Skip to main content
SpringerLink
Log in

What factors determine whether a woman becomes depressed during the perimenopause?

  • Review Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Perimenopause has long been associated with psychological distress, both anecdotally and clinically. Research has identified this time as a period of increased risk for both first-episode depression and for depression reoccurrence. However, we know that the majority of women do not experience these difficulties during perimenopause. This review examines the current research literature looking at the factors associated with depression during perimenopause, with a view to identifying those factors which are protective and those factors which predict increased risk. From the literature, it is evident that some women have a hormonal vulnerability to mood disorders. However, this does not account for the phenomenon of perimenopausal depression in and of itself. Rather, there appears to be a complex interplay between hormonal vulnerability, the psychosocial resources one has (coping skills and social support), their overall well-being (exercise and other lifestyle factors) and the demands on their coping resources (stressful life events). The complexity of the relationship between perimenopause and depression means that there is a need to look beyond either as a sole explanation of mood during midlife. Education is required for both general practitioners and for women regarding the individual risks of psychological distress during perimenopause, as well as the knowledge of the life factors which we know to be protective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • ABS (2009) Home and away: the living arrangements of young people. Aust Soc Trends 4102:25–30

    Google Scholar 

  • AIHW (2003) Perinatal statistics series: Australia’s mothers and babies 2000. N. P. S. Unit. Perinatal Statistics Series no. 12. Australian Institute of Health and Welfare, Canberra

  • Almeida OP (1999) Sex playing with the mind. Effects of oestrogen and testosterone on mood and cognition. Arquivos de Neuro-Psiquiatria 57(3A):701–706

    Article  PubMed  CAS  Google Scholar 

  • Arpels JC (1996) The female brain hypoestrogenic continuum from the premenstrual syndrome to menopause. A hypothesis and review of supporting data. J Reprod Med 41(9):633–639

    PubMed  CAS  Google Scholar 

  • Avis NE, Brambilla D et al (1994) A longitudinal analysis of the association between menopause and depression: results from the Massachusetts Women’s Health Study. Ann Epidemiol 1994(14):214–220

    Article  Google Scholar 

  • Avis NE, Crawford S et al (1997) Psychosocial, behavioural, and health factors related to menopause symptomatology. Womens Health 3:103–120

    PubMed  CAS  Google Scholar 

  • Avis NE, McKinlay SM (1991) A longitudinal analysis of women’s attitudes toward the menopause: results from the Massachusetts Women’s Health Study. Maturitas 13(1):65–79

    Article  PubMed  CAS  Google Scholar 

  • Ayubi-Moak I, Parry BL (2002) Psychiatric aspects of menopause. In: Kornstein SG, Clayton AH (eds) Women’s mental health: a comprehensive textbook. Guilford, New York, pp 132–143

    Google Scholar 

  • Ballinger S (1985) Psychosocial stress and symptoms of menopause: a comparative study of menopause clinic patients and non-patients. Maturitas 7:315–327

    Article  PubMed  CAS  Google Scholar 

  • Barber CE (1989) Transition to the empty nest. Ageing and the family. Health and Company, Lexington, pp 15–32

    Google Scholar 

  • Binfa L, Castelo-Branco C et al (2004) Influence of psycho-social factors on climacteric symptoms. Maturitas 48:425–431

    Article  PubMed  Google Scholar 

  • Bloch M, Schmidt PJ et al (2000) Differential behavioural effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry 157:924–930

    Article  PubMed  CAS  Google Scholar 

  • Boyce P, Parker G et al (1991) Personality as a vulnerability factor to depression. Br J Psychiatry 159:106–114

    Article  PubMed  CAS  Google Scholar 

  • Bromberger JT (2004) A psychosocial understanding of depression in women: for the primary care physician. J Am Med Wom Assoc 59:198–206

    PubMed  Google Scholar 

  • Bromberger JT, Assman SF et al (2003) Persistent mood symptoms in a multiethnic community cohort of pre- and peri-menopausal women. Am J Epidemiol 158:347–356

