A Longitudinal Evaluation of the Relationship Between Reproductive Status and Mood in Perimenopausal Women

Behavioral Endocrinology Branch, NIMH, NIH, Department of Health and Human Services, Rm. 3N238, Bldg. 10, 10 Center Dr., MSC 1276, Bethesda, MD 20892-1276, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 01/2005; 161(12):2238-44. DOI: 10.1176/appi.ajp.161.12.2238
Source: PubMed


Mood and reproductive function were prospectively evaluated in asymptomatic premenopausal women to determine whether the onset of depression was temporally linked to the perimenopause.
Twenty-nine asymptomatic, regularly cycling women were monitored longitudinally for an average of 5 years until at least 6 months of amenorrhea occurred. Outcome measures included mood ratings and menstrual diaries completed daily, the Structured Clinical Interview for DSM-IV, and plasma levels of follicle-stimulating hormone obtained at 3-6-month intervals. The number of episodes of depression and their timing relative to the final menstrual period were determined. Differences in outcome measures between women who did and did not become depressed during the perimenopause were determined by Student's t test, chi-square tests, and Fisher's exact test.
The authors observed 11 episodes of new-onset depression in nine of the 29 women. In the 24 months surrounding the last menstrual period nine episodes of depression were observed. Six of the nine women who became depressed during the study had no prior depressive episodes. For the 24 months surrounding the final menses, the risk for onset of depression was 14 times as high as for a 31-year premenopausal period of time. Women who developed depression during the perimenopause were not distinguished from those who remained asymptomatic on the basis of symptom profile, duration of the perimenopause, endocrine measures, or past historical variables.
These preliminary data suggest that events related to the late perimenopause may be associated with an increased susceptibility to develop depression in some women.

