Women who experience an early menopause are at a significantly higher risk of depression, according to a study based on the largest Canadian data sample to date.
Dr. Alison Shea, an obstetrician and gynecologist at St. Josephs Healthcare Hamilton, led the study which was published in Menopause.
The most striking finding was that those who had an early menopause so before age 40 had a significantly higher risk for depression, she said. Theres more than a doubling of depression risk for these women.
The research used baseline data from 13,216 women aged 45 to 64 collected as part of the Canadian Longitudinal Study on Aging.
In North America, the average age a woman experiences menopause is 51.
The main theory behind the higher risk for depression has to do with estrogen levels, said Dr. Shea, who is a specialist in menopause and reproduction mental health. Women who are exposed to estrogen longer from an earlier period and a later menopause have a lower risk of depression later in their life.
There could be social factors, too.
Menopause is a loss of reproductive function, Dr. Shea said. That loss is profound for many women. She noted that whether women have had their own children before the onset of menopause is also a significant factor for their mental health.
The study also found that women who had an early menopause were also more likely to experience depression if they had low education, low income, no children, lived alone, and had little social support.
While some factors such as ovary removal, radiation, chemotherapy, and smoking can cause people to experience menopause early, in most cases, the reason for early menopause is unknown, said Dr. Shea, noting that it is believed to be related to auto-immune mechanisms.
She noted that the research can help health practitioners identify women at risk of depression for hormone replacement therapy, which she said not all doctors do.
Its astounding how many women I see in my menopause clinic who they had lost their period at 41 and Im not seeing them until 48. They had all those years of not having any hormones, Dr. Shea said. Some family doctors are attuned to this, but others are not.
Ideally, women should begin hormone replacement therapy four to six months after a woman stops having her period, but Dr. Shea said most women dont get treatment until they reach the average age of menopause. She noted doctors can refer patients to a gynecologist or a menopause specialist if theyre not comfortable prescribing hormones directly.
Women who may not have begun therapy right away should still speak to a gynecologist, Dr. Shea said, adding that hormone therapy can begin within 10 years of the onset of menopause.
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She noted that without hormone replacement, women are at a higher risk for other diseases, including heart disease and osteoporosis at an earlier age.
The study also found that those who were using hormone therapy had a higher risk for depression, but Dr. Shea said the depression was likely attributed to more severe symptoms of menopause, rather than the hormone therapy itself.
We know that the number one reason for hormone therapy is hot flashes, she said. Hot flashes in the menopause time are a very strong risk factor for depression. Its their more severe menopausal symptoms that are driving their depression rather than the hormone therapy.
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