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Shifting estrogen levels in perimenopausal women may increase risk for stress, depression

Women with fluctuating estradiol levels due to entering menopause were more likely to have emotional sensitivity to psychosocial stress, which may contribute to depression when experiencing a stressful life event, according to recently published data.

“These data suggest that estradiol variability may enhance emotional sensitivity to psychosocial stress, particularly sensitivity to social rejection. Combined with [recent very stressful life events] proximate to the menopausal transition, this increased sensitivity may contribute to the development of depressed mood,” the researchers wrote.

To assess the impact of fluctuating estradiol levels and recent stressful life events on depressive symptoms among women transitioning into menopause, researchers analyzed data on 52 women, aged 45 to 60 years, who had been assigned to the placebo group of a randomized controlled trial on hormone therapy. Hormone levels and depressive symptoms were recorded at 1, 8 and 14 months from baseline. Stressful life events included divorce or separation, serious illness of a close friend or relative, significant current financial troubles, physical or sexual assault or abuse, or significant arrest of self or loved one.

Results demonstrated that at 14 months, women who had more fluctuation in their estradiol levels and more stressful life events at baseline were more likely to have greater depressive symptoms. No correlation was seen between depressive symptoms and estradiol levels among women who had not experienced a stressful life event at baseline.

Women who were more sensitive to rejection at 8 months and had experienced stressful events at baseline were more likely to have depressive symptoms at 14 months.

JoAnn Pinkerton

Fluctuating estradiol levels increased feelings of anger, irritability and rejection, according to the researchers.

“These results provide tremendous insight for practitioners. Clinicians need to understand the impact of perimenopausal hormone fluctuations and the degree of stressful events that a woman is experiencing to determine the best treatment options when a middle-aged woman complains of depression or exaggerated irritability. This study provides a foundation for future studies to evaluate the value of psycho-social interventions, such as cognitive therapies, to lessen the effect of major life events, as well as the use of estrogen therapy during perimenopausal and menopausal stressful times,” JoAnn Pinkerton, MD, NCMP, executive director of the North American Menopause Society, said in a press release. – by Casey Hower