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Menopause and Mood
(revised 9/2006)

(See also, if needed, menopause and bipolar disorder)

Menopause (primarily "perimenopause", the phase up to 10 years prior to the end of menses, which occurs on average at age 51 in the U.S.A.)  clearly is associated with mood symptoms in women who have never had mood problems before, as well as return and/or 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

Depression During the Transition to Menopause: A Guide for Patients and Families
An "expert consensus" paper by experts; good basics

Basics about estrogen for Psychiatry purposes
Psychiatrists don't generally prescribe hormones. If they did, here are the data they'd have to consider, in my opinion.  

Estrogen effects on stress tolerance
This is not exactly about menopause.  It just came out (Dec. 2003) and the implications seemed so enormous I can't resist posting it here prominently. 

You'll see the strategy of supplemental estrogen discussed in a review article on this topic, courtesy of the author:  Louann Brizendine, M.D., Director of the Women's Mood and Hormone Clinic at UCSF in San Francisco.  See her links in Resources, belowConsidering treating menopause-related mood symptoms leads directly into the complicated subject of hormone therapy risksThat 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. 

Summary

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:

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 entails.  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. In the meantime, here are some additional resources on this issue. 

Resources (updated 12/2004)

The Women's Mood and Hormone Clinic at UCSF, in San Francisco
    Director, Louann Brizendine, M.D.
    Dr. Brizendine's review article for psychiatrists on this topic (Current Psychiatry; October 2003; pdf here)

The Harvard Women's Mental Health program
    Here you will find more general information this topic, as well as an array of other resources in this area. 

Mood/Menopause Specialists
    Here is a list specialists by region, for both the United States and Canada. 

Jeanne Alexander, M.D. in the San Francisco area
    Here is her newsletter.  Note the free back issues in the lower left hand corner of the home page.