Researchers show that menopause doesn't necessarily affect mental health

A new review paper by the authors and colleagues at Brigham and Women's Hospital concludes that menopause does not uniformly increase the risk of depression and other mental health conditions.

Menopause has long been thought to cause psychological distress, but new research suggests this is not necessarily the case. This review was written by experts from Brigham and Women's Hospital, a founding member of the Massachusetts General Brigham Health System, and international collaborators, and is the third in a series of papers on menopause published in 2008. It is the th. lancet. The authors found no evidence that menopause universally poses a risk for mental health conditions such as depressive symptoms, major depressive disorder, anxiety, bipolar disorder, and psychosis in all women. There wasn't.

However, researchers found that certain groups were at higher risk for mental health problems during menopause. Individuals are more likely to report symptoms of depression if they have previously experienced depression, if their sleep is severely disrupted by nighttime hot flashes, or if they suffer from depression. Stressful life events associated with menopause.

Researchers believe that in addition to creating negative expectations in people approaching menopause, it can also lead to the misattribution of psychological distress and mental illness to menopause, leading to delays in accurate diagnosis and treatment in women. states that it may cause harm.

“The key message for women and their clinicians is that if someone has mental health symptoms during the menopausal transition, they should not assume that these two things are related.” said co-author Hadin Joffe, MD, MSc. She is interim director of psychiatry and executive director of the Connors Center for Women's Health at Brigham and Women's Hospital.

“We don't want to override the fact that some people experience mental health symptoms during the menopausal transition, but it's not guaranteed.”

The menopausal transition (the period between the onset of hormonal and menstrual changes and the beginning of the last menstrual cycle) can last 4 to 10 years and begins on average at age 47. Menopause is often thought to be mentally taxing due to hormonal fluctuations, but this period also coincides with the great stress of midlife and other life events such as relationships and job changes, so the relative impact of these factors is It is difficult to distinguish between the contributions of

To investigate whether there is a link between the transition to menopause and mental health conditions, researchers investigated depressive symptoms during menopause, major depressive disorder, anxiety, bipolar disorder, Previous studies examining the incidence of psychosis were reviewed. They gave more weight to prospective studies examining mental health before and during or after menopause, including some studies conducted at Massachusetts General Brigham.

They found that although some studies have shown an association between the incidence of depressive symptoms and menopause, more severe clinical depression during menopause is more likely to occur in those previously diagnosed with depression. It was discovered that this only occurs in

“If you've never had major depression before, it's very unlikely that you'll develop clinical depression for the first time during the menopausal transition,” Joffe says.

Symptoms of depression were also more prevalent in those who experienced a very long menopausal transition, those who suffered from severe sleep disruption due to nocturnal hot flashes, and those who experienced stressful life events in the six months prior to the assessment. observed frequently.

Although researchers found no convincing evidence that the risk of anxiety, bipolar disorder, or psychosis universally increases during the menopausal transition, there is little evidence of an association between these symptoms and menopause. Literature is lacking.

Most studies on menopause have been conducted in high-income countries, so it is unclear how these results translate to low- and middle-income regions. Also, little is known about how menopause affects transgender and gender diverse individuals.

These results indicate that hormone therapy is not appropriate as a first-line treatment for clinical depression during menopause, the researchers said. Instead, if a patient exhibits mental health symptoms during menopause, clinicians should consider the patient's background, previous mental health diagnoses, and current living situation.

“There is a negative image about menopause in the media, but without examining the mental state before menopause, it is important to understand what is biologically related to menopause rather than life stages and life trajectories. “It's very difficult,” Joffe said. “Clinicians need to think about what happened before, because depression can coincide with menopause but is unrelated.”