- A new study reports that women are more likely to develop depression during perimenopause than in the pre-menopause or post-menopause stages of their life.
- Researchers recommend that medical professionals screen women for depression during their perimenopausal years.
- About 10% of women may develop depressive symptoms during their lifetime.
Women are at a higher risk of developing depression symptoms during the perimenopause stage of their life than in their premenopause or postmenopause years, according to a new study published in the Journal of Affective Disorders.
Researchers completed a meta-review to estimate the risk of developing clinical depression and depressive symptoms during the different stages of menopause. The analysis included seven research papers with a total of 11,965 participants. The studies:
- Were peer-reviewed
- Were longitudinal prospective studies
- Used females over 18 who were pre-, peri- or postmenopausal
- Assessed the difference between the different stages of menopause
- Used standard inventories for symptoms of depression
In all the studies, the researchers used each woman’s health history as a control measurement, comparing before and post menopause stages to mental health during perimenopause.
The researchers concluded that the risk of depression in perimenopause highlights the need for screening and support for this group of women.
“As providers, we very often see patients that are going through menopause,” said Dr. Cielo Gnecco, an obstetrician and gynecologist with Orlando Health Women’s Institute Center for Obstetrics & Gynecology in Florida who was not involved in the study. “We tend to focus on hot flashes, low libido, and mood changes that can be associated with menopause. As a provider that deals with menopausal patients so often, I could definitely be more proactive about screening my patients for depression during this transition.”
“Although I treat and counsel patients very often during this transition, my main focus is oftentimes not how depression can affect them,” Gnecco told Medical News Today. “Most OB-GYNs get very limited exposure and training regarding treatment of patients during menopause or hormone replacement therapy. This article is eye opening and definitely something I will incorporate in my practice. Depression is, in my opinion, one of the most important things to be aware of as if can affect patients in so many different ways.”
The researchers noted that they did find a significant increase in depression when comparing post-menopausal women to those in perimenopause.
“This study highlights how menopause transition is a period of vulnerability with women being at increased risk of depression at this time,” Aimee Spector, a professor of clinical psychology of aging at University College London and an author of the study, told Medical News Today. “It is also important to be mindful that many people live well through menopause transition and that depression may be the result of many factors beyond menopause.”
Other studies have shown similar results. For example, a
“Depression and anxiety are common during menopause and the post-menopause, with vasomotor symptoms and a prior history of major depression elevating risk of menopausal associated depression. Psychosocial factors also may increase risk of depression during menopause,” the study authors wrote.
“I think there is a period of vulnerability, and during this time, there is a higher rate of depression. Some women may be more sensitive to hormonal shifts,” said Dr. Michael Krychman, an OB/GYN and medical director of Women’s Health Services at MemorialCare Saddleback Medical Center in California who was not involved in the study. “Depression is multi-faceted. Hormonal shifts can contribute to it, but there are often biological and psychosocial elements.”
“Women should be empowered to talk about these things – not to minimize their symptoms,” Krychman told Medical News Today. “Many women don’t need treatment for menopause, but if they are bothered or distressed by symptoms, they should know that there are safe and effective interventions. The best treatments are those that target the causes. For example, if the depression is hormonal, then hormone treatments will probably work best. If the depression is biological or psychosocial, antidepressants and cognitive behavioral therapy might be best.”
“Doctors must also be careful not to over-medicalize,” Krychman said. “They must listen and emphasize to find a treatment tailored to the individual woman.”
“I am not surprised that depression is so prevalent during this stage. Women go through so many emotional and physical changes when going through menopause,” Gnecco said. “Physical symptoms tend to affect quality of life significantly and this, in turn, can lead to issues with anxiety and depression. Lack of sleep, hot flashes, and fatigue can also lead to depression, and as physicians, we do not often focus on this. We need to look at the big picture and how patients deal with the changes during menopause.”
The researchers noted that depressive symptoms are twice as common in women than in men and are more likely to occur during midlife. As was found in previous studies, depressive symptoms are associated with perimenopause. They are less likely to appear in postmenopausal women.
About 10% of women may develop depressive symptoms, according to the Anxiety and Depression Association of America.
Symptoms of depression during perimenopause, according to the
- Sadness not brought on by an event or something the woman has done
- Anxiety or irritability
- Feelings of hopelessness, worthlessness, or helplessness
- Loss of interest or pleasure in hobbies and activities
- Fatigue, lack of energy, or feeling slowed down
- Difficulty concentrating, remembering, or making decisions
- Changes in sleep or appetite
- Physical aches or pains that do not have a clear physical cause
- Thoughts of death or suicide or suicide attempts
Symptoms of depression can interfere with the ability to carry out daily activities and make it difficult to enjoy life.
Women using traditional, first-line treatment, such as antidepressants, often have poor or modest outcomes, according to a
“Physicians may frequently be presented with women aged 40 to 60 who show symptoms or signs of depression,” Spector told Medical News Today. “It is important to consider menopause transition within their assessment, aiming to understand whether this might be contributing to their symptoms. This might be directly (e.g. through hormone changes) or indirectly, through poor sleep or stress at work due to cognitive factors. This understanding may help determine the best treatment pathway, for example, considering menopause hormone treatment or cognitive behavioral therapy as alternatives to anti-depressant medication.”