Depressed mood during the menopausal transition and early postmenopause

Woods, Nancy Fúgate; Smith-DiJulio, Kathleen; Percival, Donald B.; Tao, Eunice Y.; Mariella, Anne; Mitchell, Ellen Sullivan

doi:10.1097/gme.0b013e3181450fc2

Cited by 233 publications

(114 citation statements)

References 47 publications

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“…After completing an initial in-person interview, 390 women consented to provide data annually by questionnaire, daily menstrual calendar, and/or health diary. At the end of 5 years, 243 women consented to continue to participate for an additional 5 years and 170 agreed to provide a first morning urine specimen 8–12 times per year on day 6 of the menstrual cycle 19, 20 . For the current analyses, the data set contained data from 379 women who provided diary data on at least one occasion.…”

Section: Methodsmentioning

confidence: 99%

“…Nonetheless, recent studies of symptoms indicate that hot flashes co-occur with mood symptoms 1,2,3,4 and sleep disruption 5,6 and that the effects of interventions may extend beyond hot flashes 7 . In addition, complaints of cognitive and pain symptoms often accompany women’s experiences of hot flashes 8,9,10 , yet these symptoms may not be considered in intervention trials focusing on therapies for hot flashes.…”

Section: Introductionmentioning

confidence: 99%

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Symptom clusters during the late reproductive stage through the early postmenopause

et al. 2012

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Objective Identify symptom clusters that characterize women’s experiences through the late reproductive stage, the menopausal transition and early postmenopause; and explore the influence of the menopausal transition stages and early postmenopause, compared to the late reproductive stage, on the clusters of symptoms women experience. Methods Participants from the Seattle Midlife Women’s Health Study whose symptom calendars were staged for menopausal transition provided data for a total of 6857 occasions. Multilevel latent class analysis was used to identify classes using scores for hot flashes and symptom factors (sleep, cognitive, mood, pain, tension). Results Class 1 included observations of low severity levels for all symptoms, whereas class 2 included low severity hot flashes and moderate severity levels for all other symptom factors. Class 3 included high severity hot flashes with lower severity levels of all other symptom factors. During the early and late menopausal transitions stages and early postmenopause, the likelihood of being in class 3 was significantly greater than being in class 1 relative to the late reproductive stage. There were no significant effects of menopausal transition stages on the likelihood of being in class 2. Conclusions This effort is the first to examine latent classes or clusters of symptoms over the prolonged period from late reproductive stage through early postmenopause. As such, the data contribute to understanding of symptom experiences beyond our early efforts to characterize the late menopausal transition stage.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Symptom clusters during the late reproductive stage through the early postmenopause

et al. 2012

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“…Though the existence of menopause-associated depression has long been debated (12) and several cross-sectional studies find no relationship between the prevalence of MDD and menopausal status (13, 14), longitudinal studies have been more consistent in finding that the menopause transition is associated with a substantial increase in vulnerability to clinically significant depressive symptoms, with odds ratios ranging from 1.33 to 1.79 (15-17); this increased vulnerability is also observed in longitudinal studies in women with no history of MDD (16, 18, 19). Furthermore, studies using the Structured Clinical Interview for DSM Disorders IV to examine the incidence of syndromal MDD in the menopause transition echo the above findings in mixed samples of women with or without a history of MDD (20).…”

Section: Introductionmentioning

confidence: 99%

“…First, both a history of PMDD and a history of postpartum depression – two disorders for which reproductive hormonal flux may be pathophysiologically relevant (25, 26) – are each strong predictors of perimenopausal depression (16, 17, 19). Second, vasomotor symptoms in the menopause transition are also associated with an increased risk of elevated depressive symptoms (16-18).…”

Section: Introductionmentioning

confidence: 99%

“…The first of these, the Massachusetts Women's Health Study (42) measured serum estradiol annually for 3 years in 309 women ranging from premenopausal to postmenopausal (STRAW −3 to +1) and found no association between estradiol variability and CES-D score. In a subset of Seattle Midlife Women's Health Study participants, CES-D score was not associated with a urinary metabolite of estradiol, FSH or testosterone in 131 women in STRAW stages −3 or −2 at baseline (17). In that study, the CES-D was administered annually for 8 years and hormone concentrations were measured monthly for 4 years then quarterly for 4 years.…”

Section: Introductionmentioning

confidence: 99%

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Ovarian Hormone Fluctuation, Neurosteroids, and HPA Axis Dysregulation in Perimenopausal Depression: A Novel Heuristic Model

