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Longer exposure to oestrogen tied to reduced depression risk during MT

15 Aug 2017

There appears to be an association between patterns of reproductive lifetime exposure to oestrogen and the risk of high depressive symptoms during the menopausal transition (MT) and initial postmenopausal years, such that longer exposure to oestrogen is protective, according to a recent study.

Researchers looked at 1,306 regularly menstruating premenopausal women aged 42 to 52 years at enrolment. Data were collected at baseline and annually for 10 years. The main outcome was incidence of high-level depressive symptoms (defined as Center for Epidemiological Studies Depression Scale [CES-D] score of ≥16) in the MT and initial postmenopausal years, independent of premenopausal depression symptoms. Risk factors assessed were duration of oestrogen exposure (menarche to MT), duration of hormonal birth control use, pregnancies and lactation.

Results revealed that longer duration of oestrogen exposure from menarche to MT onset was significantly associated with a reduced risk of depression during the MT and ≤10 years postmenopause (odds ratio [OR], 0.85; 95 percent CI, 0.78 to 0.92). Furthermore, longer duration of birth control use was associated with a reduction in the risk of depression (OR, 0.90; 0.83 to 0.98). No such association was observed for number of pregnancies or breastfeeding.

In middle-aged women, changes in menstrual bleeding patterns mark the approach of menopause. Hot flashes, poor sleep, depressed mood and other symptoms may occur along with such menstrual changes. The risk of depression particularly increases during MT and initial postmenopausal years, with significant fluctuations of oestrogen occurring in both periods. [Maturitas 2009;64:145–59]

Available evidence provides limited support for the hypothesis that oestrogen fluctuations contribute to greater susceptibility to midlife depression. A previous review has reported that while published studies suggest potential associations between hormone fluctuations or changes and depression in MT, there are no definitive conclusions. Such conflicting results are said to be a possible result of differences in the frequency and timing of hormone measurements, variances in measures of depressed mood, diverse comparisons of menopausal stages, and differing approaches and models in data analysis. [Womens Midlife Health 2015:doi:10.1186/s40695-015-0002-y]

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