Depression in the menopause transition: risks in the changing hormone milieu as observed in the general population

There is accumulating evidence but no definitive answers about the incidence of depressed mood in the menopause transition and its association with the changing hormonal milieu. While a changing hormonal milieu is the natural condition for all women, only a minority of mid-life women experience debilitating depressive symptoms or clinical depression. This review focuses on associations between depressed mood and the menopause transition, primarily as identified in longitudinal, population-based studies in the past decade. Further aims were to present reported associations between depressed mood and reproductive hormones in the menopause transition as evaluated in the general population and associations of depressive symptoms or clinical depression with menopausal hot flashes or poor sleep in perimenopausal women. There is evidence to support the role of the changing endocrine milieu in the development of depressed mood in the menopause transition, but the contribution of hormones as measured is small. Disentangling the numerous factors that are associated with depression in midlife women is a major challenge for research and for clinical care, where treatments are needed to improve the most distressing menopausal symptoms.