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    • "Nonetheless, results in unipolar depression during the MT overall do not relay an association of depressive symptoms with absolute FSH or estradiol levels (Schmidt et al. 2004; Bromberger et al. 2010) with the exception of increased FSH being positively associated with depressive symptoms in one study (Freeman et al. 2006). Reports on estradiol and FSH variability and risk of depression during the MT have been both positive (Freeman et al. 2004a; Freeman et al. 2006; Freeman et al. 2014) and negative (Schmidt et al. 2004; Bromberger et al. 2010; Freeman et al. 2014) and have employed differing ways of assessing variability. More thorough hormonal assessments should include testosterone which has been found associated with unipolar depression during the MT (Bromberger et al. 2010), inhibin B, an early indicator of ovarian aging, and potentially sex hormone-binding globulin as well as dehydroepiandrosterone which have both been assessed in association with unipolar depression during the menopausal transition (Bromberger et al. 2010). "
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    ABSTRACT: Little is known about the mood symptom experience of women with bipolar disorder during the menopausal transition (MT). Yet times of rapid hormonal decline, such as the postpartum, are associated with increased risk of severe mood episodes in bipolar disorder, and the MT is a time of increased risk for unipolar depression in women with or without a history of depression. Enrollment included 56 women 40-60 years old diagnosed in the bipolar spectrum who were experiencing menopausal symptoms or were up to 5 years since their final menstrual period. Menopausal stages included early menopause, late menopause, or early postmenopause based on standardized criteria. Observational, prospective standardized mood symptom and reproductive hormone assessments were completed periodically. Concurrent menopausal symptoms as well as history of mood exacerbation during past reproductive events were assessed. Forty-four women were included in the main analysis. The average Montgomery-Asberg Depression Rating Scale (MADRS) score was 4.43 points higher in the late transition/early postmenopausal stage women (n = 29) compared to the early menopausal stage women (n = 15) (±SE 2.14; p = 0.039), corresponding to a roughly 10 % higher score (range 0-40) in the late/post stage across all study visits. Results were similar for the Young Mania Rating Scale (YMRS), where the average score was 2.54 points higher in the late/early postmenopausal stage women compared to the early menopausal stage women (±SE 1.15; p = 0.027), also roughly 10 % higher (range 0-26). Estradiol and follicle-stimulating hormone (FSH) absolute levels as well as between-visit change in levels were not notably associated with YMRS or MADRS during study observation. Total Greene Climacteric Symptom (menopausal symptom) score was significantly associated with MADRS but not YMRS. History of mood exacerbation premenstrually and/or postpartum was not significantly associated with YMRS or MADRS severity during the MT. These results support the theory that times of increased reproductive hormonal changes, such as the late MT and early postmenopause, here compared to early MT, are associated with greater mood symptom severity in bipolar spectrum women. Nonetheless, absolute or change in FSH and estradiol levels were not significantly associated with depression or mood elevation severity.
    12/2015; 3(1):35. DOI:10.1186/s40345-015-0035-z
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    • "A number of risk factors have been identified, which might result in menopausal women experiencing more or less depression or depressive symptoms. These include VMS [19], hormonal vulnerability [20], socioeconomic status (SES), education and achievement (higher SES, education and income resulting in less depressive symptoms), smoking, exercise, body mass index (BMI), social support and partner status, coping, attitude, stressful life events and past history of mood disorder [21]. "
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    ABSTRACT: There is evidence that menopausal symptoms manifested at peri-menopause occur less frequently when compared to the symptoms experienced at post-menopause. The aim of this study was to investigate this and to test the hypothesis that depressive symptomatology mediates the relationship between menopausal stage and symptom frequency. This cross-sectional study included 213 women (M age=52 years), of whom 125 were peri- and 88 post-menopausal. Measures comprised the Center for Epidemiologic Studies-Depression scale (CES-D) and the Women's Health Questionnaire (WHQ) vasomotor symptoms and somatic symptoms subscales. Multiple mediated regression analyses provided evidence that somatic symptoms and vasomotor symptoms were less frequent at post- compared to peri-menopause, and that these differences were mediated by depressive symptomatology. Multivariate effect sizes ranged from small to moderate, and univariate effect sizes were uniformly small with wide confidence intervals. The frequency of vasomotor and somatic symptoms appears to increase with depressed affect. The management of symptoms could include interventions of a psychotherapeutic nature, which may offset this effect, particularly in women for whom depressive symptoms are a feature of the climacteric syndrome. The extent to which depression and the climacteric syndrome may be causally related to one another remains unclear and longitudinal research should further examine the mechanisms of this association. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
    Maturitas 03/2015; 289(2). DOI:10.1016/j.maturitas.2015.03.007 · 2.94 Impact Factor
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    • "It is stated that compared with the premenopausal period, there are persistent symptoms of mood in women in the perimenopausal period, a signifi@BULLET cant increase in depressive indications in the menopausal period through follow-up studies during this period, and that this risk minimizes signifi@BULLET cantly in the early postmenopausal period [4]. A five-year follow-up study states that there is a signifi@BULLET cant mood change in the perimenopausal period, and a 14 fold increase in risk of depression compared with the premenopausal period [5]. It is affirmed that psychological symptoms seen in the menopausal period may be related to changes in levels of estrogen, androgen or both, as well as to psychosocial and dynamic processes [6]. "
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    ABSTRACT: Abstract Among women in the perimenopausal period, rapid hormonal changes can be seen. In the present study, we aimed to investigate the relationship between depression, anxiety and changing estrogen hormone levels at menopause. Materials and Methods. The research group was composed of 30 perimenopausal women who had FSH levels higher than 20 IU and irregular menses. Anxiety and depression status was assessed with the Hospital Anxiety and Depression Scale. Patients with or without depression or serious anxiety were compared in terms of age, body mass index (BMI), hot flushes, smoking, premenstrual syndrome (PMS) and estrogen levels. Results. There were no statistically significant differences in terms of hot flushes, BMI, smoking, age, and PMS in patients with or without depression/anxiety. Estrogen levels were statistically significantly lower in the group with depression compared to the group without depression (p=0.026). Conclusion. We believe that falling levels of estrogen in the perimenopausal period can be considered to be a risk factor for depression. The possible role of estrogen replacement in the treatment of depression and anxiety should be investigated in further studies. Key Words: Perimenopause, depression, anxiety, FSH, estrogen.
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