Perimenopausal women have a 40% higher risk of experiencing depression than premenopausal women, a global analysis of research shows.
Experts from University College London (UCL) found that women may be vulnerable to depression in the run-up to the cessation of their periods, with new cases developing or existing symptoms worsening. The research highlights the need to provide support and screening to effectively address women’s mental health needs.
Perimenopause usually begins about three to five years before the onset of menopause, the researchers said. Women typically go through menopause between the ages of 49 and 52, which was previously found to be the point at which women experience the highest rates of depression.
Common psychological symptoms of perimenopause include low mood, anxiety, mood swings, low self-esteem, and problems with memory and concentration. Physical symptoms include hot flashes, sleep problems, heart palpitations, muscle pain, joint pain and weight gain.
The new research, published in the Journal of Affective Disorders, examined data from seven studies involving 9,141 women from around the world, including Australia, the US, China, the Netherlands and Switzerland.
It concluded that perimenopausal women were “at significantly higher risk of depressive symptoms and diagnoses” – around 40% higher – compared to premenopausal women.
Researchers found no significantly increased risk of depressive symptoms in postmenopausal women, compared to premenopausal women.
They suggested that a biological reason could be that the drop in estrogen levels in women during menopause causes the onset of new symptoms or the worsening of pre-existing depressive symptoms.
Estrogen “has been shown to affect the metabolism of neurotransmitters (dopamine, norepinephrine, endorphins and serotonin), all of which influence emotional state,” they said.
Night sweats can also lead to sleep problems, which may also have an impact, although this was not conclusive, she added.
Having a history of depression has also been linked to depression in menopausal women, while other studies show that caring for both aging parents and children can make women more vulnerable.
The authors said a limitation of their work was that the study could not take into account whether the women had a history of depression.
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Lead author Yasmeen Badawy said: “Combining data from global studies indicates that these findings cannot be attributed solely to cultural factors or lifestyle changes, which are sometimes used to explain the depressive symptoms experienced by women during perimenopause.”
Senior author Dr. Roopal Desai said: “This study shows that women in the perimenopausal phase are significantly more likely to experience depression than before or after this phase.
“Our findings highlight the importance of recognizing that women are more vulnerable to experiencing depression at this stage of life. It also underlines the need to support and screen women to effectively address their mental health needs.”
In an earlier study, the same researchers found that therapy – such as mindfulness and cognitive behavioral therapy – could be an effective form of treatment for non-physical symptoms of menopause.
Corresponding author Prof. Aimee Spector said: “Women spend years of their lives with menopausal symptoms which can have a huge impact on their well-being and quality of life.
“Our findings show how significantly the mental health of perimenopausal women can suffer during this period. We need more awareness and support to ensure they receive appropriate help and care, medically, in the workplace and at home.”