A recent review paper published in The Lancet as part of a series of menopause-themed papers challenged the prevailing notion that menopause uniformly increases the risk of depression and other mental health conditions.
The review showed that menopause does not universally elevate the risk of mental health conditions such as depressive symptoms, major depressive disorder, anxiety, bipolar disorder, and psychosis across all women. Instead, specific subgroups are identified as being more vulnerable to mental health challenges during menopause.
Individuals with a history of depression, severe disruptions in sleep due to nocturnal hot flushes, or concurrent stressful life events during menopause are more likely to report depressive symptoms. However, the researchers did not observe a consistent association between the menopause transition and an increased risk of anxiety, bipolar disorder, or psychosis.
While hormonal fluctuations are often attributed to emotional distress during menopause, the review highlighted the role of midlife stresses and life events, such as relationship or job changes, in contributing to mental health challenges. To assess the association between menopause and mental health conditions, the researchers analyzed previous studies, emphasizing prospective studies that examined mental health both before and during the menopause transition.
The review also cautions against the indiscriminate use of hormonal therapy as a first-line treatment for clinical depression during menopause, emphasizing the need for personalized approaches to mental health care.
The menopause transition—the time from when an individual begins to have hormonal and menstrual changes up until their final menstrual cycle—can last four to ten years and begins at 47 years of age, on average. Though menopause is often thought of as emotionally taxing due to hormonal fluctuations, this time of life also coincides with substantial midlife stresses and life events, such as relationship or job changes, which makes it difficult to tease apart the relative contribution of these factors.
To investigate whether there is an association between the menopause transition and mental health conditions, the researchers reviewed previous studies that looked at the incidence of depressive symptoms, major depressive disorder, anxiety, bipolar disorder, and psychosis during menopause. They placed higher weight on prospective studies that examined mental health pre-menopause as well as during or after the transition, including several studies that were conducted at Mass General Brigham.
They found that, while some studies showed an association between the incidence of depressive symptoms and menopause, more severe clinical depression during menopause only occurred in individuals who had 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,” says Joffe.
Depressive symptoms were also more frequently observed in individuals who experienced a very long menopause transition, individuals who suffered from severely interrupted sleep due to nocturnal hot flashes, and individuals who experienced stressful life events in the six months prior to being assessed.
The researchers found no compelling evidence that the risk of anxiety, bipolar disorder, or psychosis are universally elevated during the menopause transition, though there is scarcer literature on associations between these conditions and menopause.
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