Depressed mood during the menopausal transition: is it reproductive aging or is it life?

Ellen Sullivan Mitchell,Nancy Fugate Woods

doi:10.1186/s40695-017-0030-x

Ellen Sullivan Mitchell, Nancy Fugate Woods

Open Access

https://doi.org/10.1186/s40695-017-0030-x

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Abstract

BackgroundAlthough there has been noteworthy attention to both depressed mood symptoms and majordepressive disorder during the menopausal transition (MT), recently investigators have questioned whether there is an over-pathologizing of the MT by emphasizing hormonal effects on depression and deflecting attention from the everyday conditions of women’s lives as they relate to depressed mood. In addition, fluctuation of mood over short periods of time may not be captured by measures of depressed mood symptoms such as the CESD, especially when administered using a reference period such as a week or more. The purpose of this study was to examine the association of menopausal transition factors, health-related factors, stress factors, social factors and symptoms with repeated measures of depressed mood reported for a 24 h period.MethodsSeattle Midlife Women’s Health Study participants (n = 291, 6977 observations) provided data from 1990 to 2013 including annual questionnaires, symptom diaries and urine specimens assayed for hormones several times per year. Multilevel modeling was used to test bivariate and multivariable models accounting for depressed mood severity.ResultsIn individual models with age as the measure of time, being in early postmenopause, exercising more, and being partnered were associated with less severe depressed mood; greater perceived stress, having a history of sexual abuse, difficulty getting to sleep, early awakening, and awakening at night were each associated with higher depressed mood severity. In a multivariable model (n = 234, 6766 observations), being older, being in the early postmenopause, exercising more, being partnered, were associated with less severe depressed mood; reporting greater perceived stress, history of sexual abuse, difficulty getting to sleep and early awakening were associated with more severe depressed mood.ConclusionsClinicians need to consider the context in which midlife women experience the menopausal transition and mood symptoms as well as hormonal transitions during this part of the lifespan.

Highlights

There has been noteworthy attention to both depressed mood symptoms and majordepressive disorder during the menopausal transition (MT), recently investigators have questioned whether there is an overpathologizing of the MT by emphasizing hormonal effects on depression and deflecting attention from the everyday conditions of women’s lives as they relate to depressed mood
The purpose of the analyses reported here was to test a longitudinal model of the effects of MT factors, health-related factors, stress factors, social factors, and symptoms on depressed mood severity reported for a 24 h period. (See Fig. 1)
Awakening during the night was the only sleep symptom significantly related to MT stages in the Seattle Midlife Women’s Health Study (SMWHS) [52], but in the analyses reported here, both trouble getting to sleep and early awakening were associated with depressed mood over the past 24 h, while awakening during the night was not

Summary

Introduction

There has been noteworthy attention to both depressed mood symptoms and majordepressive disorder during the menopausal transition (MT), recently investigators have questioned whether there is an overpathologizing of the MT by emphasizing hormonal effects on depression and deflecting attention from the everyday conditions of women’s lives as they relate to depressed mood. Mitchell and Woods Women's Midlife Health (2017) 3:11 mood symptoms from multi-ethnic community-based cohorts of women studied annually (some more frequently) for 20 years or longer. These studies have revealed a pattern of increasing depressed mood symptoms during the menopausal transition. The Harvard Study of Moods and Cycles investigators found an elevated odds ratio (2.5) of experiencing depressive symptoms (CESD) during the MT vs premenopause (late reproductive stage) [14] and POAS investigators reported elevated odds ratios of 1.5 to 5.4, depending on women’s past history of depression [15, 16]. POAS investigators found that reaching the final menstrual period (FMP) played a pivotal role in reduced prevalence of depressive symptoms (CES-D) [18]

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