    Article  PubMed  Google Scholar 

  • Bromberger JT, Kravitz HM et al (2008) Predictors of first lifetime episodes of major depression in midlife women. Psychol Med 39:55–64

    Article  PubMed  Google Scholar 

  • Bromberger JT, Matthews K et al (2007) Depressive symptoms during the menopausal transition: the study of women’s health across the nation. J Affect Disord 103(1–3):267–272

    Article  PubMed  Google Scholar 

  • Bromberger JT, Meyer PM et al (2001) Psychological distress and natural menopause: a multiethnic community study. Am J Public Health 91(9):1435–1442

    Article  PubMed  CAS  Google Scholar 

  • Bromberger JT, Schott LL et al (2010) Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition. Arch Gen Psychiatry 67(6):598–607

    Article  PubMed  CAS  Google Scholar 

  • Brownson RC, Eyler AA et al (2000) Patterns and correlates of physical activity among US women 40 years and older. Am J Public Health 90:264–270

    Article  PubMed  CAS  Google Scholar 

  • Brugge KL, Kripke DF et al (1989) The association of menopausal status and age with sleep disorders. Sleep Res 18:208

    Google Scholar 

  • Burger H, Dudley E et al (1999) Prospectively measured levels of serum follicle-stimulating hormone, estradiol, and the dimeric inhibins during the menopausal transition in a population-based cohort of women. J Clin Endocrinol Metab 84:4025–4030

    Article  PubMed  CAS  Google Scholar 

  • Burleson MH, Todd M et al (2010) Daily vasomotor symptoms, sleep problems, and mood: using daily data to evaluate the domino hypothesis in middle-aged women. Menopause 17(1):87–95

    Article  PubMed  Google Scholar 

  • Carver CS, Scheier MF et al (1989) Assessing coping strategies: a theoretically based approach. J Personal Soc Psychol 56(2):267–283

    Article  CAS  Google Scholar 

  • Choi H, Lee D et al (2004) A structural model of menopausal depression in Korean women. Arch Psychiatr Nurs 18(6):235–242

    Article  PubMed  Google Scholar 

  • Cohen LS, Soares CN et al (2006) Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry 63(4):385–390

    Article  PubMed  Google Scholar 

  • Cohen S (1987) Social factors and depressive symptoms. PsycCRITIQUES 32:360–362. DOI: Electronic Collection: 2006-06447-039. http://dx.doi.org/10.1037/027006

    Google Scholar 

  • Cooke DJ (1985) Social support and stressful life events during mid-life. Maturitas 7:303–313

    Article  PubMed  CAS  Google Scholar 

  • Cooke DJ, Greene J (1981) Types of life events in relation to symptoms at the climacterium. J Psychosom Res 25(1):5–11

    Article  PubMed  CAS  Google Scholar 

  • Daley A (2008) Exercise and depression: a review of reviews. Journal of Clinical Psychology in Medical Settings 15(2):140–147

    Article  PubMed  Google Scholar 

  • Deeks AA, McCabe MP (2004) Well-being and menopause: an investigation of purpose in life, self-acceptance and social role in premenopausal, perimenopausal and postmenopausal women. Qual Life Res 13:389–398

    Article  PubMed  Google Scholar 

  • Dennerstein L, Dudley E et al (2002) Empty nest or revolving door? A prospective study of women’s quality of life in midlife during the phase of children leaving and re-entering the home. Psychol Med 32(3):545–550

    Article  PubMed  CAS  Google Scholar 

  • Dennerstein L, Lehert P et al (1999) Mood and the menopausal transition. J Nerv Ment Dis 187(11):685–691

    Article  PubMed  CAS  Google Scholar 

  • Dennerstein L, Lehert P et al (2001) Factors contributing to positive mood during the menopausal transition. J Nerv Ment Dis 189(2):84–89

