Multiple small studies have demonstrated a link between infertility and psychological distress, reporting high rates of anxiety and depressive symptoms among women with infertility. These studies have evaluated psychiatric symptoms or psychological distress; however, less is known about the prevalence of more significant psychiatric disorders in this population.
Most women undergoing infertility treatment experience increased anxiety. In a randomized clinical trial, researchers explored the effectiveness of acupuncture in diminishing anxiety in a group of women undergoing IVF. 43 patients undergoing IVF received either active acupuncture (n=22) or sham treatment (n=21). Women with a history of psychiatric illness and those using antidepressants and/or anxiolytic drugs were excluded from the study. Anxiety levels were assessed before and after treatment using the Hamilton Anxiety Rating Scale (HAS).
In this study, half of women aged 45 to 60 years reported experiencing menopausal symptoms. 69% of these women reported that their symptoms have negatively affected their lives. Among the women who endorsed menopausal symptoms, 72% had not received any treatment for their symptoms and 77% reported that they had not discussed treatment options with their healthcare providers.
The American Psychiatric Association is now considering the possibility of including premenstrual dysphoric disorder (PMDD) in the DSM-V as a new category, rather than listing a set of criteria for PMDD in the appendix (as in DSM-IV). The diagnostic criteria remain relatively unchanged. Many feel that the Inclusion of PMDD as a distinct diagnostic category will lead to greater legitimacy for the disorder and will encourage the growth of evidence-based research in this area.
Ever since 2002 when several large-scale studies called into question the safety of long-term hormone replacement therapy (HRT), there has been confusion and conflicting opinions regarding the management of menopausal symptoms. Initially there was a movement to avoid HRT altogether; now it is becoming clearer that certain women may safely use and benefit from hormonal interventions.
More than half of all women initiating treatment with hormone therapy will stop within the first year of treatment, most often because of side effects. Mood disturbance is a relatively common side effect that occurs with hormone therapy, and previous studies have suggested that progestins in the combined hormone preparations are responsible for these negative mood effects.
Menstrual problems are common among premenopausal women and become more frequent with increasing reproductive age, especially just before and during perimenopause. In the Study of Women's Health Across the Nation, a multisite study of menopause and aging, information regarding menstrual history was collected in a total of 934 premenopausal and early perimenopausal women between the ages of 42 and 52. History of major depression was associated with an increased likelihood of heavy bleeding (odds ratio, 1.89), adjusting for recent major depression, menopause status, and other confounding factors. History of depression was not associated with other abnormal bleeding or premenstrual symptoms. Future longitudinal studies are needed to explore why past depression increases the likelihood of subsequent heavy menstrual bleeding in midlife women. One possibility is that irregular fluctuations in estrogen levels may be responsible for both abnormal menstrual bleeding, as well as the dysregulation of neurotransmitter systems that mediate depressive symptoms.
In increasing numbers, women who are candidates for hormonal replacement therapy are requesting “bioidentical” rather than synthetic hormones. Although there is a tendency to think of bioidentical hormones as “all-natural”, they, like synthetic hormones, are manufactured in the laboratory. In contrast to synthetic hormones, they are chemically identical to the hormones produced by the human body; synthetic hormones are structurally different yet are designed to have similar biological effects as naturally produced hormones.
It is well established that women are at increased risk for developing depression compared to men. It has been hypothesized that this vulnerability to depression may be hormonally mediated, and several longitudinal studies have documented an increased risk of depressive symptoms during perimenopause or the menopausal transition. Based on the results of two prospective cohort studies, approximately one-third of women will develop their first episode of depression during the menopausal transition. (Cohen LS et al 2006, Freeman EW et al 2006).
