Although mood disorders and depression may occur at any age during a woman's life, women seem to more vulnerable during times of hormonal fluctuations such as the menstrual period, pregnancy and perimenopause, according to a report released by the Society for Women's Health Research in November.
During times of hormonal flux, many women are able to emerge relatively unscathed. But for others, a normal hormonal transition can trigger mild to severe mood disorders including depression and bipolar disorder. "Science has revealed clues as to why these changes may occur in some women," says Peter Schmidt, M.D., an investigator in the National Institute of Mental Health's Reproductive Endocrine Studies Unit, "but further research is needed to definitively show what causes depression and mood disorders in women during hormonal transitions."
The Society for Women's Health Research and the National Institute for Mental Health convened a thought leaders' roundtable in June to discuss current efforts to understand the effects of hormonal transitions, specifically pregnancy, postpartum, and perimenopause, on the occurrence of mood disorders in women. The report outlines the participants' views.
Roundtable participants observed that postpartum depression affects roughly 10 to 15 percent of women up to one year after childbirth, but the exact cause is not known. Some scientists believe that chemical changes in the brain may be caused by the shifts in hormone levels during pregnancy and the post-partum period, leaving women vulnerable to depression. Other life cycle changes in a woman's life such as perimenopause where hormones are shifting may produce similar emotional disturbances.
Scientific research conducted by Schmidt, David Rubinow, M.D., at the University of North Carolina at Chapel Hill, and their colleagues illustrated the effect of hormones on human mood by shutting down the ovarian cycle in an attempt to eliminate the symptoms of premenstrual syndrome. After two to three months of ovarian suppression, the study participants' problematic mood symptoms were greatly reduced. The researchers concluded that when reproductive hormones are removed, premenstrual symptoms or PMS disappears.
Despite our present understanding of the effects hormones have on a person's state of mind, more research is needed. According to the roundtable report, more studies are needed to better distinguish between the normal response to life cycle changes and the symptoms of depression. In addition, more research is needed to figure out why some women are more susceptible to depression during hormonal transitions than others.
In conjunction with the report, the Society for Women's Health Research revealed the results of a recent national survey polling doctors and their patients. The survey shows that many women underestimate their risk of depression and mood disturbances during hormonal transitions.
"Women need to be critically aware of changes in their moods during key life cycle events," Sherry Marts, Ph.D., and vice president of scientific affairs for the Society. "The roundtable began a much needed discussion about the relationship between hormonal transitions and mood disorders. Through the media briefing and the publishing of this report we hope to generate a broader understanding of how we can use this knowledge to improve health outcomes for women."
Berman KF, Schmidt PJ, Rubinow D, et al. Modulation of cognition-specific cortical activity by gonadal steroids: A positron-emission tomography study in women. Proc Natl Acad Sci 1997; 94: 8836-8841.
Schmidt PJ, Nieman LK, Danaceau MA et al. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. New Engl J Med 1998; 338: 209-16.
November 30, 2007 Society for Women's Health Research