Fluctuating estrogen levels as a result of menopause make women more susceptible to depression and effects of stress, suggests a study.
The study - conducted by researchers from the Department of Psychiatry at the University of North Carolina at Chapel Hill - is published online in Menopause, the journal of the North American Menopause Society (NAMS).
Menopause is officially defined as the final menstrual period, and it is typically confirmed when a woman has not had a period for 12 months in a row. As a result of menopause, levels of estrogen and other hormones decrease.
Before the final menstrual period, physical changes can appear, such as fluctuations in the length of time between periods.
The researchers say previous studies have shown that women are at greater risk of depression than men, and some studies have suggested this greater risk is due to reproductive events, when hormones are fluctuating more.
Rates of a major depressive disorder and clinical increases in depressive symptoms double or even triple for women in the menopausal transition and early postmenopausal period, compared with premenopausal and late postmenopausal rates, they add.
Between 26-33% of women will develop clinically significant depressive symptoms during the perimenopausal hormonal flux, when estradiol - a form of estrogen - decreases.
As such, the team decided to conduct a 12-month placebo-controlled randomized trial to assess the mood and cardiovascular benefits of transdermal estradiol in women going through menopause.
Life stress and estradiol fluctuations trigger depression
Overall, the researchers observed that estradiol variability led to greater anger, irritability and feelings of rejection, as well as the development of depressive symptoms.
Fast facts about menopause
- Menopause results in lower levels of estrogen and other hormones
- Most women go through this change between the ages of 40 and 58
- The average age of menopause is 51.
In detail, the team found that the fluctuation of estradiol in perimenopausal women increased their sensitivity to social rejection.
When this sensitivity was combined with stressors such as divorce or bereavement, the women were especially likely to develop clinically significant symptoms of depression.
Interestingly, however, if a severe life stress did not crop up, the estradiol variability did not cause depressive symptoms in the women.
The team defined severe life stresses as events such as divorce or separation, illness of a relative or friend, major financial issues, and physical or sexual abuse or assault.
Commenting on the findings, NAMS Executive Director Dr. JoAnn Pinkerton says:
"These results provide tremendous insight for practitioners. Clinicians need to understand the impact of perimenopausal hormonal fluctuations and the degree of stressful events that a woman is experiencing to determine the best treatment options when a middle-aged woman complains of depression or exaggerated irritability."
She adds that future research should assess the value of interventions - such as cognitive therapies - to mitigate the impact of stressful events, as well as the use of estrogen therapy during menopause.
Earlier this year, a study published in JAMA Internal Medicine revealed that many women may experience menopause symptoms for at least 7 years.
And Medical News Today recently reported on a study that suggested eating a soy diet could prevent osteoporosis in menopausal women.