Perimenopausal Depression
The menopause transition or ‘perimenopause’ is the 5+ years leading up to the last menstrual cycle. Perimenopause typically begins around 44-48 years of age. During this time, menstrual cycles become irregular.
Women are 3X more likely to develop depression during perimenopause and have a 2-4X increased risk of clinically significant depressive symptoms during menopause. Perimenopausal women are also 9X more likely to experience suicidal ideation than pre- or postmenopausal women or men of the same age.
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Women may be more vulnerable to depression because of sensitivity to the extreme estrogen fluctuations that occur during the menopause transition. Understanding this is the focus of Dr. Gordon's research, which we hope will provide better information for women and their healthcare providers, and help develop effective treatments.
To examine the role that sensitivity to estrogen fluctuations may play in the development of perimenopausal depression, our lab completed the year-long FEMM study in February 2019. We recruited 101 women aged 45-55 years to participate in two phases of research.
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For the first 3 months, we assessed their mood and menopause symptoms (i.e., hot flashes, night sweats, sleep problems) while measuring stress hormones in their saliva and reproductive hormones in their urine every week for 3 months. Then we measured the participants' moods monthly for 9 months and analyzed the data.
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We found that there were differences in how women's moods responded to changes in estrogen levels: 39% experienced negative changes in mood when their estrogen levels changed—about 20 were sensitive to both increases and withdrawals, 12 per cent were sensitive to increases, and 7 per cent were sensitive to withdrawals. The majority of women in the study, 61 per cent, were insensitive to estrogen changes.
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These results show that there is variability in estrogen sensitivity, predicting whether someone will experience depressive mood during perimenopause.
Thanks to the women who participated in our study and the Saskatchewan Health Research Foundation (SHRF) for funding it.
Why might certain women be more likely to experience depressive mood during perimenopause? Our research suggests that the hormonal environment of the menopause transition may contribute to this increased risk by making women more sensitive to stress, and more vulnerable to depressed mood when they encounter stressful life events.
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Psychological interventions aimed at reducing stress sensitivity may therefore benefit this population. Funded by the Saskatchewan Health Research Foundation, the Mindful Menopause Project aimed to test the efficacy of an intervention called Mindfulness-Based Stress Reduction (MBSR), an 8-week group program which combines yoga and meditation techniques, in reducing the risk of depression in the menopause transition. MBSR focuses on awareness of the present moment, non-judgmental acceptance, and being non-reactive in the face of stress.
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We recruited 104 women to participate in the MBSR program, assessed their mood, stressful life events, and estrogen sensitivity. We found that mindfulness can prevent the development of depressive mood in the menopause transition. Women who had more stressful life events and higher sensitivity to estrogen fluctuation saw the greatest benefit.
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The results of this study are promising, by showing that a hormonal mood disorder does not require a hormonal intervention!
This leads us to our current project...
The AIMS Study
Is estrogen sensitivity really ALLO sensitivity?
Allopregnanalone (ALLO) is the main metabolite made in the body from the hormone progesterone. ALLO influences receptors in the brain that affect a person's stress response and has been implicated in premenstrual dysphoric disorder (PMDD).​
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The AIMS study will examine the role ALLO may play in perimenopausal depression. We are currently recruiting women age 42-55 in Regina and Saskatoon who report an increase in depressive mood since the onset of perimenopause.
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Thanks to the Natural Sciences and Engineering Research Council of Canada (NSERC) for funding this project.
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