The primary care management of perimenopausal depression

Psychological symptoms of anxiety, depression and cognitive challenges are often the earliest signs of perimenopause and can affect up to 80% of women. Neurochemical and neurocircuitry changes triggered by fluctuating gonadal hormones affect mood, cognition and behaviour in susceptible women. Perimenopausal depression is an important syndrome occurring in this period. Notably, this condition is often not responsive to conventional antidepressant management.

The aim of this article is to provide primary healthcare practitioners with evidence-based guidance to recognise and treat perimenopausal depression.

Perimenopausal depression is a distinct subtype of major depression with a hormonal aetiology. Accurate diagnosis requires awareness of symptom patterns, history, the use of tools such as the Meno-D scale and possibly a diagnostic trial of menopause hormone therapy (MHT). Treatment is best tailored to the individual and includes lifestyle support, MHT, trauma-informed psychotherapy and psychotropic medications when appropriate. General practitioners play a critical part in diagnosis, management and ongoing support.