Depression During The Menopausal Transition

The perception that menopause leads to mood disturbances such as depression has a long history. How did these beliefs come about, and are they supported by the scientific literature? This article reviews the theories of menopause and depression, the scientific literature, and the implications of these findings for prevention and treatment. Epidemiologic studies of menopausal status and depression do not provide consistent evidence of an association between the menopausal transition and depression among the general population of women. Depression experienced by women transitioning through menopause may be attributed to factors unrelated to menopause. A subset of women, however, may be more vulnerable to the effects of hormonal changes. For some women, short-term estrogen replacement therapy to relieve vasomotor symptoms may be beneficial, although for others psychotherapy or antidepressants may be more appropriate. Additional research is needed to better understand the association between different stages of the menopausal transition and dysphoric mood or depression, and better identification of women potentially at risk for depression during the menopausal transition.     

Treatment of menopause-related mood disturbances

More than 1.7 million American women are expected to reach menopause each year. Recent Canadian statistics show that a 50-year-old woman can now expect to live until her mid-80s, which implies living at least one-third of her life after menopause. The menopausal transition is typically marked by intense hormonal fluctuations, accompanied by vasomotor symptoms (eg, hot flashes, night sweats), sleeps disturbance, and changes in sexual function, as well as increased risk for osteoporosis, cardiovascular disease, and cognitive decline. More importantly, recent studies have demonstrated a significant association between menopausal transition and a higher risk for developing depression. In the post-Women's Health Initiative Study era, physicians and patients are questioning the safety and efficacy of long-term hormone therapy use. This article reviews the current literature on the benefits and risks of using hormone therapy for the treatment of menopause-related mood disturbances and alternate strategies currently available for the management of menopause-related problems, including antidepressants, complementary and alternative medicine, and selective estrogen receptor modulators.     

Spirituality and Severity of Menopausal Symptoms in a Sample of Religious Women

Menopause represents an important life change, particularly for religious women whose identity is significantly related to family. Two competing hypotheses are examined: one, because religious women have their identity focused on family and child rearing, spirituality will be related to increased menopausal symptoms because menopause represents a loss of identity and purpose; and two, because spirituality can provide strength and comfort during difficult times, it will, therefore, be related to decreased menopausal symptoms. To test these competing hypotheses, questionnaires were administered to 218 women (average age 55, 35% premenopausal, 26% peri-menopausal, 39% postmenopausal) who were members of the Church of Jesus Christ of Latter Day Saints. Regression analyses indicated that higher levels of spiritual strength were related to decreased levels of reported menopausal symptoms. Spiritual strength was also related to increased benefit finding during menopause, decreased concern with body appearance, and increased use of adaptive coping strategies. We conclude that finding strength in spirituality may help religious women cope better with the life changes associated with menopause.     

A Review of Symptoms Commonly Associated with Menopause: Implications for Clinical Neuropsychologists and Other Health Care Providers

Menopause is a process, either naturally or medically induced, that occurs in nearly all women at some point in life. Some of the most commonly reported symptoms associated with menopause are hot flushes/flashes, fatigue, headaches, irritability, insomnia, and depression. These symptoms overlap with symptoms commonly reported in Traumatic Brain Injury (TBI) as well as postconcussive syndrome. This overlap between symptoms commonly associated with menopause and neuropsychological conditions makes it necessary to have the base rates of these symptoms and conditions available. The purpose of the present review was to consolidate the clinical literature on the most commonly reported menopausal symptoms and to calculate the base rates associated with these symptoms.     

Factors Contributing to Depression during Peri Menopause: Findings of a Pakistani Sample

The present study aimed to identify the role of different factors in menopausal depression in Pakistani women. We hypothesized that physical activity, regular exercise, social support, and attitudes towards aging and menopause would predict menopausal depression in women going through perimenopause. The sample consisted of 110 women (M _age = 47.93 years) going through natural perimenopause. The Menopausal Symptoms Scale (Nadeem and Khalid 2012) and Social Support Questionnaire (Sarason et al. 1987) were administered along with a demographic questionnaire. Multiple regression analysis was conducted to analyze the data. The results showed that higher physical activity level, satisfactory relationships with husband, and availability of social support significantly predicted lower menopause-related depression. However, satisfaction with social support did not significantly predict menopausal depression. We also observed that positive attitude towards aging and menopause was significantly correlated with decreased menopausal depression. The implications for the need to promote awareness among health professionals and the general population about menopausal symptoms in Pakistani women to improve their quality of life are discussed.     

