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Menopausal depression may be prevented by hormone therapy

15 February 2018

Many women experience low mood, anxiety and depressive symptoms around the time of the menopause. A recent randomised trial compared the effect of either placebo or HRT on depression scores in 172 perimenopausal or early postmenopausal women, studied over 12 months. The women, who were not depressed at the start of the study, were aged 45 to 60 and were randomly allocated to take either an estrogen patch and cyclical progesterone tablet, or placebo patch and tablet. A depression scale scoring system was used at baseline and at intervals throughout the study.

During the study, 25% of women developed a high depression score, which is the proportion in whom this would be expected, but the risk was halved in women taking hormone therapy. The results were significant regardless of whether or not symptoms such as flushes were treated, suggesting that there may be a direct effect on mood benefit rather than this being a secondary effect to controlling other symptoms.

Further, women who had experienced recent life stresses and those early in the menopausal transition, appeared to benefit most from hormone therapy.

The NICE guideline on diagnosis and management of menopause, published in 2015, did recommend that HRT should be offered for both vasomotor symptoms and psychological symptoms of the menopause, yet many women are still offered antidepressants first line. This small study adds more strength to understanding that hormone therapy has an important role in relation to menopausal depression, but more information is needed before hormone therapy is offered for prevention, rather than just treatment.


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