Depression Linked to Early Perimenopause
Perimenopause is a period of time that marks the transition into ]]>menopause]]> . Perimenopause begins immediately before menopause, and is characterized by hormonal fluctuations that often result in changes in frequency, flow, and duration of menstrual periods. Its onset usually occurs at age 47 to 48 and ends with the start of menopause one year after the final menstrual period.
Studies have shown that women who enter into early menopause (before age 47), are more likely to have a history of ]]>depression]]> , for which they have been medically treated, compared to women who enter into normal menopause (around age 50). But few studies have looked at the link between depression and peri menopause.
In a study published in the Archives of General Psychiatry , researchers from the Harvard Study of Moods and Cycles found that women with a history of major depression were two to three times more likely to enter into early perimenopause than women with no history of depression.
About the Study
The researchers enrolled 976 women between the ages of 36 and 44. 322 of the women met the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) criteria for major depression; the other 644 women had no current or previous history of major depression. All of the women were premenopausal.
Among the women with major depression, depression severity was measured using the Hamilton Rating Scale for Depression. Pronounced depression was defined as Hamilton scores >8.
Women were excluded from the study if they had a history of menstrual cycle irregularities, or if they were taking hormones, or were pregnant or breastfeeding.
All participants provided a blood sample from day 2, 3, or 4 of their menstrual cycle at enrollment and then every six months during a 36-month follow up. The blood samples were used to measure the reproductive hormones luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol.
The researchers determined the onset of perimenopause by conducting follow-up interviews during which they asked study participants about significant changes in menstrual cycle length, changes in menstrual flow or duration, and cessation of menstruation lasting at least three months.
In this study population, women with a history of major depression had 1.2 times the rate of perimenopause than women with no history of depression.
Compared with women who had no history of depression, depressed women with pronounced depression symptoms at the beginning of the study were twice as likely to enter into early perimenopause. And, among women with pronounced depression symptoms, those who also reported use of antidepressants were three times more likely to enter into early perimenopause than women with no history of depression.
How Does This Affect You?
The study authors speculate that depression may lead to early perimenopause by altering the body’s response to stress, which, in turn, may impact the body’s regulation of reproductive hormones.
But regardless of the mechanism, this study found that a history of depression puts women at a greater risk for early perimenopause. If early perimenopause transitions into early menopause, this could mean that women with a history of depression might be at greater risk for bone density loss, sexual dysfunction, and increased risk of cardiovascular disease—all of which have been linked to the decline in estrogen levels that accompany menopause.
Also, since prolonged perimenopause may exacerbate depression, some women may find themselves with worse depressive symptoms. The next step would be to determine whether or not effective treatment for depression could favorably influence the timing of perimenopause and menopause.
National Institute of Mental Health
National Institutes of Health
North American Menopause Society
Harlow BL, Wise LA, et al. Depression and its influence on reproductive endocrine and menstrual cycle markers associated with perimenopause. Arch. Gen. Psychiatry . 2003;60:29-36.
Last reviewed Jan 17, 2003 by ]]>Richard Glickman-Simon, MD]]>
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