Skip to main content Accessibility help
Hostname: page-component-559fc8cf4f-qpj69 Total loading time: 0.608 Render date: 2021-02-26T11:08:41.915Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

Perimenopausal Mental Disorders: Epidemiology and Phenomenology

Published online by Cambridge University Press:  07 November 2014


Perimenopause, the interval of irregular menstrual activity which directly precedes menopause, is characterized by widely fluctuating hormone levels amidst a large-scale decline in circulating estrogen. This phase in a woman's life is typically accompanied by physical discomforts including vasomotor symptoms, such as headaches, insomnia, and hot flushes, as well as genital atrophy. Not surprisingly, studies suggest a significant increase in mood lability for women during this time. While some evidence points toward an exacerbation of bipolar mood symptoms and an increase in schizophrenic psychosis during perimenopause, the majority of research conducted on perimenopausal mental disorders has focused on unipolar depression. Studies vary widely in methodology, definitions of menopausal status, and degrees of depression among subjects; however, the majority of findings indicate an increased susceptibility to depression during the perimenopausal transition. This greater susceptibility may be due to neuroendocrine effects of declining estrogen levels, the subjective experience of somatic symptoms resulting from this hormonal decline, and/or the more frequent occurrence of “exit” or “loss” events for women during this stage of life. At this time, more research is needed to address questions of prevalence, risk, and etiology for depression and other major mental disorders as related to the physiological and psychosocial changes associated with perimenopause.

Review Articles
Copyright © Cambridge University Press 2005

Access options

Get access to the full version of this content by using one of the access options below.


