Estrogens have neuroprotective and antidepressant effects.  During the perimenopause, when estrogen levels fluctuate and then fall significantly, women are more vulnerable to depression and cognitive deficits.  A recent study has investigated the association between age at menopause and risk for depression in postmenopausal women with naturally occurring menopause.

In this meta-analysis, data was obtained from 14 studies, representing a total of 67,714 women.  Researchers observed that women who experienced menopause at a later age were less likely to experience postmenopausal depression than women who entered into menopause at an earlier age.  For every two year increase in age at menopause, rates of depression decreased by 5%.  Women who experienced menopause at age 40 years or later were about half as likely to experience depression as women who experienced premature menopause.  The findings were similar whether or not the woman had a history of depression prior to menopause.

The authors concluded that longer exposure to endogenous estrogens, expressed as older age at menopause and longer reproductive period, is associated with a lower risk of depression in later life.  While this study excluded women with surgically induced menopause, these findings are consistent with previous studies reporting that early menopause due to oophorectomy was associated with an increased risk of depression later in life (Rocca et al 2008, Mantani et al 2010).  Thus, identifying women at higher risk for depression due to early menopause is important as this group of women could benefit from psychiatric intervention or estrogen-based therapies.

Ruta Nonacs, MD PhD

Georgakis MK, Thomopoulos TP, Diamantaras AA, Kalogirou EI, et al. Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause: A Systematic Review and Meta-analysis.  JAMA Psychiatry. 2016 Jan 6:1-12.

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