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Published on: January 11, 2016
by Tara Haelle for EveryDay Health:
Menopause brings with it a mix of welcome — and not-so-welcome — changes, but one of its perks is a reduced risk of depression. And for some women, the likelihood of depression after menopause is even lower, depending on when they experienced menopause.
The older a woman was at menopause, the less likely she was to develop depression later on, finds a study published January 6 in the journal JAMA Psychiatry. The findings suggest that longer exposure to naturally occurring estrogen plays some role in reducing her risk of depression after menopause.
“Although I wouldn’t change my practice at this time based on this study, the data will likely lead to more rigorous research that would help us better understand the protective effects of estrogen and other reproductive hormones on women’s moods,” says Nicole Harrington Cirino, MD, a reproductive psychiatrist and director of the Division of Women’s Mental Health and Wellness at Oregon Health & Science University in Portland.
The study focused on depression in postmenopause, not during menopause itself — a time that’s already linked to a higher risk of depression, notes Dr. Cirino, who was not involved in the study. (A woman is postmenopausal in the years following menopause, which is diagnosed when she has not had a period for 12 consecutive months.)
“We consider the period of hormonal fluctuation to be the time of greater risk,” Cirino says. “Postmenopausal women no longer have hormonal fluctuation, so their depression rates are the same as men’s, or lower.” They’re also lower than the rates in women still in their reproductive years, she adds.
The new study does not show a cause-and-effect relationship between later menopause and depression rates; it only establishes that a later age of menopause is somehow linked to slightly lower odds of depression. A variety of other aspects of a woman’s social life or psychological health could also influence her risk for depression, particularly among women who have a much earlier menopause, Cirino explains.
“Without looking at these factors in more detail, we cannot say what impact depleted estrogen alone plays on risk factors for late-life depression,” Cirino says. “Psychiatric illnesses are complex, as are the effects of reproductive hormones on women’s moods. We need more research to definitively say estrogen — and a later menopause — is protective against late-life depression.”
More Than a Dozen Studies Offer Clues to Depression Risk
The new study actually pooled findings from previously published research. A multinational team led by author Marios K. Georgakis, MD, of the National and Kapodistrian University in Athens, Greece, reviewed more than 13,000 studies identified in a medical database based on a search of keywords related to menopause and depression.
They narrowed these studies down to 14 papers, involving more than 67,000 women, that specifically looked at depression after menopause and women’s ages at menopause or the length of their reproductive years, starting when they had their first period. Women were found to be 2 percent less likely to have later depression for every two years older they were at menopause, even in the few studies that took into account past depression. Further, severe depression was 5 percent less likely for every two years older women were at menopause.
This modest decrease in risk became much bigger when researchers compared women who had later-life menopause to those who experienced early menopause. In four studies, the risk of later depression in women experiencing menopause at age 40 or later was halved compared to risks for women who had premature menopause.
“The most helpful finding in this study is that healthcare providers can identify those women who are at high risk for developing depression prior to menopause,” says Sherry Ross, MD, an ob/gyn and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California. “Early interventions, such as non-medical and medical treatments, can be initiated so that when menopause occurs, these at-risk women can avoid catastrophic depression and mental chaos,” says Dr. Ross, who was not involved in the study.
Planning Ahead for Depression During Menopause
Although this study focuses on the period after menopause, it doesn’t change the fact that women going through the transition may still have a higher risk of depression until they are through it.
“We always hear about hot flashes, irregular periods, and insomnia classically linked to menopause, but other mental changes are equally annoying though less talked about,” Ross says. These include memory loss, poor concentration, and a short attention span. “Menopause can worsen a woman’s depression or bring out a depression a woman didn’t know she had,” Ross adds. “All of these symptoms need to be discussed with your healthcare provider.”
Recognizing that the risk of depression is higher during menopause can help women seek help sooner, Cirino suggests.
“Women should not expect that depression, chronic insomnia, low energy, or feeling unwell are a normal part of the menopause transition,” Cirino says. “Hot flashes, for instance, are associated with higher rates of depression during perimenopause and are treatable. In fact, depression is fairly easy to diagnose, and primary care doctors can often diagnosis it with a simple in-office screen.”
This study did not address whether hormone therapy during or after menopause could help depression. It’s possible, however, that hormone therapy or antidepressants could treat depression symptoms, says Ross. Changes in lifestyle could also help, she adds.
“Treatment could include aggressive management, such as antidepressants and anti-anxiety medications, or lifestyle modifications, including diet, regular exercise, limiting alcohol consumption, and other behavioral changes,” she adds.
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