1. Burt, VK, Altshuler, LL, Rasgon, N. Depressive symptoms in the perimenopause: prevalence, assessment, and guidelines for treatment. Harv Rev Psychiatry. 1998;6(3):121132.CrossRefGoogle Scholar
2. Avis, NE, McKinlay, SM. The Massachusetts Women's Health Study: an epidemiologic investigation of the menopause. J Am Med Womens Assoc. 1995;50(2):45-49, 63.Google Scholar
3. Avis, NE, McKinlay, SM. A longitudinal analysis of women's attitudes toward the menopause: results from the Massachusetts Women's Health Study. Maturitas. 1991;13(1):6579.CrossRefGoogle ScholarPubMed
4. McKinlay, SM, Brambilla, DJ, Posner, JG. The normal menopause transition. Maturitas. 1992;12:103115.CrossRefGoogle Scholar
5. Rapkin, AJ, Mikacich, JA, Moatakef-Imani, B, Rasgon, N. The clinical nature and formal diagnosis of premenstrual, postpartum, and perimenopausal affective disorders. Curr Psychiatry Rep. 2002;4(6):419428.CrossRefGoogle ScholarPubMed
6. Novaes, C, Almeida, OP, de Melo, NR. Mental health among perimenopausal women attending a menopause clinic: possible association with premenstrual syndrome? Climacteric. 1998;1(4):264270.CrossRefGoogle Scholar
7. Schmidt, PJ, Roca, CA, Bloch, M, Rubinow, DR. The perimenopause and affective disorders. Semin Reprod Endocrinol. 1997;15(1):91100.CrossRefGoogle ScholarPubMed
8. Freeman, MP, Smith, KW, Freeman, SA, et al. The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatry. 2002;63(4):284287.CrossRefGoogle Scholar
9. Hunter, MS. Somatic experiences of the menopause: a prospective study. Psychosom Med. 1990;52:357367.CrossRefGoogle Scholar
10. Collins, A, Landgren, BM. Reproductive health, use of estrogen and experience of symptoms in perimenopausal women: a population-based study. Maturitas. 1994;20:101111.CrossRefGoogle ScholarPubMed
11. Jaszmann, L, Van Lith, ND, Zaat, JCA. The perimenopausal symptoms: the statistical analysis of a survey. Med Gynaecol Sociol. 1969;4:268277.Google Scholar
12. McKinlay, SM, Jefferys, M. The menopausal syndrome. Br J Prev Soc Med. 1974;28(2):108115.Google Scholar
13. Ballinger, CB. Psychiatric morbidity and the menopause; screening of general population sample. Br Med J. 1975;3(5979):344346.CrossRefGoogle Scholar
14. Bungay, GT, Vessey, MP, McPherson, CK. Study of symptoms in middle life with special reference to the menopause. Br Med J. 1980;281(6234):181183.CrossRefGoogle Scholar
15. Matthews, KA, Wing, RR, Kuller, LH, et al. Influences of natural menopause on psychological charactersitics and symptoms of middle-aged healthy women. J Consult Clin Psychol. 1990;58:345351.CrossRefGoogle Scholar
16. Adelstein, AM, Downham, DY, Stein, Z, Susser, MW. The epidemiology of mental illness in an English city. Soc Psychiatry. 1968;3:4759.CrossRefGoogle Scholar
17. Weissman, MM, Myers, JK. Rates and risks of depressive symptoms in a United States urban community. Acta Psychiatr Scand. 1978;57(3):219231.CrossRefGoogle Scholar
18. Hallstrom, T, Samuelsson, S. Mental health in the climacteric. The longitudinal study of women in Gothenburg. Acta Obstet Gynecol Scand Suppl. 1985;130:1318.CrossRefGoogle Scholar
19. Kaufert, PA, Gilbert, P, Tate, R. The Manitoba Project: a re-examination of the link between menopause and depression. Maturitas. 1992;14(2):143155.CrossRefGoogle ScholarPubMed
20. Gordon, JH, Borison, RL, Diamond, Bl. Modulation of dopamine receptor sensitivity by estrogen. Biol Psychiatry. 1980;15:389396.Google Scholar
21. Ball, P, Knuppen, R, Haupt, M, Breuer, H. Interactions between estrogens and catechol amines. 3. Studies on the methylation of catechol estrogens, catechol amines and other catechols by the ctechol-O-methyltransferases of human liver. J Clin Endocrinol Metab. 1972;34(4):736746.CrossRefGoogle Scholar
22. Kumar, MS, Chen, CL, Muther, TF. Changes in the pituitary and hypothalamic content of methionine-enkephalin during the estrous cycle of rats. Life Sci. 1979;25(19):16871696.CrossRefGoogle ScholarPubMed
23. Guicheney, P, Leger, D, Barrat, J, et al. Platelet serotonin content and plasma tryptophan in peri- and postmenopausal women: variations with plasma oestrogen levels and depressive symptoms. Eur J Clin Invest. 1988;18(3):297304.CrossRefGoogle Scholar
24. Sherwin, BB, Suranyi-Cadotte, BE. Up-regulatory effect of estrogen on platelet 3H-imipramine binding sites in surgically postmenopausal women. Biol Psychiatry. 1990;28:339348.CrossRefGoogle Scholar
25. Cone, RI, Davis, GA, Goy, RW. Effects of ovarian steroids on serotonin metabolism within grossly dissected and microdissected brain regions of the ovariectomized rat. Brain Res Bull. 1981;7:639644.CrossRefGoogle Scholar
26. Biegon, A. Effects of steroid hormones on the serotonergic system. Ann N Y Acad Sci. 1990;600:426432.CrossRefGoogle ScholarPubMed
27. Meltzer, HY. Role of serotonin in depression. Ann N Y Acad Sci. 1990;600:486499.CrossRefGoogle ScholarPubMed
28. Schneider, LS, Small, GW, Hamilton, SH, et al. Estrogen replacement and response to fluoxetine in a multicenter geriatric depression trial. Fluoxetine Collaborative Study Group. Am J Geriatr Psychiatry. 1997;5:97106.CrossRefGoogle Scholar
29. Coiro, V, Volpi, R, Marchesi, C, et al. Abnormal serotonergic control of prolactin and cortisol secretion in patients with seasonal affective disorder. Psychoneuroendo crinology. 1993;18:551556.CrossRefGoogle ScholarPubMed
30. Dennerstein, L, Burrows, GD, Hyman, GJ, Sharpe, K. Hormone therapy and affect. Maturitas. 1979;1(4):247259.CrossRefGoogle ScholarPubMed
31. Ditkoff, EC, Crary, WG, Cirsto, M, Lobo, RA. Estrogen improves psychological function in asymptomatic postmenopausal women. Obstet Gynecol. 1991;78:991995.Google ScholarPubMed
