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Estrogen exposure duration tied to depressive symptoms during menopausal transition

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July 26, 2017

The risk for depression in women during the menopausal transition and up to 10 years after decreased with longer duration of estrogen exposure as well as longer duration of oral contraceptive use, according to findings published in Menopause.

Wendy K. Marsh, MD, MSc, associate professor in the department of psychiatry, University of Massachusetts Medical School in Worcester, and colleagues evaluated data from the Study of Women’s Health Across the Nation (SWAN) study on 1,306 regularly menstruating premenopausal women to examined patterns of estrogen exposure during the reproductive years and risk for depression during the menopausal transition and early postmenopausal years.

The Center for Epidemiological Studies Depression Scale was used to assess depressive symptoms, and a score of at least 16 indicated clinical depression. Duration of estrogen exposure (menarche to menopausal transition), duration of hormonal birth control use, pregnancies and lactation were examined as risk factors for depressive symptoms.

Participants were observed for a mean 5.4 visits during the menopausal transition and early postmenopausal years. Time from menarche to onset of menopausal transition was a mean 35.6 years and was negatively associated with age at menarche (P < .001) and positively associated with age at onset of menopausal transition (P < .001). Compared with participants who did not report depression, participants who reported depression during the menopausal transition or up to 10 years after menopause were more likely to have a premenopausal history of depression and any history of antidepressant use, to have less education, to be Hispanic and to smoke at baseline.

The risk for high depressive symptoms during the menopausal transition or the early postmenopausal years was lower with a longer interval between menarche and menopausal transition onset. The odds for depression decreased by 5% with each additional year between menarche and menopausal transition onset (OR = 0.95; 95% CI, 0.92-0.98). The risk for subsequent high depressive symptoms score was associated with older age at menopausal transition onset but not age at menarche. The odds for depression were lower in all postmenopausal participants and greater in participants with a later menopausal transition compared with early menopausal transition.

The incidence of menopausal transition/postmenopausal depression was not associated with number of pregnancies or duration of breast-feeding, whereas longer duration of oral contraceptive use and fewer days with vasomotor symptoms were associated with lower risk for depressive symptoms.

“The relative contribution of estrogen to the risk of developing depression during [menopausal transition] and postmenopause has long been debated,” the researchers wrote. “The current study provides important new evidence that reproductive events and estrogen exposure might be setting the stage premenopausally for the risk of clinically significant depressive symptoms during the [menopausal transition] and beyond. Differences in duration of estradiol exposure and moderators of the patterns of exposure during the reproductive years may inform future research on disentangling the inter-relationships between depressive symptoms and hormone dynamics, and aid in identifying women who are at increased risk of depression during [menopausal transition]. They warrant further investigation on the putative mechanistic factors. If further corroborated, these findings may also have implications for the extent to which variations in reproductive hormone exposure during reproductive years might subsequently alter the risk for depression later in life.” – by Amber Cox

Disclosures: Marsh reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.