Menopause and depression

The relationship between menopause and depression is complex and multifactorial. Menopause is a stage in a woman's life that marks the cessation of menstruation, generally around age 50. During menopause, hormone levels, particularly estrogen, decline significantly. This hormonal transition can influence the mental and emotional health of some women, although not all experience negative effects on their mental well-being. Dr. Elisa Llurba provides insights into the relationship between menopause and depression.

Some studies suggest that between 20% and 40% women may experience significant depressive symptoms during perimenopause (the period surrounding menopause) and in the first few years after menopause, although the number of women experiencing depressive syndrome is around 3%. 

Menopause itself is a risk factor for depression (1). This may be due to several factors:

1. Hormonal changes. The decline in estrogen levels during menopause can affect the balance of neurotransmitters in the brain, such as serotonin, which plays a crucial role in regulating mood. These hormonal changes can contribute to the onset of depressive symptoms.
2. Physical symptoms. Women going through menopause often experience physical symptoms such as hot flashes, night sweats, sleep problems, and fatigue. These physical symptoms can negatively impact quality of life and contribute to feelings of emotional distress.
3. Psychosocial factors. Menopause can coincide with other life events, such as children leaving home, career changes, or retirement. These changes can cause stress and emotional challenges, which, along with hormonal changes, may increase the risk of depression.
4. Personal background. Women with a personal history of depression are 12 times more likely to experience depression during menopause. Genetic and environmental factors can interact with hormonal changes to influence mental health.
5. History of premenstrual syndrome or postpartum depression. Women with this background show greater emotional sensitivity to the decrease in estrogen and are therefore more susceptible to experiencing depression during menopause.
6. Change in self-image and identity. Menopause is sometimes associated with changes in the perception of femininity and self-image. This can affect self-esteem and contribute to emotional problems, including depression.

It's important to note that not all women experience depression during menopause, and many go through this transition without significant mental health problems. However, for those who do experience depressive symptoms, it's important to seek medical and psychological support. 

Hormone therapy is the treatment of choice for depression during menopause, either alone or in combination with antidepressants.. In addition, it is important to consider other therapeutic approaches that can help relieve symptoms and improve quality of life during menopause, such as diet and exercise.

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Literature

1. Alblooshi S, Taylor M, Gill N. Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. Australas Psychiatry. 2023 Apr;31(2):165-173. doi: 10.1177/10398562231165439. Epub 2023 Mar 24. PMID: 36961547; PMCID: PMC10088347.
2. Venborg E, Osler M, Jørgensen TSH. The association between postpartum depression and perimenopausal depression: A nationwide register-based cohort study. Maturitas. 2023 Mar;169:10-15. doi: 10.1016/j.maturitas.2022.12.001. Epub 2022 Dec 23. PMID: 36621208.
3. https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms
4. SOGC CLINICAL PRACTICE GUIDELINE| VOLUME 43, ISSUE 11, P1316-1323.E1, NOVEMBER 2021. https://doi.org/10.1016/j.jogc.2021.08.009