    Article  PubMed  CAS  Google Scholar 

  • Dennerstein L, Smith A et al (1994) Psychological well-being, mid-life and the menopause. Maturitas 20:1–11

    Article  PubMed  CAS  Google Scholar 

  • Dennerstein L, Smith AMA et al (1993) Menopausal symptoms in Australian women. Med J Aust 159:232–236

    PubMed  CAS  Google Scholar 

  • Elavsky S, McAuley E (2005) Physical activity, symptoms, esteem, and life satisfaction during menopause. Maturitas 52:374–385

    Article  PubMed  Google Scholar 

  • Freeman EW, Sammel MD et al (2006a) Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry 63(4):375–382

    Article  PubMed  CAS  Google Scholar 

  • Freeman EW, Sammel MD et al (2004a) Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry 61:62–70

    Article  PubMed  CAS  Google Scholar 

  • Freeman EW, Sammel MD et al (2004b) Premenstrual syndrome as a predictor of menopausal symptoms. Obstet Gynecol 103(5 pt 1):960–966

    Article  PubMed  CAS  Google Scholar 

  • Freeman MP, Hill R et al (2006b) Escitalopram for perimenopausal depression: an open-label pilot study. J Wom Health 15(7):857–861

    Article  Google Scholar 

  • Fuh J-L, Wang S-J et al (2006) A longitudinal study of cognition change during early menopausal transition in a rural community. Maturitas 53(4):447–453

    Article  PubMed  Google Scholar 

  • Gold EB, Block G et al (2004) Lifestyle and demographic factors in relation to vasomotor symptoms: baseline results from the study of women’s health across the nation. Am J Epidemiol 159(12):1189–1199

    Article  PubMed  Google Scholar 

  • Goldstat R, Briganti E et al (2003) Transdermal testosterone therapy improves wellbeing, mood, and sexual function in premenopausal women. Menopause 10(5):390–398

    Article  PubMed  Google Scholar 

  • Greene JG, Cooke DJ (1980) Life stress and symptoms at the climacterium. Br J Psychiatry 136:486–491

    Article  PubMed  CAS  Google Scholar 

  • Hardy R, Kuh D (2002) Change in psychological and vasomotor symptom reporting during the menopause. Soc Sci Med 55:1975–1988

    Article  PubMed  Google Scholar 

  • Harlow BL, Cohen LS et al (1999) Prevalence and predictors of depressive symptoms in older premenopausal women. Arch Gen Psychiatry 56:418–424

    Article  PubMed  CAS  Google Scholar 

  • Harlow SD, Gass M et al (2012) Executive summary of the Stages of Reproductive Aging Workshop +10: addressing the unfinished agenda of staging reproductive aging. Menopause 19(4):105–114.

    Google Scholar 

  • Hecht E, Mensh IN (1975) Life’s ups and downs may leave you down and out. PsycCRITIQUES 20: 639–640. DOI: Electronic Collection: 2006-06277-020. http://dx.doi.org/10.1037/0013564 Accessed 13 Aug 2010

  • Holte A, Mikkelsen A (1991) Psychosocial determinants of climacteric complaints. Maturitas 13:205–215

    Article  PubMed  CAS  Google Scholar 

  • Hunter M (1992) The South-East England longitudinal study of the climacteric and postmenopause. Maturitas 14:117–126

    Article  PubMed  CAS  Google Scholar 

  • Igarashi M, Saito H et al (2000) Stress vulnerability and climacteric symptoms: life events, coping behavior, and severity of symptoms. Gynecol Obstet Investig 49(3):170–178

    Article  CAS  Google Scholar 

  • Joffe H (2003) Assessment and treatment of hot flushes and menopausal mood disturbance. Psychiatr Clin N Am 26(3):563

    Article  Google Scholar 

  • Joffe H, Hall JE et al (2002) Vasomotor symptoms are associated with depression in perimenopausal women seeking primary care. Menopause 9(6):392–398

