(See also, if needed, menopause and bipolar disorder)
Menopause affects mood, especially “perimenopause”, the phase roughly 5 years prior to the end of menses (age 51, on average, in the U.S.,, but that’s quite variable. And some people say “10 years”, so menopause becomes a factor to consider around age 41, and especially around age 45 or so.
Menopause is clearly is associated with mood symptoms in women who have never had mood problems before, but even more so with worsening of previous mood conditions. Psychiatry is slowly recognizing that treating these conditions requires understanding the mood effects of menopause alone. There are a few who already believe they know how to do this, as you’ll see below.
North American Menopause Society
Perhaps the best single information source; the Scientific News section is particularly well organized, and there are expert comments which help interpret the implications of new research.
Considering treating menopause-related mood symptoms leads directly into the complicated subject of hormone therapy risks. That remains (as of 9/2006 revision) a very complex topic. Things got more complicated, if anything, after the second big publication from the famous study on this issue, the Women’s Health Inititiative (WHI). The first one, you’ll remember, said “whoa, wait a minute, synthetic estrogen/progesterone combination seems to (very slightly) raise the risk of heart disease, not lower it as we had thought. So it’s not a good idea to use it simply to lower the risk of heart disease, or think that this is an added benefit you get when you use Premarin for hot flashes.”
The second publication from the WHI, April 2006, looked at women who were taking synthetic estrogen alone, because they had already had a hysterectomy before entering this study. In this group, women with low breast cancer risk before the study ended up with lower breast cancer rates if during the study they were taking the synthetic estrogen; whereas those with higher breast cancer risk, primarily from a family history of same, ended up with a higher breast cancer rate if using the hormone (versus those who did not take the synthetic estrogen).Stefanick
Note that both the big WHI study, of estrogen/progesterone combination, and the newer publication on estrogen alone, used synthetic estrogen, not the estradiol which is more commonly used now for hormone replacement. So how to interpret these results is still very unclear and widely debated. A fact sheet from the National Institute of Health presents much of the basic information you’ll need to understand this issue.
Menopausal mood shifts are joked about, but are also serious. In my view, and the view of numerous women with whom I’ve spoken who are having such symptoms, menopausal symptoms can play a role in other common problems with serious consequences, including:
- increased relationship conflicts with adolescent children;
- increased conflict with husbands, leading in some cases to divorce; and
- decreased ability to feel competent in work settings, leading in some cases to lower pay and less job security;
Thus further understanding of treatment options is a very important public health issue. At this point however, things are bogged down in the debate over how much risk hormone replacement therapy actually involves. I wish we would see a good randomized trial of exercise as a treatment, because I’ve seen a couple of cases where that really seemed to make a big difference. Unfortunately, there is no big-bucks pharmaceutical company in a position to market exercise if they fund such a study. However, just for the record, here’s my discussion of exercise and how to make it a little easier, a little more likely.
[Update 5/2015: an important study was just published by the National Institute of Mental Health team that has done core research on hormones and mood for several decades.
In this new paper, they report that women with a history of perimenopausal depression worsened when their estrogen patch was discontinued. Not that surprising, perhaps, but this does that sure enough, the estrogen treatment was helping mood. That’s not been quite nailed down before this.
It helps that they had two control groups: women with a history of perimenopausal depression whose patch was not switched to a placebo (they continued their prior dose of estrogen); and women who did not have a history of perimenopausal depression who were switched to placebo. In neither of these two groups did mood worsen.
Note that this was just a worsening of mood, not full depression, developing in the susceptible women after estrogen was stopped. Their depression scores went up, but not way up, not into the depressed range. ]