Mood and Menopause

menopauseWhat is the relationship between the hormone changes that take place around the time of menopause and depression. It seems as though there are many women who report that their depression gets worse in the peri-menopausal period, but is this a pattern? And if so what does that mean in terms of the interaction between mood and hormones?

A recent article in the Journal of the American Medical Association (JAMA) Psychiatry followed a random sample of 203 women who were not yet menopausal through the transition to menopause. This study is the largest longitudinal study (following a group of women over time) and is therefore an important source of information about this transition for women as a whole.

In general, the risk of depression in the years before the last menses went up somewhat (new depression in the nine years before depression occurred about 1.6 times more often than at other times in a woman’s life)… but, most notably, the risk dropped to the same risk as at other times during the year of the last menstrual period, and then dropped even further, to about 60% of the risk before menopause, after the last menstrual period.

The chart below shows the risk of significant depression in the women broken down by how many years before or after their last menses they were. The pattern is similar whether women had a history of depression or not, a moderate increased risk 4 – 9 years before last menses, and then a drop to below the previous rate after the last menses. Of course,  the percentage of women with a history of prior depression who had depression in the perimenopause was much higher than in women with no prior history.

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The authors conclude by noting that this study provides some reassurance to women entering the menopause and certainly suggests that prescribing estrogen frequently to prevent post-menopausal depression has to be seriously questioned…

Although only a small percentage of women experience mood difficulties in relation to menopause, many want to know what to expect in this transition period. Women overall can expect depressive symptoms to decrease after FMP, although those with a history of depression have a continuing high risk of recurrence. However, women whose first experience of depressive symptoms occurred as they approached menopause can expect a low risk of depressive symptoms after the second year following menopause.

REFERENCE

Longitudinal Pattern of Depressive Symptoms Around Natural Menopause. Ellen W. Freeman, PhD1,2; Mary D. Sammel, ScD3; David W. Boorman, MS4; Rongmei Zhang, PhD3 JAMA Psychiatry. 2014;71(1):36-43. doi:10.1001/jamapsychiatry.2013.2819.