Self-evaluations of male and female managers

Two separate samples of males and females holding first-level management positions in United States organizations completed questionnaires which asked for self-evaluation on a number of job-related characteristics and for attributions of causality for successful and unsuccessful job experiences. In support of previous research, results indicated that males evaluated their performance more favorably than did women, and rated themselves as having more ability and greater intelligence. Men also saw ability as more responsible for their success than did women, but the sexes did not differ in attributions to luck, effort, or task. Implications for equal opportunity and potential for change are considered.     

Beyond Credentials: The Effect of Physician Sex and Specialty on How Physicians Are Perceived

The experiment investigated the effect of physician sex and specialty on participants’ perceptions of doctors. Participants (N = 206) viewed a physician profile (male/female orthopedic surgeon or male/female dermatologist) and then evaluated the physician on a survey. While male participants reported they would be more willing to see a female physician and believed female physicians would be more caring, female participants reported they would be more willing to see physicians in counter-stereotypical specialties and rated them as more caring. The study suggests that not only do men and women focus on different things in selecting physicians but also that negative stereotypes of female physicians have dramatically decreased.     

Perimenopausal mental disorders: epidemiology and phenomenology

Perimenopause, the interval of irregular menstrual activity which directly precedes menopause, is characterized by widely fluctuating hormone levels amidst a large-scale decline in circulating estrogen. This phase in a woman's life is typically accompanied by physical discomforts including vasomotor symptoms, such as headaches, insomnia, and hot flushes, as well as genital atrophy. Not surprisingly, studies suggest a significant increase in mood lability for women during this time. While some evidence points toward an exacerbation of bipolar mood symptoms and an increase in schizophrenic psychosis during perimenopause, the majority of research conducted on perimenopausal mental disorders has focused on unipolar depression. Studies vary widely in methodology, definitions of menopausal status, and degrees of depression among subjects; however, the majority of findings indicate an increased susceptibility to depression during the perimenopausal transition. This greater susceptibility may be due to neuroendocrine effects of declining estrogen levels, the subjective experience of somatic symptoms resulting from this hormonal decline, and/or the more frequent occurrence of "exit" or "loss" events for women during this stage of life. At this time, more research is needed to address questions of prevalence, risk, and etiology for depression and other major mental disorders as related to the physiological and psychosocial changes associated with perimenopause.     

Is menopause depressing? An investigation of three perspectives

This study examines three perspectives in the literature about menopausal depression. According to one, the physiological changes of menopause result in increased psychological distress. Another approach proposes that menopause is most depressing for women who occupy traditional female gender roles. The third asserts that menopause is not especially depressing for most women. This study empirically examines three perspectives using data from two community surveys. These analyses suggest menopausal status may not be associated with depressive symptomatology, either directly or indirectly through traditional gender roles.This research was supported in part by PHS grant numbers 5T32MH13043, 5T32MH16373, and 5T32MH15774. I appreciate the helpful comments I received from Janet Berkeley, Bruce Link, and an anonymous reviewer on earlier versions of this paper. I also am grateful to Lenore Radloff and NIMH for providing the CMHA data and to Harold Dupuy and NCHS for the HANES data.     

Examining a Gender Stereotype: Menopausal Women1

Two studies evaluated whether there was a subtype of menopausal women and, if so, how it differed from the global gender stereotype. Study 1 had participants generate items associated with women going through menopause, midlife women, and midlife men. Results showed that there is a menopausal women stereotype, and it is mostly negative in content. Moreover, this stereotype differs from the perceptions of women in general. Study 2 examined the effects of the menopausal women stereotype by employing the illusory correlation paradigm (e.g., McConnell, Sherman, & Hamilton, 1994) and found that participants greatly overestimated the number of times that menopausal women and negative moods appeared together. This research highlights the importance of examining stereotype subtypes and subgroups     