Gordon¹,

Girdler²,

Meltzer‐Brody³

et al. 2015

AJP

173

148

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Objective In this conceptual review, we propose a novel mechanistic candidate in the etiology of depression with onset in the menopause transition (a.k.a. perimenopausal depression) involving alterations in stress-responsive pathways, induced by ovarian hormone fluctuation. Methods The relevant literature in perimenopausal depression was reviewed, including its prevalence, predictors, and treatment with estrogen therapy. Subsequently, the growing evidence from animal models and clinical research in other reproductive mood disorders was synthesized to describe a heuristic model of perimenopausal depression development. Results The rate of major depressive disorder and of clinically meaningful elevations in depressive symptoms increases two- to threefold during the menopause transition. While the mechanisms by which ovarian hormone fluctuation might impact mood are poorly understood, growing evidence from basic and clinical research suggests that fluctuations in ovarian hormones and their derived neurosteroids result in altered GABAergic regulation of the hypothalamic-pituitary-adrenal (HPA) axis. Our heuristic model suggests that for some women, failure of the GABAA receptor to regulate overall GABAergic tone in the face of shifting levels of these neurosteroids may induce HPA axis dysfunction, thereby increasing sensitivity to stress, and generating a period of greater vulnerability to depression. Conclusions The proposed model provides a basis for understanding the mechanisms by which the changing hormonal environment of the menopause transition may interact with the psychosocial environment of mid-life to contribute to perimenopausal depression risk. Future research investigating this model may inform the development of novel pharmacological treatments for perimenopausal depression and related disorders such as postpartum depression and premenstrual dysphoric disorder.

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Longitudinal Change in Reproductive Hormones and Depressive Symptoms Across the Menopausal Transition

Bromberger

Schott

Kravitz

et al. 2010

Arch Gen Psychiatry

273

198

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Context The contribution of reproductive hormones to mood has been the focus of considerable research. Results from clinical and epidemiological studies have been inconsistent. It remains unclear whether alterations in serum hormone levels across the menopausal transition are linked to depressive symptoms. Objectives To evaluate the relationship between serum hormone levels and high depressive symptoms and whether hormone levels or their change might explain the association of menopausal status with depressive symptoms previously reported in a national sample of midlife women. Design A longitudinal, community-based, multisite study of menopause. Data were collected at baseline and annually from December 1995 to January 2008 on a range of factors. Early follicular phase serum samples were assayed for levels of estradiol, follicle-stimulating hormone, testosterone, and dehydroepiandrosterone sulfate. Setting Seven communities nationwide. Participants A community-based sample of 3302 multiethnic women, aged 42 to 52 years, still menstruating and not using exogenous reproductive hormones. Main Outcome Measure Depressive symptoms assessed with the Center for Epidemiological Studies Depression Scale (CES-D). The primary outcome was a CES-D score of 16 or higher. Results In multivariable random-effects logistic regression models, log-transformed testosterone level was significantly positively associated with higher odds of a CES-D score of 16 or higher (odds ratio=1.15; 95% confidence interval, 1.01–1.31) across 8 years, and a larger increase in log-transformed testosterone from baseline to each annual visit was significantly associated with increased odds of a CES-D score of 16 or higher (odds ratio=1.23; 95% confidence interval, 1.04–1.45). Less education, being Hispanic, and vasomotor symptoms, stressful life events, and low social support at each visit were each independently associated with a CES-D score of 16 or higher. No other hormones were associated with a CES-D score of 16 or higher. Being perimenopausal or post-menopausal compared with being premenopausal remained significantly associated with a CES-D score of 16 or higher in all analyses. Conclusions Higher testosterone levels may contribute to higher depressive symptoms during the menopausal transition. This association is independent of menopausal status, which remains an independent predictor of higher depressive symptoms.

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Depressed mood during the menopausal transition and early postmenopause

Abstract: Although women in the late MT stage are vulnerable to depressed mood, factors that account for depressed mood earlier in the life span continue to have an important influence and should be considered in studies of etiology and therapeutics.

Cited by 233 publications

References 47 publications

Symptom clusters during the late reproductive stage through the early postmenopause

Symptom clusters during the late reproductive stage through the early postmenopause

Ovarian Hormone Fluctuation, Neurosteroids, and HPA Axis Dysregulation in Perimenopausal Depression: A Novel Heuristic Model

Longitudinal Change in Reproductive Hormones and Depressive Symptoms Across the Menopausal Transition

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