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• Posted March 6, 2024

Some Women Escape the Mental Health Effects of Menopause: Study

Menopause is thought to trigger mood changes among women, with changes in female hormone levels contributing to anxiety, depression and stress.

However, a new study says some women are at more risk than others for menopause-linked mental health issues, and many escape them altogether.

There's no evidence that menopause causes a universal rise in risk for mental health conditions like depression, anxiety, bipolar disorder or psychosis, researchers concluded March 5 in The Lancet journal.

Instead, certain groups of women are more likely to have mental health problems during menopause -- those with previous depression or depressive symptoms, those whose sleep is disturbed by nighttime hot flashes, and those who had a stressful life event around the time of menopause.

“We have a negative media image about menopause, but without looking at someone's mental health prior to menopause, it's very challenging to understand what might be biologically related to menopause as opposed to life stage or life trajectory,” said co-senior study author Dr. Hadine Joffe, interim chair of psychiatry at Brigham and Women's Hospital in Boston.

“Clinicians need to think about what happened before, because depression might be coincident with menopause but unrelated,” Joffee added in a hospital news release.

Menopause can last four to ten years, and tends to begins around age 47, researchers said in background notes.

Menopause is thought of as emotionally taxing on women because of hormone fluctuations, but it also coincides with substantial mid-life stresses and life events, researchers noted.

To tease out potential links, researchers pooled and reviewed data from previous studies that looked at the incidence of mental health problems during menopause.

They focused on studies that studied mental health prior to menopause, then followed those women through the transition. 

Results showed that while some studies linked depressive symptoms and menopause, severe depression occurred only in women who'd previously been diagnosed with the condition.

“If you've never had major depression before, you're extremely unlikely to have a first episode of clinical depression during the menopause transition,” Joffe said.

Depression symptoms were more frequently observed in women who underwent a very long menopause transition, had poor sleep due to hot flashes, or experienced recent stressful life events.

The team also found no compelling evidence that menopause universally increases the risk of anxiety, bipolar disorder or psychosis.

Importantly, the results indicate that hormone therapy isn't an appropriate first treatment for clinical depression during menopause, researchers said.

Instead, doctors should consider a woman's background and current life situation when she reports mental health symptoms during menopause.

“The take-home message to women and their clinicians is that we shouldn't assume that if someone has mental health symptoms during the menopause transition that those two things are related,” Joffee said.

“We don't want to invalidate the fact that some people will experience mental health symptoms during the menopause transition, but it's not guaranteed,” Joffee added.

More information

Harvard Medical School has more about menopause and mental health.

SOURCE: Brigham and Women's Hospital, news release, March 5, 2024