Depression Common in Transition to Menopause
October 25, 2012
As the body ages, changes in the production of hormones occur. The period when a woman's body begins the transition to menopause is called perimenopause. Women usually enter perimenopause in their 40s and the following changes can occur:
- periods become irregular -- they become shorter, longer, lighter or heavier
- some symptoms associated with menopause, such as hot flashes, difficulty falling asleep or staying asleep, vaginal dryness and so on
Most research suggests that HIV-negative women who undergo perimenopause do so without experiencing mood disorders. However, some studies have found that women transitioning toward menopause have an increased risk for depression. This increased risk can occur even among women who have no history of mood disorders such as depression.
Focus on HIV
A team of researchers in the U.S. enrolled HIV-positive women and women at high risk of HIV infection and found that, regardless of HIV status, women undergoing perimenopause were at increased risk for experiencing symptoms of depression. In turn, the depression experienced by HIV-positive women affected their ability to take potent combination therapy for HIV (commonly called ART or HAART) exactly as directed. The research team encourages doctors and nurses to screen their female HIV-positive patients who are experiencing changes in their monthly cycles for depression and to offer them treatment if it is present.
The research team, part of the Women's Interagency HIV study (WIHS), enrolled women in 1994 to 1995 and again between 2001 and 2002 in the following American cities:
- Los Angeles
- San Francisco
- Washington DC
The researchers recruited HIV-positive and HIV-negative women of similar age, ethnicity, level of education and HIV risk factors (including injection of street drugs).
Between April 2007 and April 2008 the WIHS team incorporated surveys about menopause and mood. As part of the overall WIHS, every six months women were interviewed, underwent physical examinations and gave blood and other fluids for analysis.
For their study on menopause, researchers focused their analyses on 835 HIV-positive women and compared them to 335 HIV-negative women.
The WIHS team used the following terms and definitions:
- premenopause: "[periods] in the past three months with no changes in regularity"
- early perimenopause: "[periods] in the past three months with changes in regularity"
- late perimenopause: "no [periods] within the past three months but some menstrual bleeding within the past 12 months"
- post-menopausal: "no [periods] within the past 12 months"
The average profile of HIV-positive women when they entered the menopause sub-study was as follows:
- age: 45 years
- menopause status: premenopause 53%; early perimenopause 14%; late perimenopause 5%; post-menopausal 28%
- currently with a partner: 26%
- unemployed: 58%
- past substance use (crack, cocaine or heroin): 64%; "heavy alcohol" use: 32%
- CD4+ cell counts: more than 500 cells: 42%; between 200 and 50 cells: 42%; less than 200 cells: 16%
- proportion with a viral load less than 80 copies/ml: 50%
- proportion taking ART: 63%
- proportion of ART users taking 95% of doses as directed: 75%
- hepatitis C virus (HCV) infection: 35%
Results -- Depression
Rates of depression were the same (38%) among HIV-positive and HIV-negative women.
The distribution of depression by stage of menopause (regardless of HIV status) was as follows:
- premenopause: 33%
- early perimenopause: 47%
- late perimenopause: 42%
- post-menopause: 43%
Taking many biological and social factors into consideration, the researchers found that women undergoing early perimenopause, regardless of HIV status, had the most severe symptoms of depression. This was also the case when researchers restricted their analysis to HIV-positive women.
Here are some other findings:
- women who had less than 200 CD4+ cells reported more severe symptoms of depression compared to women with higher cell counts
- women who took ART exactly as directed had a lower risk of depression
- women not taking ART were four times as likely to have increased symptoms of depression compared to women who took ART
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