If Menopause Is Getting You Down, Estrogen May Help Pick You Up
June 21, 2001 -- Estrogen replacement therapy in women approaching menopause is believed to be protective against heart disease and the bone thinning that causes osteoporosis. Now there is growing evidence that the female hormone acts as a powerful antidepressant in these women too.
A study from Brazil found that estrogen patches relieved depression in women between the ages of 40 and 55 who were just beginning to experience menopausal symptoms. It is one of several recent studies suggesting that estrogen therapy can positively affect mood fluctuations associated with the condition once known as "the change of life."
"Premenopausal and postmenopausal women don't have the hormonal chaos that women have as they approach menopause and begin to have symptoms like night sweats, hot flashes, and irregular periods," study author Claudio de Novaes Soares, MD, PhD, tells WebMD. "We believe this hormonal chaos really works as a trigger for depression. Studies suggest that women with a history of severe PMS or postpartum depression are more vulnerable to depression during this period."
In this study, in the June Archives of General Psychiatry, Soares and colleagues included 50 women who were experiencing clinical depression and the early symptoms of menopause known as perimenopause. Half of the women in the study wore estrogen patches for three months, and the other half wore placebo patches. Four weeks after stopping therapy, almost 70% of the women receiving the active treatment showed remission from depression, compared to just 20% of the women who did not receive estrogen.
"After they stopped using estrogen many women had a relapse of their physical symptoms, but they remained well in terms of depression," Soares says. "This suggests that depression associated with menopause isn't just a reaction to physical symptoms like not sleeping well or hot flashes, but is a separate thing."
Soares, who is now the director of clinical trials for Massachusetts General Hospital's Center for Women's Mental Health, says perimenopausal women who are depressed, but have no history of depression, may want to try estrogen therapy before beginning antidepressants.
"Women who have moderate to severe depression, and a history of severe depression, probably need both estrogen and antidepressants as they go through menopause," he says. "But other women might do very well on estrogen alone."
Diana L. Dell, MD, of Duke University Medical Center in Durham, N.C., is trained in both obstetrics and gynecology and psychiatry. She says she often uses estrogen alone to treat menopausal patients who list depression as one of their symptoms.
Dell adds that far too few women who are approaching menopause take hormone replacement therapy, mainly because they perceive the risks to be greater than the benefits. Studies have linked estrogen to an increased risk of breast, uterine and other cancers, but most doctors believe the protective benefits of estrogen replacement outweigh these risks.
"I don't know of any other preparation that women have more ambivalent feelings about," she says. "Even women who initiate estrogen therapy because of menopausal symptoms often stop using it without telling their doctors. In my practice, I talk to my patients about their fears. When you give them all the information, and they participate in the decision, most patients keep taking it."