We asked our newsletter subscribers what content they liked best and 75% chose, “the latest scientific research from journals explained in plain language”. So, today, we bring you some of that!
Three things to keep in mind:
1. Research on women’s health from 35-55 is relatively new. It wasn’t until the 1990s that there was a focus on women’s health research. So just how hormonal patterns change from our mid-30s until we reach our final menstrual period — around 50 — and what impact those changes have on our bodies and minds isn’t well understood. This surprised us! And it explains why healthcare providers often don’t have the answers we are seeking.
2. Careful interpretation of research is important. Too often, the mainstream media take the results of research and go beyond what the study has shown for the sake of an exciting headline that will lead to clicks. WLB takes the time to distill research into laywoman’s terms and we are careful to test our interpretation with our WLB advisors/experts.
3. Our aim is relevance without reaching. We try to surface insights that are relevant and useful in your day-to-day life without overinterpreting the implication of research. A bit of a tightrope walk, for sure, and not always terribly exciting, but we prefer substance to sizzle.
The Experts
In creating this post, we sought the advice of two WLB advisors, Dr. Nancy Woods and Dr. Marcie Richardson.
Dr. Woods is the Dean Emerita at the University of Washington School of Nursing. She has spent the last 40 years conducting research on midlife women’s health — publishing close to 300 papers on the topic. She was a founder of the Seattle Midlife Women’s Health Study, one of two studies that started studying women at 35, not 45 (we think that’s really important)! We are lucky to have her involved in so much of what we do at WLB.
We are also incredibly lucky to get a clinician’s perspective from Dr. Marcie Richardson who has supported thousands of women as they’ve traversed the menopausal transition. Dr. Richardson has been an ObGyn for the past 40 years, focusing on menopause for the past 25. She is the Director of the Atrius Health Menopause Clinic in Boston and is an Assistant Clinical Professor at Harvard Medical School.
The research we share today looks at the relationship between changing hormonal patterns and depressive symptoms in midlife women.
The Study
Dr. Hadine Joffee, a clinician and researcher at the Brigham and Women’s Hospital in Boston, and her colleagues looked into what might cause depressive symptoms in women during perimenopause also know as the menopausal transition1. Investigators studied 50 women between the ages of 35-56 years who were experiencing menstrual cycle irregularity – that is consecutive cycles that varied by 7 days or more. Researchers selected participants who revealed, via questionnaire, that they experienced mild-to-moderate depressive symptoms but were not in a severe depressive episode. Additionally, potential participants were screened for conditions likely to cause menstrual irregularity, severe depression, or other serious mood or substance use disorders, and were excluded from the study.
Joffe’s group looked at estrogen levels and progesterone levels measured once a week for 8 weeks and daytime and nighttime hot flashes that women rated in a daily diary.
The Findings
We learned two things from this study. First, fluctuations in estrogen and low levels of progesterone resulting from anovulation (not ovulating) were associated with more severe depressive symptoms. Second, the frequency of daytime and night-time hot flashes was not related to the severity of depressive symptoms, as was found in some previous research.
This is the first study to link varying levels of both estrogen and progesterone to the severity of depressed mood. To date, much of the research about women’s hormones in relation to symptoms has focused on the role of estrogen. For over 70 years clinicians and researchers attributed depressive symptoms to a loss of estrogen.
Recent studies of women’s hormonal patterns in the years prior to the final menstrual period have shown estrogen levels can be chaotic — both higher and lower than those seen when women are younger 2,3. This study shows that these fluctuations in estrogen are associated with depressive symptoms. But, levels of progesterone matter too. Almost all of a woman’s progesterone is produced by ovulation. When a woman does not ovulate, progesterone levels are low. Again, Joffe’s group found both fluctuating estrogen and low progesterone levels were more present in those women having more severe depressive symptoms. Understanding that progesterone levels matter to women’s experience of depressive symptoms could have implications for future treatments.
Things we hope to see in future studies
Additional symptoms: In this study, only depressive symptoms were examined. It would be interesting to see — and we will be on the lookout for — a study like this one that looks at the relationship of changing estrogen and progesterone levels to two other highly reported mood symptoms — irritability and anxiety/feelings of being overwhelmed.
Earlier timeframe: Another thing to note, this study was conducted in women who already had cycle irregularity. It would be interesting to see the study replicated in women who have periods that are coming regularly but starting to come closer together (shortening cycles). This menstrual change — the shortening of cycles — often marks the beginning of hormonal changes associated with the earliest part of the menopause transition and our guess is mood changes would be identified during this time as well.
Delve deeper
Here is a video in which Dr. Richardson talks about the earliest changes. At that same link, you can learn more about the hormonal changes that happen and other symptoms women experience.
Sources:
1. Joffe, H, de Wit, A, Coborn, J, et al. Impact of Estradiol Variability and Progesterone on Mood in Perimenopausal Women With Depressive Symptoms. J Clin Endocrinol Metab, March 2020, 105(3):e642–e650
2. Hale GE, Robertson DM, Burger HG. The perimenopausal woman: endocrinology and management. J Steroid Biochem Mol Biol. 2014; 142:121–131.
3. Butler L, Santoro N. The reproductive endocrinology of the menopausal transition. Steroids. 2011; 76 (7):627–635.
