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CLINICAL REVIEW: Helen Roberts Managing the menopause BMJ 2007; 334: 736-741 [Full text]

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Letter to the Editor - Management of Menopause

Robert Colebunders, Verena Renggli   (30 April 2007)

Letter to the Editor - Management of Menopause 30 April 2007
Robert Colebunders, Head HIV/STD Unit Clinical Science Department Insititute of Tropical Medicine, Antwerp, Verena Renggli Send response to journal: Re: Letter to the Editor - Management of Menopause	We read with interest the clinical review by Helen Roberts about managing the menopause (1). We would like to comment, however, about the author’s statement that “evidence from longitudinal studies does not suggest that mood symptoms are increased at menopause”. This statement is misleading. Indeed, in nearly all cohort studies an increase in mood changes and even depression in the peri-menopause was noted. However, in certain studies this was considered not to be a direct effect of the menopause itself (2, 3). Other studies have suggested a clear relationship between mood changes and the menopause (4, 5). In a study by Cohen LS et al, pre-menopausal women with no lifetime history of major depression who entered the peri-menopause were twice as likely to develop significant depressive symptoms as women who remained pre-menopausal, after adjustment for age at study enrolment and history of negative life events (4). In another population based cohort study among women with no history of depression, a diagnosis of depressive disorder was 2 1/2 times more likely to occur in the menopausal transition period compared with the pre- menopausal period (5). Moreover, in the latter study a depressed mood was strongly associated with a change in the hormonal milieu. In different studies, the prevalence of mood symptoms varied from 11 to 21 percent in the peri-menopause (6). The fact that estrogen replacement was shown in certain clinical trials to be beneficial for the treatment of menopausal mood symptoms, also suggests the causal relationship between mood changes and the menopause (7). Recognising these mood disorders as a normal phenomenon during the peri- menopause is important for the management of this condition. Indeed, in most women such mood changes will not be related to an underlying psychiatric problem and does not require any anti-depressive nor hormonal treatment. For peri-menopausal women, their partners and family it is important to know that such mood changes may appear but that they will disappear spontaneously after a while. Colebunders R 1,2; Renggli V 1 - 1. Institute of Tropical Medicine, Antwerp, Belgium 2. University of Antwerp, Antwerp, Belgium No conflict of interest References 1. Roberts H. Managing the menopause. BMJ. 2007 Apr 7;334(7596):736-41. 2. Avis NE, Brambilla D, McKinlay SM, Vass K. A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women's Health Study. Ann Epidemiol. 1994 May;4(3):214-20. 3. Khan SA, Pace JE, Cox ML, Gau DW, Cox SA, Hodkinson HM. Climacteric symptoms in healthy middle-aged women. Br J Clin Pract 1994; 48: 240–42 4. Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry. 2006 Apr;63(4):385 -90. 5. Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2006 Apr;63(4):375-82. 6. NIH State-of-the-Science Conference Statement on Management of Menopause-Related Symptoms. NIH Consensus and State-of-the-Science Statements Volume 22, Number 1 March 21–23, 2005 7. Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry. 2001 Jun;58(6):529-34. Competing interests: None declared