When the arrival of menopause brings symptoms of depression

A new study suggests that hormone therapy might help with perimenopausal depression. But is it safe for you?

perimenopausal depression
Hormone therapy has long been a controversial topic, and a new study about the role of hormones in depression is adding some fodder to the debate. A study published in the January 10 issue of JAMA Psychiatry determined that hormone therapy may help ward off symptoms of depression in women. Researchers found that perimenopausal and early postmenopausal women who were treated with hormones were less likely to experience symptoms of depression than women in the study who were given a placebo.

But while the findings of the study are important — particularly considering that a woman's risk of depression doubles or even quadruples during the menopausal transition — that doesn't mean hormone therapy should be widely used for preventing depression in women at this stage of life, says Dr. Hadine Joffe, the Paula A. Johnson Associate Professor of Psychiatry in Women's Health at Harvard Medical School, who wrote an editorial accompanying the study. "It's not a 'never,' but it shouldn't be a standard approach; in general, all of medicine has moved away from using hormones for prevention," she says.

About the study

The study ran from October 2010 to February 2016 and included 172 perimenopausal and early postmenopausal women ranging in age from 45 to 65 who were experiencing low-level symptoms of depression. Roughly half used a skin patch containing the hormone estradiol for 12 months as well as intermittent oral progesterone pills. The rest received a fake skin patch and placebo pills.

The women were evaluated at the beginning of and throughout trial for symptoms of depression using the Center for Epidemiologic Studies Depression Scale. Researchers found that only 17% of women in the hormone group developed clinically significant depression, compared with 32% of those in the placebo group.

Untreated depression can cause physical symptoms, such as headaches and fatigue, in addition to emotional symptoms, including persistent sadness and even suicidal thoughts. It can interfere with daily function and reduce quality of life. However, hormone use brings its own health risks, such as a greater chance of blood clots and stroke. "It would be irresponsible to recommend this as a blanket prevention treatment for women," says Dr. Joffe, who is also executive director of the Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital.

But that's not to say the findings should be ignored. Rather, the key message for women is that depression during perimenopause and early postmenopause should be taken seriously, and women at this stage of life should be more closely monitored for depressive symptoms, she says. In addition, study authors identified at least one risk factor for depression that stood out among women in this group — recent life stress. "A lot of people have stress, so I think it's an important message that stress contributes to depression," says Dr. Joffe.

Lessons learned

Depression symptoms are not a sign of someone's failure to cope. "This really is a brain phenomenon," says Dr. Joffe. With this in mind, women should formulate some action points based on the findings.

Be aware of depression risk. Knowing that depression is more common during perimenopause and early postmenopause can help you identify worrisome symptoms and take action sooner if they do occur. If you are perimenopausal or in early postmenopause, your doctor should ideally be screening you for mood symptoms at your regular visits. If this is not the case, bring up the topic yourself.

Weigh hormone therapy's pros and cons. Hormone therapy may be the right choice for some women. Talk to your doctor about the potential benefits and risks of therapy. Consider how long the therapy would be used and whether there are other medical reasons to consider using hormones. Also weigh the benefits of behavioral strategies or antidepressant drugs. Keep in mind that more research is needed to fully understand the potential benefits and drawbacks of using this therapy to prevent depression, says Dr. Joffe.

Consider lifestyle changes and treatment. Regardless of whether you opt for hormone therapy or not, non-drug strategies can also be used to reduce the likelihood of depressive symptoms, including lifestyle interventions, such as managing stress and boosting physical activity.

If symptoms do develop, ask your doctor for a referral to a mental health specialist.

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