Dear Carolyn,

I am so sorry you are going through such a difficult time. Many of the symptoms you describe — low mood, trouble sleeping, being unable to concentrate, a loss of interest in things you used to enjoy — are consistent with depression.

Each woman who has experienced the changes in mood that can come with monthly menstrual cycles knows that varying levels of hormones can strongly influence our moods. For some, certain times in the cycle have us feeling resilient, while at other times, tears come far too easily. Similarly, pregnancy and childbirth with their dramatic hormonal changes are vulnerable periods for the development of mental health issues, like peripartum depression. And, the hormonal changes of menopause can have significant effects on some women’s mental health.

A recent study (Georgakis MK, Thomopoulos TP, Diamantaras A, et al. “Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause: A Systematic Review and Meta-analysis.” JAMA Psychiatry. Published online January 06, 2016) published in one of the country’s leading psychiatric journals shows that the age a woman has menopause affects her risk for depression as she ages. Analyzing data from fourteen previous studies of more than 65,000 women, researchers found that an older age of menopause was associated with a decreased risk of developing depression later in life, with women undergoing menopause at a younger age at higher risk. Overall, they found that a two year increase in the age of menopause was correlated with a two percent decreased risk of developing depression. While the finding was significant from a statistical standpoint, it may be somewhat less important in actual clinical practice, as a two percent change in risk over two years is relatively small. However, the risk appears to be greatest for those who undergo menopause prior to 40 years of age, as they were at about double the risk of those who went through menopause later in life. Of interest, these effects were not significantly changed when the use of hormone therapy was taken into account.  Future research will be needed to determine whether hormone therapy for those undergoing early menopause has any protective effects against depression later in life.

Previously, attention had been paid to the acute effects of fluctuating hormones, like those that occur with menstrual cycles, pregnancy, and menopause itself. This study broadens our lens; rather than attributing mood to immediate changes, the study would indicate that longer cumulative exposure to endogenous estrogens is protective against depression later in life. This adds depression to the list of other diseases, including cardiovascular disease, cognitive decline, and dementia, that have been associated with early menopause.

It is unclear how reproductive hormones produce these protective effects. We know that estrogen receptors are present throughout the brain and previous research has shown that genetic variation in the estrogen receptors affect an individual’s risk for depression later in life.  How these differences may lead to increased risk of depression is unclear. Previous work has shown that later age at menopause also offers cardiovascular protection, and it may be that these effects on the blood vessels of the brain contribute to decreasing depression risk.

You fit the patient profile of women who have experienced menopause at a young age. Women in this group, as the studies show, seem to be at a slightly increased risk of developing depression. This is a treatable mental illness, and knowing you are at increased risk can offer you the opportunity to get the help you need earlier. Your options include both pharmacological interventions and psychotherapy. There are a number of antidepressants available and, if you choose to go that route, you can work with your doctor to find one that’s right for you.

Another option is to start psychotherapy, which studies have shown is as effective as antidepressant medications, and is typically considered the first line of treatment for mild to moderate depression. In studies, no particular form of therapy has been shown to be better than others and thus it is important to find a therapist you trust and a technique you feel you can work with. An added advantage of psychotherapy is the positive effects last long after you have stopped therapy because you can continue to apply the skills you have learned.

Depression is a treatable illness. Please seek the treatment you deserve.

References

Georgakis MK, Thomopoulos TP, Diamantaras A, et al. Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause: A Systematic Review and Meta-analysis. JAMA Psychiatry. Published online January 06, 2016.

Joffe H, Bromberger JT.  Shifting Paradigms About Hormonal Risk Factors for Postmenopausal Depression: Age at Menopause as an Indicator of Cumulative Lifetime Exposure to Female Reproductive Hormones. JAMA Psychiatry. Published online January 06, 2016.

Ryan J, Scali J, Carrière I, Peres K, Rouaud O, Scarabin PY, Ritchie K, Ancelin ML. Oestrogen receptor polymorphisms and late-life depression. Br J Psychiatry. 2011 Aug;199(2):126-31.