Date of Award

Spring 2023

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Staveteig, Mindy

Keywords

menopause transition, perimenopause, depression, antidepressants, hormone replacement therapy, estradiol fluctuation, depression screening, hormones, perimenopausal depression, SSRIs, climacteric

Abstract

During the menopause transition (MT), also known as perimenopause, women are at a significantly increased risk of depression. Although the pathophysiology is not fully understood, it is likely to be complex and multifactorial. Data evaluating the involvement of HPA axis dysregulation and correlating female reproductive hormone fluctuations, specifically estradiol, are factors that may contribute to this incidence. Currently antidepressants are the treatment for depression but with biological changes occurring during perimenopause, hormone replacement therapy alone or in combination may have comparable antidepressant effects. The combination of menopause symptoms, depressive symptoms, and psychosocial challenges, make recognition and treatment depend on many variables. Perimenopausal depression is a unique subtype of depression that should be screened with specific criteria to represent the varying symptoms experienced. Since it is an underrecognized and undertreated condition, clinicians in contact with this population, commonly OBGYNs and primary care providers, should routinely screen these women with appropriate measures to adequately initiate effective treatment. The current review summarizes relevant literature regarding perimenopausal depression prevalence, predictors/etiology, screening modalities, and appropriate treatment between antidepressants and/or hormone replacement therapy. References were searched using electronic search databases PubMed and Embase using keywords and similar articles. Articles were excluded if they did not assess the specific population of perimenopause or if it did not primarily focus on depression. Results are mixed regarding the most efficacious treatment between HRT, antidepressants, or both, but all have shown promising benefits and may need specific screening to identify the main contributors to further tailor treatment.

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