Abstract
Menopause is a natural event, which women experience around age 50. It is defined as the final menstrual period and is preceded by many years of “menopausal transition” associated with marked biological, especially hormonal, changes. Although it is a physiological process, especially the fluctuations and final loss of estrogen activity may have a negative impact on mental well-being; lead to vasomotor symptoms, sleep disturbances, sexual problems, cognitive decline, and depressive symptoms; and may even contribute to an upsurge in the incidence of severe mental disorders such as depressive disorders or schizophrenic psychoses. In addition to these biological changes, for women this phase of life is often burdened with numerous psychosocial stressors, role changes, losses, and the experience of aging.
This has many implications for the clinic and for research. In the clinic the specific diagnostic and therapeutic needs of women of this age group have always to be taken into account. Appropriate treatment strategies should not only include specific psychotherapeutic and psychosocial interventions but also consider estrogen replacement where indicated in addition to standard psychiatric care. The latter of course has always to be based on a thorough individual risk-benefit assessment and decided on in close cooperation with gynecologists and the well-informed woman herself.
While many studies suggest a benefit in perimenopausal depression, there still is a lack of well-designed studies on the indications and contraindications of estrogen replacement in perimenopausal women at risk for or suffering from other mental disorders. Further research is needed, especially regarding perimenopause and schizophrenic psychoses, the relative risk of hormone replacement as compared to treatment with psychoactive drugs or the best augmentation strategies. Last but not least, we need more research on psychotherapies addressing the specific needs of women of this age group.
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Riecher-Rössler, A. (2019). Menopause and Mental Health. In: Chandra, P., Herrman, H., Fisher, J., Riecher-Rössler, A. (eds) Mental Health and Illness of Women. Mental Health and Illness Worldwide. Springer, Singapore. https://doi.org/10.1007/978-981-10-0371-4_9-1
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