Menopause, which is defined as the cessation of menses for at least 1 year, begins at an average age of 50 to 51 years. A direct link between menopause and depression has not been substantiated. In fact, epidemiologic studies suggest that the risk of depression decreases in women after age 50. A large 5-year longitudinal prospective study of women between the ages of 45 and 55 years examined the effect of menopause on depression.The study, which controlled for prior depression, menopausal symptoms, and concurrent hormonal treatment, showed that the onset of natural menopause was not associated with an increased risk of depression.
Perimenopause, which typically occurs between the ages of 45 to 50 years, is the transition time between premenopause (the period when women normally have menstrual cycles) and menopause. Several studies and community surveys have reported a peak in the prevalence of MD during perimenopause. For example, Ballinger et al. reported a significant increase in psychiatric morbidity among perimenopausal women ages 45 to 49 years. Similarly, in a longitudinal study, Avis et al.
reported that women who experienced increased menopausal symptoms during a prolonged perimenopausal period (at least 27 months) had a moderately increased risk of developing transitory depression. More recent evidence, based on international Epidemiologic Catchment Area data, also suggested a peak in the onset of depressive illness during the perimenopausal years. Affective changes at the time of menopause may be secondary to the occurrence of vasomotor or other physical symptoms, rather than menopausal status itself.
Environmental events and developmental life stressors, such as changes in family structure, caring for an elderly parent, having children leave or return home, involvement in outside work in addition to running a household, and reappraisal of one’s future role, also have been shown to affect mental health during this life stage.
These psychosocial factors may contribute more to such common menopausal symptoms as fatigue, anxiety, and sadness than the physiologic changes of menopause.[55,57] Women with a previous history of PPD, premenstrual syndrome, or prior depressive episodes are at increased risk for developing a depressive illness at menopause. In a longitudinal study by Avis et al., prior depression was the variable most predictive of subsequent depression in postmenopausal women.