Men's and women's attitudes and beliefs about the menstrual cycle

Recent analyses of menstrual distress have emphasized sociocultural influences. Yet beliefs and attitudes of men—an important socialization force in the lives of women—have received little attention. In the present study, 239 students (156 females and 83 males) from three colleges filled out a survey on expectations for menstrual and premenstrual symptoms, attitudes about mensturation, sources of menstrual-related information, and effects of menstruation upon daily activities. The major findings are as follows: First, although both males and females believed women experience certain cycle-related symptoms, females reported that women experience more severe menstrual and premenstrual symptoms (when compared to intermenstrual ones) than males reported, while males believed women experience more severe menstrual than premenstrual symptoms than females believed. Second, males learned less about menstruation from the majority of possible informational sources and rated most sources as more negative than did the females. Third, males believed that menstruation had more of an effect on women's moods and had a more debilitating effect on women's lives than did females. Fourth, females rated menstruation as more bothersome than did males. Fifth, more males believed their mothers experienced menstrual irritability and moodiness, while more females believed their mothers experienced swelling. The findings are discussed in terms of the role of socialization and the type of information imparted to males and females in America today.     

Which Symptoms of Depression and Anxiety Matter Most? An Investigation of Subjective Importance Ratings With College Students in India

One goal of clinical psychological science is to help people with problems that matter to them. However, little is known about which kinds of symptoms are viewed as most important, particularly among individuals in non-western settings. We examined the extent to which young adults in India rated individual symptoms of depression and anxiety as important, concerning, and undesirable. Participants were college students at Indian Universities (n = 283). They received a measure of depressive symptoms (Patient Health Questionnaire-9) and anxiety symptoms (Generalized Anxiety Disorder Screener-7). For each of the 16 symptoms, they provided three judgments relating to the extent to which they found the symptom important, harmful, and undesirable. These judgments were averaged to form a “subjective importance rating” (SIR) for each symptom. Anxiety symptoms were viewed as more important than depressive symptoms (d = 0.34), and nonsomatic symptoms were viewed as more important than somatic symptoms (d = 0.83). Females rated symptoms as more important than males (d = 0.32), and individuals with higher self-reported symptoms rated symptoms as more important. Sad mood, suicidal ideation, and controlling worries were rated as the most important symptoms, whereas concentration problems, appetite problems, and psychomotor problems were rated as the least important. Overall, some symptoms are viewed as more important and concerning than others. We discuss how this understanding can affect our conceptualization, assessment, and treatment of mental disorders around the world.     

Gender-Typed Behavioral Examples of Histrionic Personality Disorder

Findings that clinicians diagnose Histrionic Personality Disorder more frequently in women may be due to the feminine gender weighting of the criteria or because the diagnostic label elicits a feminine stereotype. Using a method derived from the act-frequency approach, undergraduates generated behavioral examples of the DSM-IIIR and DSM-IV Histrionic criteria without regard to sex or according to sex role instructions that elicited masculine or feminine sex roles. A national sample of psychologists and psychiatrists rated the representativeness of the symptoms for the Histrionic criteria or for Histrionic Personality Disorder. Feminine behaviors were rated more representative of Histrionic Personality Disorder and somewhat more representative of the Histrionic criteria than masculine behaviors suggesting that the feminine sex role is more strongly associated with the label than the criteria. Masculine behaviors were also rated less representative than sex-unspecified examples. Results provide a possible explanation for the higher rates of diagnosis of Histrionic Personality Disorder in women.     

Sleep in Women: A Review

Sleep complaints are common in women, and women are more likely to suffer from insomnia than men. Multiple factors across a woman's lifespan, including hormonal changes, age‐related physiological changes, psychosocial factors, the presence of sleep disorders, and physical and mental health conditions, can contribute to complaints of poor sleep in women. This article reviews the literature on the characteristics of, and contributing factors to, subjectively and objectively measured sleep during the menstrual cycle, pregnancy, and post‐partum period, as well as the menopausal transition and postmenopause. Evidence from both subjective and objective measurements supports the presence of chronic sleep fragmentation associated with pregnancy, acute sleep deprivation during labour and the immediate post‐partum periods, as well as disrupted sleep during the first few months after childbirth. While there is evidence for menstrual cycle and menopause related sleep disturbance based on women's self report, findings from objectively measured sleep have been mixed. Observational and intervention studies on the relationship between sleep and women's psychological well‐being suggest that underlying causes of sleep disturbance across a woman's lifespan are often multi‐factorial. Comprehensive assessments and targeted interventions are needed in managing sleep problems in women. Cognitive behavioural interventions have been shown to reduce sleep complaints during the perinatal and menopausal periods, and improvements in sleep are likely to lead to improvements in women's overall well‐being.     

