Menopause and Mental Health: Beyond the Textbook Definition

Written and edited by Sarah Bonza MD, MPH, FAAFP, Dip-ABLM

The article in the Lancet, Promoting good mental health over the menopause transition ((Brown et al., 2024) uses the criteria for major depressive disorder to assert that there is no compelling evidence for increased risk for depressive symptoms or disorders during the menopause transition. This study uses a limited view on mental health during the menopause transition. It’s conclusions focus solely on the diagnostic criteria for major depressive disorder and overlook the broader range of mental health symptoms that women may experience during this time.

Subtle Mental Health Changes During Perimenopause

Caring female doctor attentively listens to a young woman talk about her symptoms. The doctor is taking notes notes in the woman’s medical chart. iStock

It is crucial to address the impact of menopause on mental health, as it is a significant stage in a woman’s life that can bring about various physical and emotional changes. As the body undergoes hormonal fluctuations, many women may experience mood swings, anxiety, depression, and cognitive changes. These symptoms are distinct from major depressive disorder or psychiatric disorders. Nonetheless, these symptoms can be distressing for women. In my clinical practice, I frequently encounter women who reach out for support specifically because of mood disturbances during the perimenopause stage.

They commonly report “I am not myself,” or “something is not right.” These concerns are not a DSM-V reportable problems. Prior studies suggest mood changes or “depressive symptoms” can be a common experience for women during the menopause transition. (Maki et al., 2019)(Bromberger et al., 2011)(Kulkarni, 2018)(Soares, 2010). They report symptoms of anxiety, rage, irritability and bouts of depression. These symptoms are not typically pervasive, but they can be distressing to the individual.

Validating Women’s Concerns

My concern with this review, is that it may result in women once again having their concerns swept under the rug. Women’s experiences during the menopausal transition are diverse and personal, and it is important to acknowledge and validate their concerns. Furthermore, the Lancet review’s focus solely on hormonal changes as the primary factor for mental health during menopause overlooks the compunding impact of lifestyle habits. Factors such as diet, sleep, exercise, and social connection have been shown to affect mood and overall mental health.

How Physicians Can Help Their Patients

I urge physicians to listen to their patients when they say “something is not right” or “I am not myself.” Taking women’s experiences and concerns seriously is essential for providing the best possible care during the menopause transition. Their concerns may not fall under the DSM-V criteria for Major depressive disorder, but this does not mean their symptoms are not distressing or valid.

Incorporate Lifestyle Factors in Future Research

It is important for future research studies to include a more diverse range of symptoms, participants and incorporate a comprehensive examination of lifestyle factors. This will help develop a more accurate understanding of the relationship between menopause and mental health and inform evidence-based interventions that address the unique needs of women during this stage of life.

References

1. Bromberger, J T., Kravitz, H M., Chang, Y., Cyranowski, J M., Brown, C., & Matthews, K A. (2011, February 9). Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychological Medicine, 41(9), 1879–1888. https://doi.org/10.1017/s003329171100016x
2. Brown, L., Hunter, M S., Chen, R., Crandall, C J., Gordon, J L., Mishra, G D., Rother, V., Joffe, H., & Hickey, M. (2024, March 1). Promoting good mental health over the menopause transition. https://doi.org/10.1016/S0140-6736(23)02801-5
3. Kulkarni, J. (2018, December 3). Perimenopausal depression — an under-recognised entity. https://doi.org/10.18773/austprescr.2018.060
4. Maki, P M., Kornstein, S G., Joffe, H., Bromberger, J T., Freeman, E W., Athappilly, G., Bobo, W V., Rubin, L H., Koleva, H., Cohen, L S., & Soares, C N. (2019, February 1). Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. Journal of Womens Health, 28(2), 117–134. https://doi.org/10.1089/jwh.2018.27099.mensocrec
5. Soares, C N. (2010, December 1). Can depression be a menopause-associated risk?. BMC Medicine, 8(1). https://doi.org/10.1186/1741-7015-8-79