Menopause-related estrogen fluctuations raise stress levels, postmenopausal depression increases diabetes and heart disease risk

Estrogen fluctuations associated with menopause raise the levels of and susceptibility to stress, while postmenopausal depression increases the risk of diabetes and heart disease. Estradiol (a form of estrogen) fluctuates during menopause transition, causing heightened emotional sensitivity to stress. When these hormonal changes overlap with a very stressful life event, the result is depressive mood.

Women are generally at a higher risk for depression than men. Some studies reveal the risk is as high as double. Earlier studies linked the increased likelihood of developing a depressive disorder with reproductive events, when hormones are in a greater fluctuation. Between 26 to 33 percent of women will experience depressive symptoms during perimenopausal hormonal flux.

The 12-month placebo-controlled randomized trial evaluated mood and cardiovascular benefits of transdermal estradiol in perimenopausal women. The findings of the study revealed that women who received a placebo experienced depressive symptoms along with greater anger and irritability. It should be noted, though, that the effects of fluctuating estradiol are not the same for all women, especially in the absence of a serious stressful life event. In these cases, depressive symptoms do not develop.

JoAnn Pinkerton, the executive director of The North American Menopause Society, said, “These results provide tremendous insight for practitioners. Clinicians need to understand the impact of perimenopausal hormonal fluctuations and the degree of stressful events that a woman is experiencing to determine the best treatment options when a middle-aged woman complains of depression or exaggerated irritability. This study provides a foundation for future studies to evaluate the value of psycho-social interventions, such as cognitive therapies, to lessen the effect of major life events, as well as the use of estrogen therapy during perimenopausal and menopausal stressful times.”

In postmenopausal women, depression may increase diabetes, cardiovascular disease risk

An alternative study revealed that postmenopausal women are at a higher risk for diabetes and cardiovascular disease. The results were higher for women who took antidepressants, had a higher body mass index (BMI), larger waist circumference, and inflammation. The study looked at whether elevated depressive symptoms and antidepressants are associated with biomarkers for glucose dysregulation and inflammation, BMI, or inflammation. The main findings indicate that antidepressant use is strongly associated with a higher BMI and waist circumference, and elevated depressive symptoms are tied to higher levels of insulin and insulin resistance.

Dr. Yunsheng Ma explained, “It may be prudent to monitor post-menopausal women who have elevated depression symptoms or are taking antidepressant medication to prevent diabetes and cardiovascular disease.”

Based on the analysis of data from1,953 postmenopausal women, the researchers concluded that elevated depressive symptoms were strongly associated with increased insulin levels. Women taking antidepressants also had a higher BMI and waist circumference, compared to the women not on antidepressants.

Dr. Ma continued, “Identifying these markers in women is important for diabetes prevention because they can be monitored for possible action before progression to full-blown diabetes.”

Dr. Simin Liu, investigator and coauthor, concluded, “Given that diabetes and cardiovascular disease can be effectively prevented or delayed in high-risk individuals with lifestyle modifications or pharmacological interventions, our findings indicate the prudence of monitoring BMI, waist circumference, along with established biomarkers for diabetes and cardiovascular risk including serum glucose, insulin resistance, and CRP [C-reactive protein] among women with elevated depression symptoms, or who are taking antidepressant medication, to prevent diabetes and cardiovascular disease. Further intervention trial is needed to confirm our findings and identify the specific patterns of change associated with diabetic and cardiovascular disease risk markers and individual antidepressants and depression.”