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Associations of depression with the transition to menopause

Freeman, Ellen W. PhD

doi: 10.1097/gme.0b013e3181db9f8b
Special Section: Menopause, Cognition and Mental Health

Objectives: The aims of this study were to identify the risk of depression in the transition to menopause in women with and without a history of depression and to consider that the changing hormonal milieu is one of multiple risk factors for perimenopausal depression.

Method: A review of epidemiologic studies of depressed mood in the menopausal transition since the State-of-Science Report of the National Institutes of Health in 2005 was conducted.

Results: Recent longitudinal cohort studies indicate that the likelihood of depressed mood in the menopausal transition is approximately 30% to three times greater compared with that during premenopause. Women with a history of depression are nearly five times more likely to have a diagnosis of major depression in the menopausal transition, whereas women with no history of depression are two to four times more likely to report depressed mood compared with premenopausal women. In some studies, the changing hormonal milieu is significantlyassociated with depressive symptoms in the menopausal transition. Other risk factors for depressed mood in perimenopausal women include poor sleep, hot flashes, stressful or negative life events, employment status, age, and race.

Conclusions: The findings support the concept that the menopausal transition is a "window of vulnerability" for some women and is framed by the changing hormonal milieu of ovarian aging.

Recent population-based studies indicate that women are more probable to report depressed mood in the menopausal transition compared with the premenopause status. In some studies, the changing hormonal milieu is significantly associated with depressive symptoms in the transition period.

From the Departments of Obstetrics/Gynecology and Psychiatry, University of Pennsylvania, Philadelphia, PA.

Received January 25, 2010; revised and accepted March 1, 2010.

This article was presented at the annual meeting of The North American Menopause Society, San Diego, CA, September 2009.

Funding/support: Support was received through grants from the National Institutes of Health: RO1-AG-12745 (Dr. Freeman) and RR024134 (Clinical and Translational Research Center).

Financial disclosure/conflicts of interest: None reported.

Address correspondence to: Ellen W. Freeman, PhD, Department of Obstetrics/Gynecology, 3701 Market Street, Suite 820 (Mudd), Philadelphia, PA 19104. E-mail:

©2010The North American Menopause Society