Distress and coping with hot flushes at work: Implications for counsellors in occupational settings

This study explored whether mid-life women regard hot flushes at work as a substantial stressor. A sample of 29 working women reporting hot flushes for at least 12 months rated the degree to which each of ten work situations influenced flush distress or discomfort. Ratings were compared with qualitative accounts of coping with flushes at work. Results showed that women differed markedly in the work situations that they regarded as most problematic, but flush distress was commonly magnified during formal meetings, in hot enclosed spaces and in the presence of male colleagues. A substantial minority viewed colleagues as conveying negative attitudes towards menopausal problems, which jeopardised general confidence at work as well as creating specific difficulties during frush episodes. Flush distress was higher among those reporting embarrassment and dificulties disclosing menopausal status to others. Respondents made suggestions for ways in which the working environment could be improved to assist women in managing hot flushes. Coping with flushes was largely seen as an individual rather than organisational responsibility. Other stigmatising health problems may present similar subjective problems at work, and this needs further study. Some implications for counsellors working in organisational settings are explored.     

Effects of sex and sex roles on the perceived maladaptiveness of DSM-IV personality disorder symptoms

This study investigated the influence of sex on the perceived maladaptiveness of DSM-IV personality disorder criteria based on previous findings that inconsistency of symptoms with sex roles affects the perception of personality disorder symptoms. The effects of rater characteristics (i.e., sex, sex role) were also examined. A total of 161 undergraduates (65 men, 96 women) rated the diagnostic criteria according to how maladaptive they were for males (male condition), females (female condition), or without regard to sex (neutral condition that served as a baseline) using a 7-point scale. Participants' sex role was determined using the Bem Sex Role (1981a) Inventory. Dependent and depressive personality disorder criteria (trend for borderline) were rated more maladaptive for females than males, whereas obsessive-compulsive personality disorder criteria were rated more maladaptive for males than females. Participant sex and sex role had little or no significant effects on the ratings. Results are compared with those of previous research. Methodological issues and implications for the diagnosis of personality disorders are discussed.     

Sex differences in judgments of physical attractiveness: a social relations analysis

Men and women rated the physical attractiveness of other men and women who were sitting nearby and were rated by them in return. They also provided meta-perceptions of how they thought those others rated them. Attractiveness ratings were partly a function of both the target being rated and the perceiver providing the ratings regardless of the sex of the perceiver or target, but the highest levels of consensus occurred when men judged the attractiveness of women and the highest levels of idiosyncrasy occurred when men rated other men. Meta-perceptions were also idiosyncratic; some believed that they were consistently considered attractive, whereas others thought they were seen as unattractive. People were aware of what others thought of them and, in particular, women's meta-perceptions were highly related to men's judgments of them. People agree about others' attractiveness, and those who are attractive to others know they are pretty or handsome.     

The Baby Boomers Meet Menopause: Fertility, Attractiveness, and Affective Response to the Menopausal Transition

The purpose of this study was to identify social factors that affect women’s concerns about menopause. Data from a sample of 1,037 baby-boomer women who took part in two waves of the Midlife in the United States survey (MIDUS) were utilized. Two waves of survey data were collected in 1996 and 2005 from a nationally representative sample of women born between 1946 and 1964 residing in the United States. Women’s concerns about the effects of menopause on attractiveness, fertility, and the cessation of menstruation were examined. Analyses were replicated in Wave I and II of the study. Women who occupied multiple roles had fewer concerns about the loss of fertility. Women who had more symptoms were significantly more concerned about the effects of menopause on attractiveness. Concerns about the effects of menopause were also related significantly to women’s age, education, and financial security.     

Menopausal attitudes, objectified body consciousness, aging anxiety, and body esteem: European American women's body experiences in midlife

Seventy-four European American women aged 50-68 years completed surveys of menopausal attitudes, appearance aging anxiety, body esteem, body surveillance, and body shame. Hypotheses based on the connections between cultural constructions of femininity and menopause were partially supported. Menopausal attitudes and appearance-related aging anxiety were related to body surveillance. Appearance-related menopausal attitudes were related to both body surveillance and body esteem. Body shame moderated the relationship between appearance-related menopausal attitudes and body esteem.