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Perimenopausal hormone therapy may fend off midlife depressive symptoms

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PHILADELPHIA — Although hormone therapy has not been shown to decrease established depressive symptoms during menopause, euthymic perimenopausal women may be protected from developing depressive symptoms with transdermal estradiol treatment, according to a presenter at the Annual Meeting of the North American Menopause Society.

“The risk of developing significant depressive symptoms increases considerably in the menopause transition and early postmenopausal period,” presenter Jennifer L. Gordon, PhD, assistant professor in the department of psychology at the University of Regina in Canada, told Endocrine Today. “Transdermal estradiol may be effective in mitigating that risk, particularly for women in the early menopause transition and women experiencing multiple stressful life events.”

In a randomized, double-blind, placebo-controlled trial conducted between October 2010 and February 2016, Gordon and colleagues assigned 172 perimenopausal women aged 45 to 60 years without depressive symptoms to 12 months of either (0.1 mg per day) plus oral micronized progesterone (200 mg per day for 12 days every 3 months) or to transdermal placebo plus oral placebo. Participants were screened for depressive symptoms at baseline and months 1, 2, 4, 6, 8, 10 and 12 using the Center for Epidemiological Studies – Depression Scale (CES-D); presence of clinically significant depressive symptoms was defined as a score of 16 or above.

Participants in the placebo group were 2.5 times more likely to have at least one CDS-D score in the depressive range than those in the treatment group (P = .03). The effect of treatment compared with placebo was significant for early menopausal women (P < .01), but not for women in later reproductive stages. The effect of treatment was greater for women who experienced a greater number of stressful life events in the 6 months leading up to the study (P for the interaction < .01). Effectiveness of treatment was unaffected by baseline estradiol levels, baseline vasomotor symptoms, history of depression or history of abuse.

“It may be surprising that depression history does not predict transdermal estradiol's mood benefit,” Gordon said. “Having a history of depression is a risk factor for developing depression in the menopause transition, so we were expecting women with a history of depression to show a greater benefit with estradiol, but that wasn't what we found.

“Instead, it seems that a brief clinical interview assessing menstrual bleeding patterns and the presence of stressful life events may be better suited to identifying the patients for whom transdermal estradiol will be most beneficial during the menopause transition,” she said. — by Jill Rollet

Reference:

Gordon JL, et al. ABSTRACT S-23. Presented at: Annual Meeting of the North American Menopause Society; Oct. 11-14, 2017; Philadelphia.

Disclosures: This research was supported by NIH grants RO1-MH087619 and T32 MH093315. Gordon reports no relevant financial disclosures.