Treatment of Menopause-Related Mood Disturbances

Abstract

More than 1.7 million American women are expected to reach menopause each year. Recent Canadian statistics show that a 50-year-old woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by intense hormonal fluctuations, accompanied by vasomotor symptoms (eg, hot flashes, night sweats), sleeps disturbance, and changes in sexual function, as well as increased risk for osteoporosis, cardiovascular disease, and cognitive decline. More importantly, recent studies have demonstrated a significant association between menopausal transition and a higher risk for developing depression. In the post-Women's Health Initiative Study era, physicians and patients are questioning the safety and efficacy of long-term hormone therapy use. This article reviews the current literature on the benefits and risks of using hormone therapy for the treatment of menopause-related mood disturbances and alternate strategies currently available for the management of menopause-related problems, including antidepressants, complementary and alternative medicine, and selective estrogen receptor modulators.

Randomized controlled trial of whole soy and isoflavone daidzein on menopausal symptoms in equol-producing Chinese postmenopausal women

“…The negative findings of the present study could be attributed to the trial not being specifically conducted among women with severe menopausal symptoms or women in early menopause. 34 Consistent with observational studies, 32,33,35 women in our study mainly complained of musculoskeletal, psychological, or nonspecific somatic symptoms (such as backache, stiffness in joint, poor sleeping, or nervous tension) rather than vasomotor symptoms (hot flashes and night sweats). Evidence has shown that Asian women, in general, experience fewer vasomotor symptoms (10%-20%) during menopause than women in Western countries (50%-80%) 32,33 and that nonspecific somatic symptoms, such as disturbances in sleep and mood, associated with menopause are the major reasons that Asian women seek therapy.…”

The role of sex steroids in catamenial epilepsy and premenstrual dysphoric disorder: Implications for diagnosis and treatment

“…Progesterone together with estrogen produces symptoms consistent with PMS, and higher doses of estrogen with progesterone have been shown to increase symptom severity. Estrogen alone, however, is an effective antidepressant in perimenopausal women with MDD [10][11][12] and may enhance overall wellbeing in menopausal women in general [50]. These data in humans are interesting and parallel nicely with the results of Murphy and Segal [36].…”

“…There are no studies to date investigating the relationship between MDD and CE in perimenopausal or menopausal women, although these disorders have been studied independently in this population. Harden [9] showed that perimenopausal hormone therapy and postmenopausal hormone therapy are both associated with seizure exacerbation, and it is well known that women are at greater risk for MDD during the menopausal transition [10][11][12].…”

Menopause, cessation of menses, vs. “menopause”, a primary brain disorder?

“…The evidence for acute estrogen/ progesterone effects on neuronal membranes is at best controversial, and these experimental findings may only involve secondary effects resulting from upstream sensing by the brain's hypothalamic-pituitary axis which then secondarily activates other brain circuitry. The best evidence indicates that receptors for these sex steroids are intracellular, especially nuclear, and after puberty restricted to the hypothalamus, preoptic area and amygdala [16].…”