)menopause and menopause, talks among other things about depression and mental health in early menopause and how and where to find help.
Bouts of sadness, exhaustion, and a feeling of powerlessness dominated the daily life of Annunziata Schnurbein until she finally received a diagnosis: perimenopause at 37. To prevent other women from going through the same ordeal, she founded the platform PeriHub. There, she provides information about menopause and its potential effects on (mental) health, raising awareness - Schnurbein is passionately committed to ensuring that the topic of menopause receives the attention it deserves.
What were your first symptoms? At what age did they appear?
Perimenopause initially sneaks in very subtly. Some cycles you have symptoms, some you don’t – depending on whether ovulation still occurs and how good the egg quality is. Therefore, I find it difficult to attribute the onset of my perimenopause to a specific age.
Since I have been tracking my cycle since my early 30s, I would say that the first irregularities like headaches and lack of motivation appeared in my mid-30s. But I was really thrown off course at 37: During a very stressful phase at work, nothing worked anymore, and I could only cry. Diagnosis: burnout.
This was uncharacteristic for me because I am/was someone who handles stressful situations well and approaches new challenges positively and with full energy. At 39, my condition worsened further – even without stress, I could no longer function and was diagnosed with moderate depression.
In addition to the mental symptoms of perimenopause, physical complaints such as leaden exhaustion occurred.
For weeks I suffered from intense bouts of sadness and crying fits that shook me every day. In addition to the mental symptoms, physical complaints such as leaden exhaustion, dizziness, concentration problems, visual disturbances, and a changed body odor occurred. Today I know: All of these can also be menopausal symptoms.
What therapies were prescribed?
Before the diagnosis of "depression" was made, many other possibilities were considered - from Long Covid to multiple sclerosis. These potential diagnoses alone were frightening. In the end, I was prescribed antidepressants (SSRIs) and psychotherapy.
I saw the diagnosis as a great stigma for a long time. I had internalized societal prejudices so much that the label of a "mental illness" further burdened my condition.
How can you tell that a depression is menopause-related?
That's a difficult question - even experts often have problems with it. After all, the doctors only see the patient in a snapshot and do not know their background.
Personally, I felt from the beginning that my condition had a physical-biological cause. Although the mental symptoms were so overwhelming - I was just lying on the sofa crying - I knew deep inside that I wasn't actually sad. It felt like something was "wired" incorrectly in my brain. This feeling was foreign to me, I didn't recognize myself anymore.
In addition, there were always good days. The lows came and went, regardless of external circumstances. However, the connection to my cycle was clear: it was particularly bad around ovulation and just before the period.
Diagnosis of menopause-related depression
The diagnosis of a menopause-related depression should definitely be made by experts. Ideally, there should be a coordination between psychologist/psychiatrist and gynecologist. By asking targeted questions - for example about mood swings, cycle connections, and accompanying physical symptoms - a menopause-related depression can be diagnosed (at the appropriate age).
Another indicator: If women have already suffered from depression during previous phases of hormonal changes (puberty, postpartum, etc.). It is important to take a holistic approach to diagnosis and therapy, because hormones or antidepressants alone do not always help. My appeal: Seek professional help as early as possible during mood swings, regardless of whether you suspect hormonal causes or not.
© Perihub
"It took over two years for me to receive the correct diagnosis," said Annunziata Schnurbein.
Did exercise or meditation help you?
I have had a regular exercise and meditation routine for years. However, during my depression, neither really helped me. Yoga was either not possible due to my exhaustion or even triggered new crying spells. Meditation gave me some support by helping me accept the situation, but it did not change my symptoms.
It was only when I received the correct diagnosis and therapy that exercise and meditation started to work again. Today, my well-being suffers without them. I therefore see them alongside a healthy diet as an important pillar of my menopause therapy and would like to recommend a healthy lifestyle to every woman in (peri-)menopause.
How long did it take you to get the correct diagnosis?
If I take burnout as a starting point, it took over two years for me to get the correct diagnosis. And that only because I trusted my intuition and did not let go of the suspicion of a physical-hormonal cause against all odds.
Only after more than 20 exhausting doctor's appointments did I finally have certainty
Because the antidepressants helped me quickly reduce the crying fits, but my everyday life remained a struggle. The many physical symptoms persisted. It was clear: Symptoms are being treated here, not the cause. So I continued to search for a diagnosis that made sense to me. Only after more than 20 exhausting doctor's appointments did I finally have certainty.
