Perimenopausal women have a 40% higher risk of experiencing depression than premenopausal women, a global analysis of research suggests.
Experts from University College London (UCL) found women could be vulnerable to depression in the run-up to their periods stopping, with the development of new cases or existing symptoms worsening. The research underlines the need to provide support and screening to effectively address women’s mental health needs.
The perimenopause usually begins about three to five years before the onset of menopause, the researchers said. Women typically go through the menopause aged 49 to 52, which has previously been found to be the point at which women experience the highest rates of depression.
Common mental health symptoms of perimenopause include low mood, anxiety, mood swings, low self-esteem and issues with memory and concentration. Physical symptoms include hot flushes, sleep problems, heart palpitations, muscle aches, joint pains and weight gain.
The new research, published in the Journal of Affective Disorders, examined data from seven studies involving 9,141 women from across the world, including Australia, the US, China, the Netherlands and Switzerland.
It concluded that perimenopausal women were “at a significantly higher risk for depressive symptoms and diagnoses” – about 40% higher – compared with premenopausal women.
Researchers did not find a significantly increased risk for depressive symptoms in postmenopausal women, when compared with those who were premenopausal.
They suggested that one biological reason may be that the drop in oestrogen women experience during menopause triggers the onset of new symptoms or the worsening of pre-existing depressive symptoms.
Oestrogen “has been found to affect the metabolism of neurotransmitters (dopamine, norepinephrine, endorphin, and serotonin), all of which influence emotional states,” they said.
Night sweats can also lead to sleep problems, which may also have an influence, though this was not conclusive, they added.
Having a previous history of depression has also been associated with depression in women with menopause, while other studies have said caring for both ageing parents and children may make women more vulnerable.
The authors said one limitation of their work was that the study was unable to account for whether the women had a previous history of depression.
Lead author Yasmeen Badawy said: “Combining data from global studies indicates that these findings cannot be attributed to cultural factors or lifestyle changes alone which have been sometimes used to explain the depressive symptoms that women experience during perimenopause.”
Senior author Dr Roopal Desai said: “This study shows that women in the perimenopausal stage are significantly more likely to experience depression than either before or after this stage.
“Our findings emphasise the importance of acknowledging that women in this life-stage are more vulnerable to experiencing depression. It also underlines the need to provide support and screening for women to help address their mental health needs effectively.”
In a previous study, the same researchers found that therapy – such as mindfulness and cognitive behavioural therapy – could be an effective form of treatment for non-physical symptoms of the menopause.
Corresponding author Prof Aimee Spector said: “Women spend years of their lives dealing with menopausal symptoms that can have a huge impact on their wellbeing and quality of life.
“Our findings show just how significantly the mental health of perimenopausal women can suffer during this time. We need greater awareness and support to ensure they receive appropriate help and care both medically, in the workplace and at home.”
