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Hormone therapy and mood in perimenopausal and postmenopausal women

a narrative review

Toffol, Elena MD, PhD1; Heikinheimo, Oskari MD, PhD2; Partonen, Timo MD, PhD1

doi: 10.1097/GME.0000000000000323
Review Article
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Objective Between 15% and 50% of women experience depressive symptoms during the menopausal transition; in 15% to 30% of perimenopausal women, they are severe enough to be regarded as a depressive disorder. Fluctuations in gonadal hormone levels are thought to contribute to these depressive conditions. Hormone therapy is commonly used to alleviate climacteric symptoms, but its effects on mood are less clear. We narratively reviewed the literature on the effects of different types of hormone therapy on mood.

Methods Using PubMed/Medline, we searched for studies of hormone therapy in relation to depressive symptoms and disorders in perimenopause and postmenopause.

Results A number of studies consistently reported estrogen therapy to be effective in improving mood in perimenopausal women. However, its efficacy for overt depression or during postmenopause was more questionable. The progestogenic component in combined hormone therapy was found to potentially counteract the beneficial influence of estrogens on mood and to even induce negative mood symptoms. In specifically focused studies, a combination of hormone therapy and antidepressants was effective in depressed perimenopausal and postmenopausal women.

Conclusions Hormone therapy may contribute to alleviating menopause-related depressive symptoms. Its administration should be followed across time and should be specifically individualized. In cases of more severe depressive conditions, a combination of antidepressant and hormone therapy should be considered.

From the 1Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland; and 2Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.

Received April 7, 2014; revised and accepted July 8, 2014.

The Finnish Cultural Foundation had no role in study design, data handling, or manuscript preparation.

Funding/support: E.T. received financial support from the Finnish Cultural Foundation.

Financial disclosure/conflicts of interest: O.H. has received lecture fees from and has undertaken consultancies for Bayer, Gedeon Richer, and MSD/Merck, and has received author royalties from Kustannus Oy Duodecim. T.P. has received lecture fees from Servier Finland and author royalties from Kustannus Oy Duodecim and Oxford University Press.

Address correspondence to: Elena Toffol, MD, PhD, Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, PL30, Helsinki 00271, Finland. E-mail: elena.toffol@thl.fi

© 2015 by The North American Menopause Society.