    Article  PubMed  Google Scholar 

  • Kendler KS, Thornton LM et al (2000) Stressful life events and previous episodes in the etiology of major depressive symptoms and major depression in women: an evaluation of the “kindling” hypothesis. Am J Psychiatry 157:1243–1251

    Article  PubMed  CAS  Google Scholar 

  • Kendler KS, Walters EE et al (1995) The structure of the genetic and environmental risk factors for six major psychiatric disorders in women: phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Arch Gen Psychiatry 52(5):374–383

    Article  PubMed  CAS  Google Scholar 

  • Kendler KS, Prescott CA et al (2000) Causal relationship between stressful life events and the onset of major depression: reply. Am J Psychiatry 157(8):1345

    Article  Google Scholar 

  • Kronenberg F (1990) Hot flashes: epidemiology and physiology. Ann New York Acad Sci 592:52–86

    Article  CAS  Google Scholar 

  • Kuh DL, Wadsworth M et al (1997) Women’s health in midlife: the influence of the menopause, social factors and health in earlier life. Br J Obstet Gynecol 104:923–933

    Article  CAS  Google Scholar 

  • McKinlay JB, Mckinlay SM et al (1987) The relative contribution of endocrine changes and social circumstances to depression in mid-aged women. Journal of Health and Social Behavior 4:345–363

    Article  Google Scholar 

  • Miech RA, Shanahan MJ (2000) Socioeconomic status and depression over the life course. J Heal Soc Behav 41(2):162–176

    Article  Google Scholar 

  • Mirzaiinjmabadi K, Anderson D et al (2006) The relationship between exercise, body mass index and menopausal symptoms in midlife Australian women. Int J Nurs Pract 12(1):28–34

    Article  PubMed  Google Scholar 

  • Moline ML, Broch L et al (2003) Sleep in women across the life cycle from adulthood through menopause. Sleep Med Rev 7(2):155–177 [Review] [119 refs]

    Article  PubMed  Google Scholar 

  • Morse CA, Dudley E et al (1998) Relationships between premenstrual complaints and perimenopausal experiences. J Psychosom Obstet Gynecol 19(4):182–191

    Article  CAS  Google Scholar 

  • Murrell SA, Himmelfarb S et al (1983) Prevalence of depression and its correlates in older adults. Am J Epidemiol 117(2):173–185

    PubMed  CAS  Google Scholar 

  • Neri I, Demyttenaere K et al (1997) Coping style and climacteric symptoms in a clinical sample of postmenopausal women. J Psychosom Obstet Gynecol 18:229–233

    Article  CAS  Google Scholar 

  • Noble RE (2005) Depression in women. Metabolism 54:49–52

    Article  PubMed  CAS  Google Scholar 

  • Öztürk Ö, Eraslan D et al (2006) The risk factors and symptomatology of perimenopausal depression. Maturitas 55:180–186

    Article  PubMed  Google Scholar 

  • Parry BL (2008) Perimenopausal depression. Am J Psychiatry 165(1):23–27

    Article  PubMed  Google Scholar 

  • Parry BL (2010) Optimal management of perimenopausal depression. Int J Wom Health 2:143–151

    Article  CAS  Google Scholar 

  • Parry BL, Martinez LF et al (2006) Sleep, rhythms and women’s mood. Part II. Menopause. Sleep Med Rev 10:197–208

    Article  PubMed  Google Scholar 

  • Raup JL, Myers JE (1989) The empty nest syndrome: myth or reality? J Couns Dev 68(2):180–183

    Article  Google Scholar 

  • Richards M, Rubinow DR et al (2006) Premenstrual symptoms and perimenopausal depression. Am J Psychiatry 163(1):133–137

    Article  PubMed  Google Scholar 

  • Santoro N, Torrens J et al (2005) Correlates of circulating androgens in mid-life women: the study of women’s health across the nation. J Clin Endocrinol Metab 90(8):4836–4845

