PubMed · 3399159
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J A Brockie. 1988. The menopause.. https://pubmed.ncbi.nlm.nih.gov/3399159/
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OBJECTIVE: Prevalence of depression is suggested to be substantially higher in women around menopause. Declining estrogen levels might be an explanation. This study attempts to determine whether depressive symptomatology in healthy women is independently related to menopausal transition. METHOD: All caucasian women born between 1941 and 1947, living in the city of Eindhoven the Netherlands were invited to take part in a screening program (n=8098) of whom 78% participated (n=6648). About 92% returned the questionnaires of which 81% (n=4975) was fully completed. Women using estrogens and/or having undergone hysterectomy and/or ovariectomy were excluded (43.6%). Of the remaining 2820 women, after 3.5 years, 2748 returned another postal questionnaire, of which 76% was fully completed (n=2103). Depressive symptomatology was assessed using the Edinburgh Depression Scale (EDS). Independent relationship between an intra-individual change in EDS score during the follow-up period and menopausal transition was analysed by multiple logistic regression (enter as well as stepwise method). RESULTS: Beside the classical determinants of depression (unemployment OR 3.1, CI 1.6-5.8, inability to work OR 1.7, CI 1.0-2.8, financial problems OR 2.9, CI 1.1-7.3 death of a partner OR 2.6, CI 1.1-6.1, death of a child OR 5.9, CI 1.1-32.1 and a previous episode of depression OR 2.0, CI 1.5-2.7) transition from pre to perimenopause and peri to postmenopause was significantly related to a high increase (>5.4) of the EDS score (OR 1.8, CI 1.1-3.3 and OR 1.8, CI 1.5-2.7, respectively). CONCLUSION: The transition from pre to perimenopause as well as from peri to postmenopause seems to be independently related to a high increase of depressive symptomatology. This suggests that the decrease of ovarian estrogen production is a risk factor for depressive symptomatology.
Perimenopause is characterized by decreasing levels of estrogens and progesterone until gonadal secretion comes to a complete halt. There are still very different views and positions on the significance of the menopause. Physical, mental-vegetative and depressive symptoms during climacteric are different in each culture. Currently, there is some controversy as to whether or not there really is a rise in actual depression during the perimenopausal phase of woman's life. The observations from humans taken together indicate that depressive disorders, as defined in ICD-10, do not occur more frequently during perimenopause. In this context, the terms subthreshold depression and or subsyndromal depression are important, describing depressive symptoms which do not fulfil the complete clinical picture of a depressive episode, either because there are not enough symptoms or because they are not severe enough. The affected women still suffer, but until now not enough studies have been carried out on this particular area. In view of the complexity and relevance of the perimenopausal period in a woman's life, it is necessary to establish and maintain a network of treatment between the family physician, gynecologist, psychiatrist and or psychotherapist, as soon as significant depressive symptoms occur.
The gynecologic problems associated with the perimenopause and detailed in this review represent common and often vexing concerns for women during this transition. By heeding the evidence-based approaches to evaluation and treatment described herein, clinicians can improve the health and lives of their perimenopausal patients.