32. Sherwin, BB, Gelfand, MM. Sex steroids and affect in the surgical menopause: a double-blind cross-over study. Psychoneuroendocrinology. 1985;10:325335.CrossRefGoogle ScholarPubMed
33. Aylward, M. Estrogens, plasma tryptophan levels in perimenopausal patients. In: Campbell, S, ed. The Management of the Menopause and Postmenopausal Years. Baltimore, MD: University Park Press, 1976:135148.CrossRefGoogle Scholar
34. Campbell, S. Double blind psychometric studies on the effects of natural estrogens on postmenopausal women. In: Campbell, S, ed. The Management of the Menopause and Postmenopausal Years. Baltimore, MD: University Park Press, 1976:149158.CrossRefGoogle Scholar
35. Montgomery, JC, Appleby, L, Brincat, M, et al. Effect of oestrogen and testosterone implants on psychological disorders in the climacteric. Lancet. 1987;1(8528):297299.CrossRefGoogle ScholarPubMed
36. Campbell, S, Whitehead, M. Oestrogen therapy and the menopausal syndrome. Clin Obstet Gynaecol. 1977;4(1):3147.Google ScholarPubMed
37. Strickler, RC, Borth, R, Cecutti, A, et al. The role of oestrogen replacement in the climacteric syndrome. Psychol Med. 1977;7(4):631639.Google ScholarPubMed
38. Thomson, J, Oswald, I. Effect of oestrogen on the sleep, mood, and anxiety of menopausal women. Br Med J. 1977;2(6098):13171319.CrossRefGoogle ScholarPubMed
39. Palinkas, LA, Barrett-Bonnor, E. Estrogen use and depressive symptoms in perimenopausal women. Obstet Gynecol. 1992;80:3036.Google Scholar
40. Wiklund, I, Holst, J, Karlberg, J, et al. A new methodological approach to the evaluation of quality of life in postmenopausal women. Maturitas. 1992;14:211224.CrossRefGoogle ScholarPubMed
41. Siddle, NC, Fraser, D, Whitehead, Ml, et al. Endometrial, physical and psychological effects of postmenopausal oestrogen therapy with added dydrogesterone. Br J Obstet Gynaecol. 1990;97:11011107.CrossRefGoogle ScholarPubMed
42. Schneider, MA, Brotherton, PL, Hailes, J. The effect of exogenous oestrogens on depression in menopausal women. Med J Aust. 1977;2:162163.Google ScholarPubMed
43. Klaiber, EL, Broverman, DM, Vogel, W, Kobayashi, Y. Estrogen therapy for severe persistent depressions in women. Arch Gen Psychiatry. 1979;36(5):550554.CrossRefGoogle ScholarPubMed
44. Schmidt, PJ, Nieman, L, Danaceau, MA, et al. Estrogen replacement in perimenopause-related depression: a preliminary report. Am J Obstet Gynecol. 2000;183(2):414420.CrossRefGoogle ScholarPubMed
45. 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;58(6):529534.CrossRefGoogle ScholarPubMed
46. Rasgon, NL, Altshuler, LL, Fairbanks, LA, et al. Estrogen replacement therapy in the treatment of major depressive disorder in perimenopausal women. J Clin Psychiatry. 2002;63(suppl 7):4548.Google ScholarPubMed
47. Shapira, B, Oppenheim, G, Zohar, J, et al. Lack of efficacy of estrogen supplementation to imipramine in resistant female depressives. Biol Psychiatry. 1985;20(5):576579.CrossRefGoogle ScholarPubMed
48. Schmidt, PJ, Nazli, H, Rubinow, DR. A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. Am J Psychiatry. 2004;161(12):22382244.CrossRefGoogle ScholarPubMed
49. Hay, AG, Bancroft, J, Johnstone, EC. Affective symptoms in women attending a menopause clinic. Br J Psychiatry. 1994;164(4):513516.CrossRefGoogle ScholarPubMed
50. Porter, M, Penney, GC, Russell, D, et al. A population based survey of women's experience of the menopause. Br J Obstet Gynaecol. 1996;103(10):10251028.CrossRefGoogle ScholarPubMed
51. Lindamer, LA, Lohr, JB, Harris, MJ, Jeste, DV. Gender, estrogen, and schizophrenia. Psychopharmacol Bull. 1997;33(2):221228.Google Scholar
52. Andia, AM, Zisook, S, Heaton, RK, et al. Gender differences in schizophrenia. J Nerv Ment Dis. 1995;183(8):522528.CrossRefGoogle Scholar
53. Riecher-Rossler, A, Hafner, H, Stumbaum, M, et al. Can estradiol modulate schizophrenic symptomatology? Schizophr Bull. 1994;20(1):203214.CrossRefGoogle ScholarPubMed
54. Riecher-Rossler, A, Hafner, H, Dutsch-Strobel, A, et al. Further evidence for a specific role of estradiol in schizophrenia? Biol Psychiatry. 1994;36(7):492494.CrossRefGoogle Scholar
55. Hallonquist, JD, Seeman, MV, Lang, M, Rector, NA. Variation in symptom severity over the menstrual cycle of schizophrenics. Biol Psychiatry. 1993;33(3):207209.CrossRefGoogle ScholarPubMed
56. Kendell, RE, Chalmers, JC, Platz, C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150:662673.CrossRefGoogle ScholarPubMed
57. Seeman, MV. Interaction of sex, age, and neuroleptic dose. Compr Psychiatry. 1983;24(2):125128.CrossRefGoogle Scholar
58. Gattaz, WF, Vogel, P, Riecher-Rossler, A, Soddu, G. Influence of the menstrual cycle phase on the therapeutic response in schizophrenia. Biol Psychiatry. 1994;36(2):137139.CrossRefGoogle Scholar
59. Kulkarni, J, de Castella, A, Smith, D. Adjunctive estrogen treatment in women with schizophrenia. Schizophr Res. 1995;15:157.CrossRefGoogle Scholar
60. Lindamer, LA, Buse, DC, Lohr, JB, Jeste, DV. Hormone replacement therapy in postmenopausal women with schizophrenia: positive effect on negative symptoms? Biol Psychiatry. 2001;49(1):4751.CrossRefGoogle ScholarPubMed

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 58 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 26th February 2021. This data will be updated every 24 hours.

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Perimenopausal Mental Disorders: Epidemiology and Phenomenology
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Perimenopausal Mental Disorders: Epidemiology and Phenomenology
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Perimenopausal Mental Disorders: Epidemiology and Phenomenology
Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *