Psychiatric considerations in menopause

Why menopause?

Menopause is a significant life event. The menopause transition begins around age 47 and lasts 4 to 7 years. By age 55, most women are postmenopausal. Symptoms of menopause are described in Table 2.³ Menopause is colloquially known as the “change of life”—not only because of the physical changes, but because of the meaning a woman may attribute to these changes. She may associate menopause with loss of femininity or attractiveness. Also, menopause may coincide with social and developmental changes, such as having an “empty nest”—her children having left home. How menopause is construed by a woman (and the culture/society in which she lives) impacts her experience of menopause.⁴

Perimenopausal mood disorders

The SWAN Study (Study of Women’s Health Across the Nation) found that women’s risk of experiencing depressive symptoms was greater both during and after the menopause transition.⁵ A history of depression was the strongest predictor. Interestingly, the effect of menopausal status on the risk of depression was found to be independent of the woman’s personal history of depression, upsetting life events, vasomotor symptoms, and reproductive hormone changes. Two recent studies demonstrated that among women without a history of depression, depressive symptoms were more than twice as likely to emerge during the menopausal transition than premenopausally.^6,7 Depression occurred in the context of the changing hormonal milieu. A recent meta-analysis⁸ found an inverse association between age at menopause and the risk of postmenopausal depression. Table 3^1,2,4,8-12 describes risk factors for developing depressive symptoms in menopause.