Perimenopause and Depression: Why Many Women Are Misdiagnosed

Burnout, depression – and nobody thought of menopause

What diagnoses were initially made?

Before the diagnosis of 'depression' was made, many other possibilities were considered – from long Covid to multiple sclerosis. These potential diagnoses were frightening in themselves. 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.

Why was the hormonal connection overlooked for so long?

That's a difficult question – even experts often have problems with it. Doctors only see the patient at a snapshot in time and don't know their background.

I personally felt from the beginning that my condition had a physical-biological cause. Even though the mental symptoms were so overwhelming – I just lay on the sofa crying – I knew deep down that I wasn't really sad. It felt as if something in my brain was wrongly 'wired'. This feeling was unfamiliar 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 with my cycle was clear: It was particularly bad around ovulation and just before my period.

How can you tell if depression might be hormonally related?

The diagnosis of menopause-related depression should definitely be made by experts. Ideally, there is coordination between a psychologist/psychiatrist and a gynecologist. Through targeted questions – for example, about mood swings, cycle connections, and accompanying physical symptoms – menopause-related depression can be diagnosed.

Another indicator: If women already suffered from depression in previous phases of hormonal changes (puberty, postpartum, etc.). It is important to follow a holistic approach in diagnosis and therapy, because hormones or antidepressants alone do not always help. My appeal: Seek professional help as early as possible when experiencing mood lows – regardless of whether you suspect hormonal causes or not.

“Here symptoms were treated, not the cause”

Did sports 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 impossible due to my exhaustion or even triggered new crying spells. Meditation gave me a bit of support by helping me accept the situation, but it didn’t change my symptoms.

Only when I received the correct diagnosis and therapy did sports and meditation start working again. Today, my well-being suffers without them. I therefore see them, alongside healthy nutrition, as an important pillar of my menopause therapy and would like to encourage every woman in (peri-)menopause to lead a healthy lifestyle.

How long did it take for you to get the right diagnosis?

If I take the burnout as a starting point, it took over two years for me to receive the correct diagnosis. And that only because I trusted my intuition and didn’t let go of the suspicion of a physical-hormonal cause despite all the resistance.

For the antidepressants helped me reduce the crying spells quickly, but my daily life remained a struggle. The many physical symptoms persisted. It was clear: Symptoms were being treated, not the cause. So I continued my search for a diagnosis that made sense to me. Only after more than 20 exhausting doctor visits did I finally have certainty.

What was particularly frustrating about your medical odyssey?

The medical odyssey was sometimes more frustrating than the symptoms themselves. Often, I didn't feel taken seriously. Trivializing statements like "Pay more attention to your stress level" or "Just accept it, you're just depressed" were not uncommon and certainly no help.

When I pointed out hormonal causes, it was often dismissed. At 39, I was too young for the menopause, and a regular cycle argued against it. This ignorance and the outdated medical beliefs I encountered in many specialist practices were extremely frustrating.

The diagnosis perimenopause

How did you finally get the right diagnosis?

I got the right diagnosis through 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.

Which treatment ultimately helped you?

Later, a private doctor additionally prescribed me bioidentical estrogen and testosterone. Since then, I haven’t had a single depressive day—except for harmless hormonal fluctuations. I was able to successfully discontinue the antidepressants after a transition period.

How important was it that your complaints were taken seriously?

In the statutory healthcare system, it is still difficult to find good doctors for (peri)menopause. Menopause still plays 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 appointments and track symptoms. My guide “Finding a Doctor Made Easy” offers many practical tips for this.

From affected to educator

Why did you found PeriHub?

My experiences in perimenopause shaped me so strongly that I wanted to help other women cope better with this phase of life. I couldn't believe how little support women receive in the 21st century, so I began to immerse myself in the topic—from books to scientific studies.

At some point, I decided to share this knowledge and started my Instagram account PeriHub into life. On PeriHub, I openly talk about my experiences, educate about menopause, and highlight both physical and mental challenges.

What do you want to change with your work?

It is especially important to me to break the taboo surrounding menopausal depression, as it is often not recognized as hormonally caused, despite being far from uncommon. My motto is: "Get rid of the taboos. Bring on the knowledge."

Over time, companies approached me for support in creating a menopause-friendly workplace. I am continuously expanding this activity as meaningful work and to keep my Instagram account ad-free and continue to independently share knowledge.

Menopause is also an economic issue

Why should companies take menopause more seriously?

Menopause is not only 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 are often on the verge of a career leap typical at this age.

In addition, there are economic damages due to days off, which are estimated at 9.4 billion euros annually in Germany alone. According to McKinsey, better treatment of the (peri-)menopause could increase the global gross domestic product by up to 120 billion US dollars.

What measures can employers implement concretely?

In times of skilled labor shortages, it is in the interest of companies to close the existing knowledge gap in the healthcare system. Pioneers like Vodafone demonstrate how important (! and easy!) it is to educate and support women in the workplace.

Even small measures can make a big difference: informational materials in the intranet or break room, sensitivity training, or hormone-related training for company doctors are good first steps. With targeted support, companies can not only retain experienced employees but also create a modern, inclusive work environment.

"Menopause is not the end"

What three things do you wish you had known earlier about perimenopause?

Before it started for me, my knowledge about (peri-)menopause was extremely limited. I thought it was mainly about irregular or absent periods and Hot flashes. Today I know there's so much more I wish I had known back then.

• Menopause begins earlier than many think. As early as late 30s or early 40s, first signs can appear, even if the cycle is still regular. My tip: Track your cycle to detect irregularities early and better understand symptoms.
• The symptoms can be diverse and unexpected. Since women have estrogen receptors throughout the body, hormonal fluctuations affect more than just fertility. From Sleep disturbances, joint pain, heart palpitations to concentration problems and tinnitus, anything is possible. Inform yourself, so you are prepared and can properly interpret the symptoms.
• 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.

What would you like to share with women experiencing similar symptoms?

Before you lies a time in which you can live by your own rules with a high quality of life and health. I would make this decision even if you were among the lucky third of women who have no menopause symptoms.