RACHEL MARTIN, HOST:
There's a day in every woman's life when she hasn't had her period for 12 consecutive months. That day is when she starts menopause. But there are years leading up to that point. For some women, it can take as long as a decade. Those years are called perimenopause. And during that time, hormones fluctuate, periods get irregular, women can experience hot flashes, changes to their bodies, emotional ups and downs. But for many women, some of the symptoms don't stop there. Perimenopause can bring on severe anxiety or clinical depression.
NPR's Rhitu Chatterjee has more.
RHITU CHATTERJEE, BYLINE: About a decade ago, when Teri Hines was in her mid-40s, her period started to change.
TERI HINES: It increased in frequency, it increased in intensity, and it increased in duration.
CHATTERJEE: She had hot flashes, gained weight, and her energy levels took a nosedive.
HINES: I just did not have the energy to do the things that I wanted to do.
CHATTERJEE: Like the morning walk she loved to take with her dogs. At the time, Hines lived alone in Philadelphia, where she worked as an assistant principal at a school. She struggled to get out of bed and go to work and began to withdraw from her friends.
HINES: I would prefer they come to me. I would prefer to stay home rather than meeting up with everybody for an evening out.
CHATTERJEE: Looking back, she remembers feeling foggy and isolated. But she didn't realize that she might be depressed. Even though she'd struggled with depression before and had sought treatment for it, she knew her symptoms, her triggers - usually it was a big change in her personal or professional life. This time, though, she says, she was just focused on her body changing.
HINES: The physical nature of menopause consumes you and is what we're taught is what you have to pay attention to.
JENNIFER PAYNE: Perimenopause is a whole host of physical changes but can also lead to emotional changes.
CHATTERJEE: That's psychiatrist Jennifer Payne. She directs the Women's Mood Disorders Center at Johns Hopkins University. She says most women experience mood swings. They might feel blue, irritable or anxious, but women who have a history of mental illness like Hines, they're likely to experience more serious symptoms.
PAYNE: Women who have a previous diagnosis of major depression or an anxiety disorder are going to be at a greater risk during the perimenopausal time.
CHATTERJEE: There's also a higher risk for women going through major life upheavals - changes in career, a divorce or children going off to college. Payne says women who are really struggling need treatment.
PAYNE: If you're having serious depression and your functioning is affected, or you're having suicidal thoughts, or you just feel completely hopeless, that is a major depressive episode that absolutely needs treatment.
CHATTERJEE: That treatment, she says, can be in the form of talk therapy and/or medication.
PAYNE: Antidepressants can, you know, help a woman get out of a major depressive episode. Antidepressants also can be very helpful for anxiety symptoms.
CHATTERJEE: But getting a diagnosis and treatment, she says, can be an uphill battle.
PAYNE: It's a very common situation for many women, and doctors are not keeping up with that.
CHATTERJEE: That's because most physicians, even OB-GYNs, get little education about perimenopause. Hines learned this the hard way. When she first noticed her changing period, the weight gain, her falling energy levels, she mentioned it all to her doctor.
HINES: I think she might have said, yeah, you're about the age when you will begin to have these symptoms; you will begin to be perimenopausal.
CHATTERJEE: But, she says, her doctor offered no treatment or even further information, not even the fact that perimenopause can last up to 10 years. Hines did eventually realize that she might be depressed, but it took her several years of struggling with her symptoms.
HINES: That's when I made an appointment with my doctor and said, like, here's what I'm thinking. Here's what I'm feeling. And I think I might be depressed.
CHATTERJEE: This time, her physician prescribed her an antidepressant.
HINES: The minute I went on it, it felt like I had the energy to tackle those other things that were ongoing.
CHATTERJEE: Hines also started seeing a therapist, who gave her coping skills to better manage her symptoms. Hadine Joffe is the vice chair of psychiatry research at Brigham and Women's Hospital in Boston. She says women need to be direct with their providers about their mental health problems, like Hines was.
HADINE JOFFE: Just the same they would - if they had a rash, they would go in for an extra appointment. And that's the first thing they say, is I have a rash.
CHATTERJEE: Another tip she gives women - start tracking your symptoms as soon as you notice them.
JOFFE: Knowing that information, somebody can say, well, over the last six months, I only had two periods, or I had hot flashes almost every day, or my mood was bad as it gets, you know, a third of the time.
CHATTERJEE: Joffe says most of the time, women don't do this and just try to tough it out because they're used to dealing with physical discomforts and emotional struggles. But, she says, seeking help is important.
JOFFE: I want people to have permission. I want people to feel that they owe it to themselves and the people around them that they aren't suffering.
CHATTERJEE: Because with the right tools and treatment, they don't have to suffer during this time of transition. Rhitu Chatterjee, NPR News.
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