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Menopausal transition, mood, and cognition: an integrated view to close the gaps

Soares, Claudio N. MD, PhD, FRCPC1; Maki, Pauline M. PhD2

doi: 10.1097/gme.0b013e3181de0943
Special Section: Menopause, Cognition and Mental Health

Epidemiological and clinic data support the notion that some women may be at higher risk for developing mood and anxiety symptoms and cognitive complaints during certain periods in life that are marked by intense hormone variations and psychosocial stressors. The complexity of the so-called windows of vulnerability poses a particular challenge to professionals involved in the care of female patients. Menopausal transition is perhaps a paramount example; the process itself is marked by progressive, dynamic changes in hormone levels and reproductive function that interact with the aging process, changes in metabolism, sexuality, lifestyle behaviors, and overall health.

The putative compounded burden of health challenges associated with this transition has become a main focus of attention of physicians and researchers who aim to identify preventive and/or early intervention strategies to promote healthy aging in midlife women. Recent studies have provided further evidence that the menopausal transition may be not only a window of vulnerability for depression and cognitive impairment but also a critical "window of opportunity" for the success of hormone-based treatments.

The need for further investigation and better understanding of common underlying mechanisms seems intuitive. An ultimate goal could include preventive strategies for women presenting with various risk factors for cardiovascular, cognitive, and mood disorders as well as treatments that could be tailored to multiple symptom domains during the menopausal transition.

Menopausal transition may not only be a "window of vulnerability" for depression and cognitive impairment but also a critical "window of opportunity" for the success of hormone-based treatments. This personal perspective challenges clinicians and researchers to pursue a more comprehensive approach and to tailor treatment strategies while managing symptomatic midlife women.

From the 1Department of Psychiatry and Behavioural Neurosciences; Department of Obstetrics and Gynecology; Mood Disorders Division; Women's Health Concerns Clinic, McMaster University, Hamilton, Ontario, Canada; and 2Psychiatry and Psychology, Center for Cognitive Medicine, University of Illinois, Chicago, IL.

Received February 8, 2010; revised and accepted February 11, 2010.

Financial disclosure/conflicts of interest: Claudio N. Soares, MD, PhD, FRCPC-Grant/research support: Eli Lilly, AstraZeneca, Physicians Services, Inc. Foundation, Allergen National Centre of Excellence, Hamilton Community Foundation, Wyeth Pharmaceuticals, Canadian Institute of Health Research, National Alliance for Research on Schizophrenia and Depression Foundation. Research consultant: Wyeth, Eli Lilly, Bayer Healthcare Pharmaceuticals, Pfizer. Speakers' bureau: AstraZeneca, Wyeth, Eli Lilly, Pfizer, Lundbeck. Advisory boards: AstraZeneca, Wyeth, Eli Lilly, Bayer Healthcare Pharmaceuticals.

Address correspondence to: Claudio N. Soares, MD, PhD, FRCPC, Women's Health Concerns Clinic, St Joseph's Healthcare Hamilton, 301 James St South, FB 638, Hamilton, Ontario, Canada L8P 3B6. E-mail:

©2010The North American Menopause Society