FRIDAY, Jan. 17, 2003 (HealthDayNews) -- Depressed women begin perimenopause -- the period of hot flashes and mood swings that comes just before menopause -- earlier than non-depressed women, new research says.
Researchers followed 332 women aged 36 to 45 with a history of major depression, and 644 without depression. None of the women had gone through menopause yet.
Women with a history of depression had a 20 percent greater chance of having perimenopausal symptoms during the 36 months of the study than the non-depressed women.
Women who were depressed at the time of the study and women who had the most severe history of depression were twice as likely to begin perimenopause. And women who were depressed and taking antidepressants had nearly three times the risk of having symptoms of perimenopause during the study.
The researchers believe the added risk has little to do with the antidepressants. Instead, they believe women taking them may have particularly severe depression that isn't alleviated by medicine.
During perimenopause, a relatively new term, women often experience typical menopause symptoms: mood swings, hot flashes and sleep disruptions due to their wildly fluctuating hormones.
Previous research has shown women with a history of depression are at greater risk of relapsing during perimenopause, says Bernard Harlow, lead author of the study that appears in the current issue of Archives of General Psychiatry.
"What's happening is these women with a history of depression are sitting in a period of flux," says Harlow, an associate professor of obstetrics-gynecology at Harvard Medical School and an associate professor of epidemiology at the Harvard School of Public Health. "It's a very vulnerable period of time for women susceptible to mood disorders. It is really horrible."
"It would be better for them to get into the menopause and be done with it," he says.
Perimenopause occurs when a woman's ovaries age and produce less estrogen. Perimenopause can last for a year or two, or for as long as 10, Harlow says.
In the study, women were considered to have symptoms of perimenopause if they had a change in menstrual flow amount or duration; if they missed a period for three months or more; or if they had a seven day or longer change in their menstrual cycle length. (For example, a woman who used to get her period every 28 days was now getting it every 35 days.)
A woman is considered to be in menopause when she's gone one year without a period.
Harlow and his colleagues also did blood tests on the women every six months to measure their hormone levels.
They found depressed women had lower levels of estrogen and higher levels of follicle stimulating hormone and lutenizing hormone than non-depressed women.
One indicator that the ovaries are withering is an increase in follicle stimulating hormone and lutenizing hormone, which are produced by the pituitary gland. The ovaries and the pituitary gland work in harmony: follicle stimulating and lutenizing hormone from the pituitary signals the ovaries to produce more estrogen.
If the ovaries don't produce enough estrogen, levels of follicle stimulating and lutenizing hormone increase, Harlow says.
However, Harlow notes, measuring hormone levels is a somewhat unreliable method of determining whether a woman is menopausal because during perimenopause, the levels fluctuate wildly -- a woman can have levels typical of a much younger woman one day and a much older woman the next, he says.
"It's a crap shoot as to whether you're going to catch the hormone level at the high end or the low end," Harlow says. "The menstrual cycle is a much better indicator of changes."
Susan Simonds, a psychologist in private practice in Moscow, Idaho, who specializes in women with depression, says the study is one of the first to look at the role depression plays in perimenopause.
"The study demonstrates the important link between reproductive hormones and depression, which is something that has only recently begun to be studied," Simonds says. "We just don't know enough about it yet and we need to know more."
Only about 60 percent of women who are depressed seek treatment, according to the study.
"This study shows the importance of getting early treatment for depression and for continuing to seek more effective treatments if antidepressants don't reduce symptoms," Simonds says.
Harlow and his colleagues set out to determine if depressed women began actual menopause sooner, but the study period wasn't long enough. They're conducting follow-ups to determine that now.
"I suspect they do begin menopause sooner, but we don't know that for sure yet," he says.
More information
The Mayo Clinic has more information about perimenopause and menopause. To order a copy of a perimenopause/menopause handbook, visit the North American Menopause Society. For information on the signs and treatments for depression, check the National Institute of Mental Health.
