Depression at menopause

Two recent studies find that the transition to menopause is linked to depression and imply that the depression is at least partly the result of hormonal changes.

In one study, 231 Philadelphia women, ages 35–47, were followed for eight years. All were premenopausal (had regular menstrual cycles) and none had ever been clinically depressed. During the study, 43% went into the menopausal transition, also called perimenopause: They began to have skipped and irregular periods and changes in menstrual blood flow. Women were four times more likely to report a high number of depressive symptoms during perimenopause than before, and twice as likely to develop clinical depression.

After correcting for possible effects of smoking, body mass index (a measure of weight-height ratio), premenstrual syndrome, hot flashes, and insomnia, as well as general health, marital and employment status, and age, the researchers found that depressive symptoms were correlated with changes in hormone production. The strongest risk factor for depression was a fluctuating level of the female hormone estradiol.

A 6-year study based on telephone interviews and questionnaires answered by 460 Boston women ages 36–45, none of whom had been depressed before, found that those who entered perimenopause (70%) were nearly twice as likely to develop serious depressive symptoms and clinical depression, regardless of age and stressful events such as divorce and death in the family.

The increased risk was greatest for women who had hot flashes. The researchers say that hot flashes can raise the risk of depression or that depression may result from the same hormonal changes that cause hot flashes. In this study, hormone replacement had no effect on depressive symptoms in general but did provide some relief for severe depression. The authors believe that by suppressing hot flashes, hormone replacement might at least temporarily improve depression in women undergoing menopause.

If you’re a menopausal or post-menopausal woman, tell us about your experiences with depression during this change of life.

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