I’m not sure what was worse: the immediate shock
of learning I was in premature menopause or the low-grade depression that I
slumped into in the weeks afterward. I think I was numb for a day or two, then
the reality hit me like a wall. I kept trying to push my emotions aside,
telling myself I could handle it, that it wasn’t that bad. But I couldn’t stop
the grief about being suddenly infertile, the fears about my health, and all
the questions that kept rattling around in my head: Was I still sexy? Was I
old? Was I attractive? Was I still a real woman? I didn’t feel like me any
more. . .
(The Premature Menopause Book, by Kathryn
Petras)
Early menopause and POF bring with it a wrenching
emotional change along with the physical one. Yes, your emotions are inevitably
affected by the shifting hormones in your body. And the reality of your
condition affects your emotions even more. Not surprisingly, a recent, study
conducted in London found that premature menopause was substantially associated
with higher than average levels of depression. The single most upsetting
element of premature menopause, according to all the women surveyed, was the
most basic: Their loss of reproductive capacity. It did not make a difference
if they had children or not -- or even if they had been trying to have
children. The sudden switch from fertile woman to irrevocably infertile woman
was the biggest blow of all.
Other studies also revealed the causal relationship
between premature menopause and chance of clinical depression later in life.
The risk for postmenopausal depression is decreased with
later age at menopause, supporting evidence of potential anti-depressive
effects associated with longer exposure to endogenous estrogens, latest meta-analysis
suggests.
"Our analysis showed that overall, increasing age at
menopause by 2 years decreases the postmenopausal risk by 2% (per 2-year
increment)," admitted lead author Eleni Th Petridou, MD, PhD, of the
National and Kapodistrian University of Athens, in Greece.
"Considering that age at menopause may differ among
women up to 20 years, the cumulative protective effect becomes quite
sizeable."
The meta-analysis included 14 studies involving 67,714
women; results showed that increasing age at menopause was linked with a
reduction in the odds ratio for depression per 2-year increment. Similar
reductions were seen with a longer duration of the reproductive period.
In looking at three studies involving severe depression,
which included 52,736 participants, the effect was greater: there was a 5%
decrease in the risk for severe depression with each 2-year increase in age at
menopause. Three studies that controlled for past depression also showed
decreases in subsequent depression with older age at menopause.
Four studies, involving 3033 participants, showed that
menopause at age 40 years or later was associated with a 50% decreased risk for
depression compared with menopause occurring in women younger than 40 years.
Studies that included women with surgically induced
menopause were not included in the meta-analysis, but the authors said the
findings were "in accordance with previous studies reporting that early
menopause due to oophorectomy increases the risk of depression later in
life."
Importantly, the association of increased postmenopausal
depression with earlier menopause remained consistent after controlling for use
of hormone replacement therapy (HRT) ― in the seven studies (56,813 cases) in
the analysis that included HRT data, the proportion of patients having ever
received HRT varied between 20% and 45%. There were no significant differences
in the results in those patients.
"It seems that HRT use does not offset the odds of
depression," Dr Petridou said. "It should be noted, however, that
other endogenous sex hormones, such as progesterone, might also be implicated
in the protection conferred against postmenopausal depression."
The findings appear to underscore a neuroprotective role
of circulating estradiol, which some studies have shown "acts in neurons
and glial cells via the intracellular estrogen receptors α and β, as well as
[having] antiatherogenic actions including enhancement of endothelial function,
blockage of smooth muscle cell proliferation, and inhibition of
inflammation," the authors write.
In terms of prevention of the potential loss of those
benefits, as a result of early menopause, clinicians should monitor those
patients, and research should continue to focus on refining HRT, Dr Petridou
said.
"The findings of the current meta-analysis point to
women with a premature menopause as a high-risk group for selective depression
screening and close mental follow-up to identify depressive symptomatology
earlier and treat it more effectively," Dr Petridou said.
Furthermore, randomized, controlled studies should be
aimed at preventing postmenopausal depression with new and targeted sex HRTs,
she added.
"The significant differences of exogenously
administered sex hormones should be seriously considered in new studies to come
up with safer HRT conferring also anti-depressive protection of endogenous sex
hormones."
In an editorial, that accompanied the study, Hadine Joffe,
MD, director of the Division of Women's Health, Brigham and Women's Hospital,
in Boston, Massachusetts, and Joyce T. Bromberger, PhD, of the University of
Pittsburgh, note, that early menopause has been already associated in previous
researches with a variety of non-psychiatric diseases, including cardiovascular
disease, cognitive decline, and dementia, and that the new analysis underscores
the risk for depression.
"The current article adds postmenopausal depression
to that list, with findings that show similarly that the effect of a slightly
early natural menopause is small, while the effect of premature menopause is
much stronger," they say.
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