Patients and clinicians may not be fully aware that women are at increased risk for depression during the menopausal transition. The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen all adults for depression, highlighting the importance of screening in populations at particularly high risk for depression. While these recommendations have prompted increased awareness of psychiatric illness in pregnant and postpartum women; this level of vigilance does not exist for perimenopausal women who are also vulnerable to depressive illness.
In a recent study from, researchers assessed for depression and anxiety in 485 postmenopausal women (between 35 and 78 years of age, mean age 56.33 ± 7.34 years) presenting to an Obstetrics and Gynecology Polyclinic in Sakarya, Turkey (Ozdemir et al, 2020). In this group of women seeking treatment, 199 (41%) were found to have depressive symptoms.
Depressive symptoms were more common in women reporting:
- Being a widow or separated from one’s partner (odds ratio [OR]: 3.48),
- Alcohol consumption (OR: 11.8),
- History of illness requiring continuous medication (OR: 3.58),
- Physical disability (OR: 2.24),
- History of psychiatric illness (OR: 4.21),
- Having 4 or more living children (OR: 4.17)
This study parallels previous studies, in that physical disability and comorbid medical illness are predictors of menopausal depression. While the prevalence of depression in menopausal women seems very high in this study, other studies have also shown very high rates of depression in this population. iN a recent meta-analysis (Zeng et al, 2019), the pooled prevalence of depression in menopausal Chinese women was 36.3% (95% CI: 27.5-45.1%).
In the United States, the Study of Women’s Health Across the Nation (SWAN) followed a cohort of 443 perimenopausal women (ages 42 – 52 years) as they transitioned into the menopause (Bromberger et al, 2015). During the 13 years of prospective follow-up, 39% of the women experienced an episode of major depression. Women without a lifetime history of MDD at baseline had a lower risk of developing MDD during the menopausal transition than those with a prior MDD history (28% v. 59%).
Primary care providers and OB-GYNs play a pivotal role in the detection of and management of perimenopausal depression. However, we need to provide better information regarding perimenopausal depression and tools for depression screening, so that this population of vulnerable women do not slip through the cracks. Many perimenopausal women experience disabling symptoms for long periods of time; yet the misconceptions regarding menopause prevent women from getting the help they need. (You can hear more about one woman’s experience with getting treatment for perimenopausal depression on a recent broadcast from NPR.)
Ruta Nonacs, MD PhD
Bromberger JT, Schott L, Kravitz HM, Joffe H. Risk factors for major depression during midlife among a community sample of women with and without prior major depression: are they the same or different? Psychol Med. 2015 Jun;45(8):1653-64.
Ozdemir K, et al. Depression, anxiety, and fear of death in postmenopausal women. Menopause 2020.
Zeng LN, Yang Y, Feng Y, Cui X, Wang R, Hall BJ, Ungvari GS, Chen L, Xiang Y. The prevalence of depression in menopausal women in China: A meta-analysis of observational studies. J Affect Disord. 2019 Sep 1;256:337-343. Review.