Affective illness onset in women during the pre-, peri-, and post-menopausal phases

Background: Many reports associate particular phases of the human reproductive cycle with psychiatric symptoms including depression, although details of associations of morbidity of depressive, bipolar, and anxiety disorders with pre-, peri-, and post-menopausal phases require further clarification. This naturalistic study evaluated the timing of onset and morbidity of mood and anxiety disorders in women during these menopausal phases. Methods: Women (N = 928) with a primary diagnosis of BD type I or II (BD1 or BD2), major depressive disorder (MDD) or an anxiety disorder were clinically evaluated after menopause to determine the onset of affective illness during the pre, peri-, or post-menopausal phases. Psychometric scales were used to assess affective illness and multivariable regression modeling was used to compare menopausal phases. Results: Many descriptive and clinical measures differed significantly with illnesses starting in the three menstrual phases. Women with onset of affective illness in the perimenopause phase spent 1.33 more time ill than those starting in the premenopausal phase and 1.46 more time ill than women with postmenopausal onset, with corresponding differences in illness episodes/year as well as suicidal risks. Conclusions: Study findings are consistent with the view that onset in the peri-menopausal phase may be associated with an excess of affective morbidity in both MDD and BD and that the post-menopausal phase may involve less morbidity.