While earlier observational studies suggested that postmenopausal hormone treatment may improve cognitive functioning in women, studies from the Women's Health Initiative have shown that estrogen replacement therapy started in postmenopausal women (65 years or older) did not enhance cognitive functioning nor did it decrease the risk of dementia.
An article published in the October 2007 issue of Archives of General Psychiatry suggests that older women who experience panic attacks may be at increased risk of having a heart attack or stroke and at increased risk of death over the next five years. MGH researcher Jordan W. Smoller, M.D. and colleagues followed 3,369 healthy postmenopausal women as part of the Women’s Health Initiative. Upon entry into the study, participants filled out a questionnaire about the occurrence of panic attacks in the previous six months and were then followed prospectively for an average of 5.3 years to assess risk for cardiovascular disease. About 10 percent of the women reported having a full-blown panic attack in the six months prior to the study.
The transition to menopause has typically been considered a time when women may be more vulnerable to mood changes. There have been inconclusive data, however, as to whether women with no lifetime history of depression transitioning to menopause are at increased risk for developing an episode of major depression.
Depression is common in postmenopausal women suffering from menopausal vasomotor symptoms (hot flushes, night sweats) and insomnia. While estrogen replacement therapy may alleviate these symptoms and may also have a positive impact on mood, the use of estrogen has declined over recent years. There has been great interest in finding alternative strategies for the management of menopausal symptoms, and recent data suggest that selective serotonin reuptake inhibitor antidepressants (SSRIs) and the serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine, may be effective for the treatment of depression and vasomotor symptoms in peri- and postmenopausal women. In a study presented at the annual meeting of the American Psychiatric Association, Dr. Hadine Joffe and her colleagues at the Center of Women’s Mental Health presented data on the use of duloxetine (Cymbalta), a new SNRI, for the treatment of mood, vasomotor symptoms, and insomnia in postmenopausal women.
Every year more than 1.7 million women in the United States enter into menopause. During this time of hormonal fluctuations it is typical for women to experience hot flashes, night sweats and sleep disturbance. More recently, studies have identified an association between menopausal transition and an increased risk for developing depressive symptoms (Harlow et al., 2003; Freeman et al., 2004). It is not clear how physicians and patients should deal with menopause-related physical and emotional symptoms. While hormone therapy effectively treats insomnia and hot flashes, the results have been mixed in treating mood and anxiety symptoms. Moreover, the safety of long-term use of hormone therapy is not known.
More than 50 percent of women experience some perimenopausal symptoms, including hot flushes, night sweats, and sleep disturbance, before reaching the menopause. A recent article from Aetna Intelihealth notes that many women may also experience depression. In a study form Dr. Claudio Soares, women with clinically confirmed perimenopause were interviewed:
During the menopausal transition, up to 85% of women experience vasomotor symptoms of hot flushes and night sweats. For many women, hot flushes may be severe; they can interfere with work and other daily activities and affect sleep quality. Hot flushes may be associated with fatigue, poor concentration, and depression. Given the recent data from the Women's Health Initiative regarding the risks associated with long-term use of estrogen, many peri- and post-menopausal women are understandably reluctant to take menopausal hormone therapy for the treatment of hot flushes, despite its proven efficacy. Given these concerns, there is a clear need for alternative non-hormonal therapies for the treatment of hot flushes and other menopause-related symptoms.
Each year, more than 1.3 million American women become menopausal in the U.S. The menopausal transition is marked by intense hormonal variability, and frequently accompanied by vasomotor symptoms (e.g., hot flashes, night sweats), sleep disturbance, and altered libido. In addition, as women become estrogen-deprived, they may also experience an increased risk for osteoporosis, cardiovascular disease, cognitive dysfunction, and depressive symptoms.
