Depression in a middle aged woman should not automatically be blamed on the menopause

The linking of the menopause with depression is pervasive in lay and medical discourse, despite limited supporting evidence. Historically, myths relating to menstrual taboos, as well as attitudes towards fertility and aging, have produced an image of the menopause as a time of physical and emotional decline. In the 19th century the menopause was thought to cause insanity, and it was only as recently as 1980 that the diagnosis of involutional melancholia was removed from the third edition of the Diagnostic and Statistical Manual of Mental Disorders.1 With the development of hormone replacement therapy, treatment of menopausal women shifted from the domains of psychiatry and psychoanalysis to gynaecology and endocrinology.

Initially prescribed for the treatment of vasomotor symptoms, hormone replacement therapy is now recommended for preventing osteoporosis and cardiovascular disease and improving quality of life.2 In the past few years interest has increased in the possible psychoactive properties of hormone replacement therapy. It has been proposed that oestrogen might cure “menopausal depression” and that it might offer an additional bonus of increased wellbeing or quality of life for non-depressed, healthy women.

Defining the menopause as an oestrogen deficiency disease implies that the cause of depression lies in a woman's hormones. This has important implications for the way middle aged and older women's views and behaviours are perceived in …