New perspectives on the relationship of hormone changes to affective disorders in the perimenopause

Menopause and the preceding climacteric years are normal aspects of the reproductive life cycle in women. However, the fluctuations and declines in hormone levels are physiologic changes that may have a significant impact on perimenopausal mood changes. These observations are based on both clinical experience with perimenopausal women and recent neuroendocrine research that describes hormone effects on central nervous system neurotransmitters regulating mood, sleep, and behavior. In particular, both estrogen and progesterone have profound effects on the serotonin, norepinephrine, dopamine, and endorphin receptor systems that are involved in mood regulation. This chapter discusses these correlations, describes pharmacologic and nonpharmacologic treatment approaches, and recommends directions for needed research.