New research suggests normal hormonal changes and fluctuations during the transition to menopause can lead to emotional sensitivity and depression.
Specifically, investigators from the Department of Psychiatry at the University of North Carolina at Chapel Hill found fluctuating levels of estradiol (a form of estrogen) may enhance emotional sensitivity to psychosocial stress.
When combined with a very stressful life event, this sensitivity is likely to contribute to the development of a depressed mood.
Study results appear online in Menopause, the journal of the North American Menopause Society (NAMS).
Studies have generally found that women are at greater risk to suffer from depression than men. In fact, some investigations suggest the risk is twice as great for women vs. men to suffer a major depressive disorder (MDD).
The increased risk is believed to be a result of depressive episodes that are tied to reproductive events. For example, conditions such as perinatal depression and premenstrual dysphoric disorder occur when hormones are in greater flux.
In addition, the menopausal transition and early postmenopausal period are times of particularly increased vulnerability to depression for women, with rates of MDD and clinical elevations in depressive symptoms doubling or even tripling compared to premenopausal and late postmenopausal rates.
A substantial proportion of women–between 26 percent and 33 percent — will develop clinically significant depressive symptoms within the context of perimenopausal hormonal flux.
The common physiological change occurring during the menopausal transition is extreme variability in estradiol concentrations.
The new 12-month placebo-controlled randomized trial was designed to evaluate the mood and cardiovascular benefits of transdermal estradiol in perimenopausal women. The findings from the placebo group found that, in general, estradiol variability led to the development of depressive symptoms, as well as greater anger/irritability and feelings of rejection.
More specifically, the findings suggest that perimenopausal estradiol fluctuation may increase women’s sensitivity to social rejection. The hypersensitivity, combined with psycho-social stressors such as divorce or bereavement, leave women vulnerable to developing clinically significant depressive symptoms.
Researchers note however, that the effect of estradiol variability on mood is not the same in all women and, if a severe life stress did not occur, estradiol variability did not lead to depression.
In the study very severe life stresses were defined and included divorce or separation, serious illness of a close relative or friend, significant current financial issues, physical or sexual abuse or assault, significant arrest of self or loved one.
Experts believe the study will help clinicians better manage the often complicated physical and mental issues that present during perimenopause.
“These results provide tremendous insight for practitioners. Clinicians need to understand the impact of perimenopausal hormonal fluctuations and the degree of stressful events that a woman is experiencing to determine the best treatment options when a middle-aged woman complains of depression or exaggerated irritability,” says NAMS Executive Director JoAnn Pinkerton, M.D., NCMP.
“This study provides a foundation for future studies to evaluate the value of psycho-social interventions, such as cognitive therapies, to lessen the effect of major life events, as well as the use of estrogen therapy during perimenopausal and menopausal stressful times.”