A study from colleagues at the National Centre for Mental Health and Cardiff University finds that perimenopause is associated with an increased risk of developing bipolar disorder and major depressive disorder.
What is the perimenopause?
Perimenopause describes the transitional time surrounding the final menstrual period. The timing and experience of menopause varies widely between individuals. Common symptoms include hot flashes, vaginal dryness, and night sweats, although some people experience no symptoms at all.
Experiences of women inspire research study
The study of 128,294 individuals, conceived and led by Professor Arianna Di Florio, found that participants were over two-times more likely to develop bipolar disorder for the first time during, compared to before the perimenopause. For major depression, the risk during perimenopause increased by 30%.
The research was prompted by first-hand experiences of women Professor Di Florio saw in her mental health clinic. In her clinic, Professor Di Florio provides second opinions to women who have severe psychiatric episodes that are associated with reproductive events such as menstruation, post-partum, and menopause.
Professor Di Florio said: “In my clinic, I found that some women, previously living lives without any experience of severe mental health issues, developed severe mental illness around the time of the menopause.
“Research like this is vital, as women experience these profound changes in their lives and bodies and are currently let down by the lack of detailed understandings of these changes.”
“During perimenopause – the years around the final menstrual period – approximately 80% of people develop symptoms, including hot flushes, cognitive dysfunction, sleep disturbances and mood-related symptoms. But the extent of the impact on the onset of severe mental illness was unknown.”
Although many consider mood swings and mild depression to be symptoms of perimenopause, very little research had been done investigating the effects on severe psychiatric conditions, especially in women who had no history of these disorders. This meant that there is very little scientific literature to inform and support women who are affected by these conditions for the first time during perimenopause.
“I feel a duty towards the women I work with. I wanted to provide them and other women with the answers to why they were feeling this way,” Professor Di Florio added.
The first study of its kind
The study is the first known investigation into the link between first-onset psychiatric disorders in the years around menopause. To address this research gap, Professor Di Florio’s team conducted research utilising data from UK Biobank – a large database of individuals from the UK. From this dataset, 128,294 participants were selected who had reported the age at which they experienced menopause. The research team then analysed the ages at which these participants first experienced or were diagnosed with a mental health condition.
The research focused on the four years surrounding the final menstrual period and found that rates of psychiatric disorders significantly increased compared to the six to ten years prior.
An 112% increase in incidence of bipolar disorder was observed at perimenopause. Onsets of major depressive disorder were found to increase by 30%. There was no association found between perimenopause and the onset of schizophrenia spectrum disorders. Additionally, the study focussed on first-onset experiences of psychiatric disorders during perimenopause but didn’t investigate links with the recurrence of pre-existing psychiatric disorders in perimenopause.
The increased risk of bipolar disorder and major depressive disorder was linked with the narrow four-year perimenopausal timeframe, and the risk decreased significantly once women entered the post-menopausal stages.
Hormonal change is a very important factor in mood disorders
Professor Di Florio said: “We have been able to expand our knowledge of the mental health changes associated with perimenopause, which can help provide explanations, diagnoses and support for women who have previously been left in the dark about what is happening to them.”
Dr Clare Dolman, Ambassador for Bipolar UK and Patient and Public Involvement Lead on the project, added: “This study is extremely important as it demonstrates for the first time in a very large sample that the menopausal transition has a measurable impact on women’s mental health.
“For me, this confirms what we have observed and heard from women with bipolar themselves; that hormonal change is a very important factor in mood disorders and one that deserves to be researched thoroughly.
“As a woman with bipolar myself who has gone through menopause, I am looking forward to the research community recognising the importance of this finding. The studies will allow us to predict an individual woman’s risk of becoming unexpectedly ill at this time of life. That knowledge could be lifesaving.”
What next?
We hope that this research is the first step in recognising the experiences of these women and encourages further explorations into potential biological mechanisms and treatments to help those affected by severe psychiatric conditions during the perimenopause.
This study would not have been possible without the participants and staff at UK Biobank. We also thank our collaborators at Bipolar UK, in particular Dr Clare Dolman who has been invaluable as the Patient and Public Involvement lead on this project. This project was funded by the Medical Research Council and the European Research Council.
The paper, Exploration of first onsets of mania, schizophrenia spectrum disorders, and major depressive disorder in the perimenopause is available to read online.
Read more
- Cardiff University | Reproductive Mental Health Programme
- Cardiff University | Perimenopause linked with increased risk of mania and manic depression
- NCMH | How the menopause can negatively impact mental health
- NCMH | Menopause and mental health webinar
- Bipolar UK | About