SWAN Researchers Evaluate the Risk for Elevated Depressive Symptoms in Postmenopause

It was previously thought that symptoms of depression would lessen after a woman’s final menstrual period (FMP). This study shows that it not only doesn’t lessen, but can increase after the FMP. It also states that depressive symptoms tend to be highly consistent over midlife. The data identified groups of women that share similar courses of depressive symptoms and demonstrate their patterns and persistence over time. This helped the researchers assess the relative contribution of chronological age that may be associated with health, lifestyle and/or environmental factors.

In the SWAN cohort, which is a large community sample from seven U.S. sites including 1,551 participants, three patterns of pre-final menstrual period FMP depression scores were found: consistently low scores (47.7%), moderate level scores that were below the threshold for clinically important symptoms (39.9%), and consistently high scores (12.4%). These three patterns were used to predict post-menopausal (post-FMP) depressive symptom scores. The main findings were:

1. 1. Compared to premenopause, postmenopause remains a period of increased risk for higher depressive symptoms, especially for women with pre-FMP depressive symptoms.
   2. The pre-FMP patterns of depressive symptoms were highly predictive of post-menopause depressive symptom scores, especially among women who had consistently high levels of depressive symptoms prior to the FMP.
   3. These results suggest that during the early post-menopausal years, self-reported levels of depressive mood do not necessarily decrease for women who have had high or moderate depressive symptom levels before their FMP, as had been previously thought, and depressive symptoms tend to be highly consistent over midlife.

The research, published in the March 2022 issue of the journal Menopause, is important because the menopausal transition (MT) is the time in midlife when women begin to experience menopausal changes and a time in their reproductive life cycle when they are more vulnerable to developing depressive symptoms, especially just before their FMP. Depressive symptoms can affect up to a quarter of women even prior to the MT.

Women with pre-FMP depressive symptoms should be attuned to the mounting stressors or other psychological or physical challenges to which they may be exposed. They should recognize that exposure to stressful environmental factors and/or if they have had earlier episodes of depression when premenopausal and early perimenopausal (or a family history of depression), they may be at greater risk for elevated depressive symptoms when they are postmenopausal. When possible, they should adopt healthy behaviors and preventive practices to reduce stress. Getting help could include telling their healthcare provider about depressive symptoms, or being assessed for treatment by qualified behavioral healthcare providers for depressive symptoms. They should also be aware that depressive symptoms commonly are associated with or preceded/heralded by anxiety symptoms, which may be an important “heads-up” signal.