Besides hot flashes and extra-heavy periods, what else might the menopausal transition have in store for you? Possibly major depression, according to findings from the Study of Women’s Health Across the Nation (SWAN), a multi-ethnic study of women’s health at midlife. Perimenopause begins several years before menopause (the end of menstruation) and ends a year after the last menstrual period. During this transition, ovarian hormones are in flux, resulting in irregular periods and sometimes vasomotor symptoms (hot flashes and night sweats). Many women also report depressive symptoms, but it’s unclear whether women are at increased risk for major depression at this time — and if so, whether hormones play a role. The SWAN findings suggest that perimenopause and early postmenopause are a high-risk time for major depression — and the risk is independent of hormone levels and hot flashes. Results were published online in Psychological Medicine (Feb. 9, 2011).
The study. Researchers at the University of Pittsburgh tracked the development of major depression through menopause in 221 women (144 white and 77 black) who were premenopausal when the study began. At the start of the study and annually for the next 10 years, the women provided extensive health data and blood samples (for measuring levels of estrogen, follicle-stimulating hormone, and testosterone). They were interviewed about past depression and evaluated regularly for major depressive symptoms. The researchers also collected information on vasomotor symptoms, negative life events, and menopausal status.
The results. During the 10-year study, 30% of white women and 34% of black women had at least one episode of major depression. These episodes were more likely to occur during perimenopause and early postmenopause (the first two years after menopause) than during premenopause. This finding held even after taking into account many other possible risk factors, including history of major depression, current upsetting life events, use of psychiatric drugs, high body mass index, frequent vasomotor symptoms, and reproductive hormone levels.
A history of major depression, psychiatric drug use, high body mass index, and upsetting life events were all independent risk factors for major depression, but none of them could explain why it peaked during perimenopause and early postmenopause. Depression did not correlate with hot flashes or changes in reproductive hormones, which are specifically associated with perimenopause.
Limitations and implications. The researchers evaluated vasomotor symptoms only once a year; with closer tracking, a stronger relationship with depression might have emerged. This study was relatively small, but according to the authors, the findings are consistent with results from a 2007 study in the entire SWAN cohort (3,296 women), which showed that a woman’s odds of developing depressive symptoms rise as she moves through the menopausal transition. According to lead author Dr. Joyce Bromberger, the lack of correlation between depression and estrogen levels during perimenopause “doesn’t mean that estrogen has no role. One of the current hypotheses is that it’s the variability in estrogen production that is linked to depression….Some women may be particularly vulnerable to the changing hormonal milieu and the unpredictability of menstrual cycles that mark the transition.”