From the Editor

Is menopause associated with an increased risk of depression?

Professor and Director, Division of Reproductive Endocrinology, Department of Ob/Gyn and Women’s Health, Albert Einstein College of Medicine, Bronx, New York

New, thought-provoking data presented by Drs Harsh, Schmidt, and Rubinow describe the prevalence and presentation of depression in women during perimenopause and menopause in this issue of Menopausal Medicine.

Many of us expected the latest observational studies to show that women with prior hormone-related depression would comprise the chief risk pool for perimenopausal and menopausal depression. Instead, 3 observational studies suggest a complex picture: The Harvard Study of Moods and Cycles, The Penn Ovarian Aging Study, and The Study of Women’s Health Across the Nation (SWAN) indicate that many of the women who have major depression do not have a prior history.

Perhaps clinicians should view their patients in a new light. Why? Because we often assume that women of a certain age are able to detect the signs and symptoms that suggest they may have menopause-related depression. Evidently, that is not the case. Patients who experience new onset of depression may lack the vocabulary to accurately communicate their symptoms and resultant distress. Clinicians need to look beyond the superficial symptoms that patients may mention in order to make the correct diagnosis.

Also in this issue, Drs Sites and McKinney explore another complex relationship between menopause and the metabolic syndrome. They discuss how each symptom of the metabolic syndrome—increased blood pressure, elevated insulin levels, excess body fat around the waist, or abnormal cholesterol levels—develop gradually in an aging individual. Menopause and its accompanying loss of estrogen worsen these components.

We need to help our menopausal patients meet the challenge of preventing central adiposity. Physical activity and dietary control of fat and total caloric intake are the cornerstones of current treatment. Again, the clinician must help patients recognize their health risks and encourage the necessary, often difficult, lifestyle modifications and medications needed to live a longer, healthier life.

In these, as in so many other cases, clinicians must take on the role of educator as well as physician. We can never assume that our patients know too much.

Sexuality, Reproduction & Menopause ©2008 Quadrant HealthCom Inc.