What was particularly frustrating?
The odyssey of doctor visits was sometimes more frustrating than the symptoms themselves. Often I didn't feel taken seriously. Belittling statements like "Pay more attention to your stress level" or "Accept it, you're just depressed" were not uncommon and, above all, not helpful.
When I pointed to hormonal causes, this was often dismissed. At 39, I was too young for menopause, and a regular cycle spoke against it. This ignorance and the outdated medical beliefs I encountered in many specialist practices were extremely frustrating.
How were you treated after the correct diagnosis?
I received the correct diagnosis from my uncle, a gynecologist. He suggested bioidentical progesterone via remote diagnosis over the phone. After the first dose, I felt like myself for the first time in two years the next morning.
Later, a private doctor additionally prescribed bioidentical estrogen and testosterone. Since then, apart from harmless hormonal fluctuations, I haven't had a depressive day. I was able to successfully wean off the antidepressants after a transition period.
How to find the right doctor?
In the statutory health care system, it is still difficult to find good doctors for (peri-)menopause. Menopause continues to play a subordinate role in medical studies, and the counseling is poorly reimbursed by health insurance companies.
If possible, I recommend finding a private doctor. Otherwise, it helps to prepare thoroughly for the appointments: track symptoms, specifically look for doctors, and prepare for appointments. My guide "Finding a doctor made easy" offers many practical tips for this.
© Perihub
Annunziata Schnürbein also supports many companies in creating a menopause-friendly workplace.
You started your own business with PeriHub – what is your focus? How do you help other affected individuals?
My experiences in perimenopause shaped me so much that I wanted to help other women better cope with this phase of life. I couldn't believe how little support women receive in the 21st century, and I began to engage intensively with the topic – from books to scientific studies.
At some point, I decided to share this knowledge and started my Instagram account PeriHub to life. On PeriHub, I talk openly about my experiences, clarify menopause, and shed light on both physical and mental challenges.
It is particularly important to me to break the taboo surrounding menopausal depression because, although they are anything but rare, they are often not recognized as hormonally induced. My motto is: “Away with the taboos. Here with the knowledge.”
Particularly important: breaking the taboo surrounding menopausal depression
Over time, companies approached me for support in creating a menopause-friendly workplace. I am constantly expanding this activity - as meaningful work and in order to keep my Instagram account ad-free and continue to independently impart knowledge.
How relevant is menopause for companies, and what can companies do?
Menopause is not just an individual issue, but also affects companies and society as a whole. Studies show that 10% of women in menopause quit their jobs due to their symptoms. These are always experienced employees who very often stand just before a career leap typical at this age.
In addition, there are economic damages due to sick leave, which are estimated at 9.4 billion euros annually in Germany alone. According to McKinsey, better treatment of (peri-)menopause could increase the global gross domestic product by up to 120 billion US dollars.
In times of skilled labor shortages, it is in the companies' interest to close the existing knowledge gap in the healthcare system. Pioneers like Vodafone show how important (! and easy!) it is to educate women and support them in the workplace.
Even small measures can make a big difference: informational materials in the intranet or break room, awareness training, or hormone-related training for company doctors are good first steps. With targeted support, companies can not only retain experienced female employees but also create a modern, inclusive work environment.
Can you share three tips for women in menopause that you wish you had known yourself?
Before it started with me, my knowledge of (peri-)menopause was extremely limited. I thought it was mainly about irregular or absent periods and hot flashes. Today I know there is so much more I wish I had known back then.
Menopause is not the end, but the beginning
Boiled down to three points, it would look like this:
1. Menopause begins earlier than many think. As early as the late 30s or early 40s, the first signs can appear even if the cycle is still regular. My tip: Track your cycle to detect irregularities early and better understand symptoms.
2. The symptoms can be diverse and unexpected. Since women have estrogen receptors throughout the body, hormonal fluctuations do not only affect fertility. Everything from sleep disturbances, joint pain, heart palpitations to concentration problems and tinnitus is possible. Inform yourself so that you are prepared and can correctly interpret the symptoms.
3. The menopause is not the end, but the beginning. With the right therapy, you can master this phase well and set the course for your second half of life.
Ahead of you lies a time in which you can live according to your own rules and with a high quality of life and health. I would also make this course adjustment if you belong to the lucky third of women who have no menopausal symptoms.
