Biopsychosocial predictors of depressive symptoms in the perimenopause—findings from the Swiss Perimenopause Study

Abstract

Objective: The perimenopause is associated with increased hormone fluctuations and an elevated risk of depression. A number of predictors of depressive symptoms in the menopausal transition have previously been suggested. The purpose of this study was to investigate a set of biopsychosocial predictors of depressive symptoms in perimenopausal women. Methods: This cross-sectional study, investigating 114 perimenopausal women (according to the STRAW criteria) aged 40-56 years, was conducted within the scope of the Swiss Perimenopause Study. Multiple regression analyses were performed to identify the most accurate model predicting perimenopausal depressive symptoms. Depressive symptoms were assessed with the German version of the Center of Epidemiologic Studies Depression Scale (CES-D). Validated questionnaires were used to examine psychophysiological complaints, stress, self-esteem, self-compassion, body image, and social support. Estradiol (E2) and progesterone (P4) were assessed through saliva samples, and follicle-stimulating hormone and luteinizing hormone were determined through dried blood spot samples. Seven saliva samples per participant were used to investigate absolute levels and fluctuations of sex steroids. All other variables were measured once. Results: Multiple regression analyses revealed that E2 fluctuations (β=0.15, P = 0.015), history of depression (β=0.14, P = 0.033), menopausal symptoms (β=0.47, P < 0.0001), perceived stress (β=0.17, P = 0.014), body image (β= −0.25, P = 0.014) and self-esteem (β=−0.35, P < 0.0001) were predictive of perimenopausal depressive symptoms (R 2 = 0.60). P4 fluctuations and absolute levels of hypothalamic-pituitary-gonadal hormone were not statistically significant. Conclusions: E2 fluctuations were shown to be predictive of depressive symptoms in the perimenopause. Moreover, the presence of burdensome complaints and chronic stress as well as a poor self-evaluation seem to promote depressive symptoms in perimenopausal women.

Is cognitive behaviour therapy an effective option for women who have troublesome menopausal symptoms?

“…Having persistent and/or troublesome VMS and sleep problems can make women feel stressed and irritable, which in turn can exacerbate menopausal symptoms. An estimated 9–10% of women report an increase in psychological symptoms, including depressed mood and/or anxiety, during the menopause transition (Almeida et al, 2016 ; Mishra & Kuh, 2012 ), which tends to be relatively transient, and is associated with troublesome VMS, current stress, low self‐esteem, and hormone fluctuations (Arnot, Emmott, & Mace, 2021 ; Campbell, Dennerstein, Finch, & Szoeke, 2017 ; Willi, Süss, Grub, & Ehlert, 2021 ). Longer duration of VMS has been linked with higher levels of perceived stress (Avis et al, 2015 ); acute psychological stress has been shown to provoke VMS (Swartzman, Edelberg, & Kemmann, 1990 ); there is also some evidence of altered physiological stress responsivity in women with VMS (Nathan et al, 2020 ).…”

Steroid Hormone Secretion Over the Course of the Perimenopause: Findings From the Swiss Perimenopause Study

“…Recent findings suggest highly individual fluctuations in E2 and progesterone during perimenopause ( 6 , 9 , 11 ). As such, the current results are consistent with previous findings of fluctuating secretion patterns of sex steroids during perimenopause, and contradict findings of a continuous decline due to the perimenopausal transition ( 4 , 7 ).…”

“…The Swiss Perimenopause Study addresses these limitations by employing closely spaced, longitudinal, and continuous measurements within highly standardized assessments of endocrine changes, measuring E2, progesterone, and cortisol several times for three non-consecutive months over the course of 1 year in solely perimenopausal women. Based on a recent cross-sectional study conducted by our work group ( 11 ), which reported fluctuations in E2 and progesterone levels even within one month, the aim of the present study is to contribute to a better understanding of the specific perimenopausal secretion patterns of steroid hormones by illustrating the fluctuations of E2, progesterone, and cortisol longitudinally and continuously over the course of 1 year in 127 perimenopausal women.…”

The Problem of Malnutrition Associated with Major Depressive Disorder from a Sex-Gender Perspective

“…One possible explanation is its interaction with GABA receptors [ 75 ]. Likewise, in premenopausal depressive disorder, progesterone levels remain constant [ 76 ] but E2 stands out when its levels are higher, assuming a direct risk of the intensification of depressive symptoms at this stage [ 77 ].…”