Menopause

Menopause marks the end of reproductive life in women. Aside from the physiological changes it induces, some evidence suggests that menopause may be linked with psychological changes as well. For some women, this time of life may be transformative in a positive direction. For others, studies suggest, it may be linked with depression.

Whether menopause itself causes depression or whether women who may have a predisposition to depression may be at increased risk during this period is not known. Some researchers believe that changing levels of estrogen may affect mood; others believe that the physical symptoms of menopause, such as hot flashes or insomnia, may lead to depression. Also, psychosocial factors of life change, such as changes in family roles, interpersonal losses, aging, and loss of childbearing capacity may cause changes in mood.

Predictors of depression in menopausal women include having had a prior depressive episode, a diagnosis of premenstrual syndrome, the presence of vasomotor symptoms, longer duration of the perimenopause, not having children, marital disruption, cigarette smoking, and lower income.

Hormone replacement therapy (HRT) and antidepressants are effective in treating depression in menopause. HRT (generally short-term at the lowest effective doses) may be used for mild to moderate depression in the perimenopause and when depressive symptoms are secondary to hot flashes. Antidepressants may help women suffering from moderate-severe depression or who cannot take HRT. In some cases, a combination of the two approaches is most effective.