Lifelong estradiol exposure and risk of depressive symptoms during the transition to menopause and postmenopause
Department of Psychiatry; Division of Preventive and Behavioral Medicine, Department of Medicine; Department of Obstetrics and Gynecology
Hormones, Hormone Substitutes, and Hormone Antagonists | Psychiatry and Psychology | Reproductive and Urinary Physiology | Therapeutics | Translational Medical Research | Women's Health
OBJECTIVE: Depression risk increases during the menopausal transition (MT) and initial postmenopausal years-both times of significant fluctuations of estrogen. Research to date provides limited support for the hypothesis that estrogen fluctuations play a role in the greater susceptibility to midlife depression. Importantly, not all women report depressive symptoms during the MT, and recent reports suggest that duration of exposure to estradiol throughout the adult years may also play a role in vulnerability to depression. This study examines patterns of estrogen exposure during the reproductive years and risk of depression during the MT and early postmenopausal years.
METHODS: A longitudinal, US community-based, multiethnic study of menopause. Data were collected at baseline and annually for 10 years, and included 1,306 regularly menstruating premenopausal women, aged 42 to 52 years at study entry. The main outcome was incidence of high level of depressive symptoms, Center for Epidemiological Studies Depression Scale (CES-D) score at least 16, in the MT and initial postmenopausal years, independent of premenopausal depression symptoms. Risk factors examined were duration of estrogen exposure (menarche to MT), duration of hormonal birth control use, pregnancies, and lactation.
RESULTS: In a multivariate adjusted model, longer duration of estrogen exposure from menarche to MT onset was significantly associated with a reduced risk of depression (CES-D > /=16) during the MT and 10 years or less postmenopause (odds ratio 0.85, 95% confidence interval 0.78-0.92). Longer duration of birth control use was associated with a decreased risk of CES-D at least 16 (odds ratio 0.90, 95% confidence interval 0.83-0.98), but number of pregnancies or breastfeeding was not.
CONCLUSIONS: Patterns of reproductive lifetime exposure to estrogen are associated with risk of high depressive symptoms during the MT and initial postmenopausal years; longer exposure to estrogen seemed protective.
DOI of Published Version
Menopause. 2017 Dec;24(12):1351-1359. doi: 10.1097/GME.0000000000000929. Link to article on publisher's site
Menopause (New York, N.Y.)
Marsh, Wendy K.; Bromberger, Joyce T.; Crawford, Sybil L.; Leung, Katherine; Kravitz, Howard M.; Randolph, John F.; Joffe, Hadine; and Soares, Claudio N., "Lifelong estradiol exposure and risk of depressive symptoms during the transition to menopause and postmenopause" (2017). UMass Center for Clinical and Translational Science Supported Publications. 144.