Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population.

Ellen W Freeman

doi:10.1186/s40695-015-0002-y

Abstract

There is accumulating evidence but no definitive answers about the incidence of depressed mood in the menopause transition and its association with the changing hormonal milieu. While a changing hormonal milieu is the natural condition for all women, only a minority of mid-life women experience debilitating depressive symptoms or clinical depression. This review focuses on associations between depressed mood and the menopause transition, primarily as identified in longitudinal, population-based studies in the past decade. Further aims were to present reported associations between depressed mood and reproductive hormones in the menopause transition as evaluated in the general population and associations of depressive symptoms or clinical depression with menopausal hot flashes or poor sleep in perimenopausal women. There is evidence to support the role of the changing endocrine milieu in the development of depressed mood in the menopause transition, but the contribution of hormones as measured is small. Disentangling the numerous factors that are associated with depression in midlife women is a major challenge for research and for clinical care, where treatments are needed to improve the most distressing menopausal symptoms.

Highlights

Changes in menstrual bleeding patterns signal the approach of menopause in mid-life women, and many women report hot flashes, poor sleep, depressed mood and other symptoms along with these menstrual changes
Postpartum depression following childbirth, premenstrual dysphoric disorder linked to the menstrual cycle, and depression around menopause may possibly share a sensitivity to normal shifts in reproductive hormones, which in turn modulate neuroregulatory systems associated with mood and behavior [13, 14]
When depressive symptoms were evaluated across 14 years of follow-up relative to the final menstrual period (FMP), the findings demonstrated a pivotal role of the FMP in the risk of depressive symptoms: there was a higher risk of high depressive symptoms before and a lower risk after the FMP [18]

Summary

Introduction

Changes in menstrual bleeding patterns signal the approach of menopause in mid-life women, and many women report hot flashes, poor sleep, depressed mood and other symptoms along with these menstrual changes. The extent to which symptoms that arise around menopause are directly associated with the hormone changes of ovarian aging is not well understood. There is accumulating evidence but no definitive answers about many potential risk factors and the role of the changing hormone milieu associated with depressed mood around menopause. Depressive symptoms are common in all populations but appear to increase among women in the transition to menopause. Postpartum depression following childbirth, premenstrual dysphoric disorder linked to the menstrual cycle, and depression around menopause may possibly share a sensitivity to normal shifts in reproductive hormones, which in turn modulate neuroregulatory systems associated with mood and behavior [13, 14].

Objectives

Findings

Conclusion