Menopause and Mental Health

JAMA Psychiatry published the study “Effects of Estradiol Withdrawal on Mood in Women with Past Perimenopausal Depression” online last month. The clinical study demonstrated that women with past perimenopausal depression who were crossed over from estradiol to placebo experience a significant increase in depression and women who continued on the estradiol therapy remained asymptomatic. The authors of the study believe this is the first controlled study to directly test the estrogen withdrawal theory of perimenopausal depression.

Clinical experience with both perimenopausal and menopausal women shows definite links between hormones such as estradiol, progesterone and testosterone with mood disorders like depression, anxiety and mood swings. Since the premise of the study was “perimenopause is accompanied by an increased risk of new and recurrent depression”, I would love to see a study concerning cyclic progesterone replacement in those perimenopausal women. Progesterone levels tend to fall dramatically in women several years prior to menopause. Low progesterone is associated with depression and anxiety, as well as many other estrogen dominant symptoms.

Standard antidepressant medications such as Effexor, Prozac, Welbutrin and Lexapro are effective treatment for depression and anxiety. However, women experiencing additional hormonal symptoms or side effects from the standard medications could benefit from low dose hormone replacement. As with any medical condition, your physician would be the best start for discussing your symptoms, concerns and treatment options.

by Mary Heim, RPh, FAAFM

P. Schmidt et al. Effects of Estradiol Withdrawal on Mood in Women with Past Perimenopausal Depression. JAMA Psychiatry. Online May 27, 2015
John R. Lee. Natural Progesterone: The multiple roles of a Remarkable Hormone. BLL publishing 1993
Pamela Whartian Smith. What You Must Know about Women’s Hormones. Square One publishers 2010
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