    Article  PubMed  CAS  Google Scholar 

  • Schmidt PJ, Haq N et al (2004a) A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry 161(12):2238–2244

    Article  PubMed  Google Scholar 

  • Schmidt PJ, Murphy J et al (2004b) Stressful life events, personal losses, and perimenopause-related depression. Arch Wom Ment Health 7(1):19-–26

    Article  CAS  Google Scholar 

  • Schmidt PJ, Nieman L et al (2000) Estrogen replacement in perimenopause-related depression: a preliminary report. Am J Obstet Gynecol 183(2):414–420

    Article  PubMed  CAS  Google Scholar 

  • Schmidt PJ, Nieman LK et al (1998) Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. Obstet Gynecol Surv 53(5):291–292

    Article  Google Scholar 

  • Schwingl PJ, Hulka BS et al (1994) Risk factors for menopausal hot flashes. Obstet Gynecol 84:29–34

    PubMed  CAS  Google Scholar 

  • Soares CN, Almeida OP et al (2001) Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry 58(6):529–534

    Article  PubMed  CAS  Google Scholar 

  • Soules MR, Sherman S et al (2001) Executive summary: stages of reproductive aging workshop (STRAW). Climacteric 4(11770182):267–272

    PubMed  CAS  Google Scholar 

  • Sternfeld B, Quesenberry C et al (1999) Habitual physical activity and menopausal symptoms. J Wom Health 8:115–123

    Article  CAS  Google Scholar 

  • Stewart DE, Boydell KM (1993) Psychologic distress during menopause: associations across the reproductive life cycle. Int J Psychiatr Med 23:157–162

    Article  CAS  Google Scholar 

  • Thurston R, Joffe H et al (2006) Physical activity and risk of vasomotor symptoms in women with and without a history of depression: results from the Harvard Study of Moods and Cycles. Menopause 13:553–560

    Article  PubMed  Google Scholar 

  • Veeninga AT, Kraaimaat FW (1989) Life stress and symptoms in menopause clinic patients and non-patients. J Psychosom Obstet Gynecol 10(3):269–277

    Article  Google Scholar 

  • Whiteman MK, Staropoli CA et al (2003) Risk factors for hot flashes in midlife women. J Wom Health 12:459–472

    Article  Google Scholar 

  • Wilbur J, Dan A et al (1990) The relationship among menopausal status, menopausal symptoms, and physical activity in midlife women. Fam Community Health 13:67–78

    Google Scholar 

  • Woods NF, Mitchell ES (1996) Patterns of depressed mood in midlife women: observations from the Seattle Midlife Women’s Health Study. Res Nurs Heal 19:111–123

    Article  CAS  Google Scholar 

  • Woods NF, Mitchell ES (1997) Pathways to depressed mood for midlife women: observations from the Seattle Midlife Women’s Health Study. Res Nurs Heal 20:119–129

    Article  CAS  Google Scholar 

  • Woods NF, Smith-DiJulio K et al (2008) Depressed mood during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause: The Journal of The North American Menopause Society 15(3):223–232

    Google Scholar 

  • Youngwhee L, Hwasoon K (2008) Relationships between menopausal symptoms, depression, and exercise in middle-aged women: a cross-sectional survey. Int J Nurs Stud 45:1816–1822

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, Level 1, Old Baker Building, The Alfred Commercial Road, Melbourne, VIC, 3004, Australia

    Zoe Gibbs, Stuart Lee & Jayashri Kulkarni

Authors
  1. Zoe Gibbs
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stuart Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jayashri Kulkarni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zoe Gibbs.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gibbs, Z., Lee, S. & Kulkarni, J. What factors determine whether a woman becomes depressed during the perimenopause?. Arch Womens Ment Health 15, 323–332 (2012). https://doi.org/10.1007/s00737-012-0304-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-012-0304-0

Keywords

Search

Navigation