0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation | Meta-analysis

Association of Age at Menopause and Duration of Reproductive Period With Depression After Menopause A Systematic Review and Meta-analysis

Marios K. Georgakis, MD1; Thomas P. Thomopoulos, MD1; Andreas-Antonios Diamantaras, MD1,2; Eleni I. Kalogirou, MD1; Alkistis Skalkidou, MD, PhD3; Stella S. Daskalopoulou, MD, MSc, DIC, PhD4; Eleni Th Petridou, MD, MPH, PhD1
[+] Author Affiliations
1Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
2Program Medical Neurosciences, Charité-Universitätsmedizin, Berlin, Germany
3Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
4Division of Internal Medicine, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
JAMA Psychiatry. 2016;73(2):139-149. doi:10.1001/jamapsychiatry.2015.2653.
Text Size: A A A
Published online

Importance  Estrogens have neuroprotective and antidepressive effects; however, associations between indices of reduced endogenous estrogens and risk for postmenopausal depression have not been systematically explored.

Objective  To investigate the association of age at menopause and the duration of the reproductive period with the risk for depression among postmenopausal women with naturally occurring menopause.

Data Sources  A search strategy for use of MEDLINE was developed (through January 1, 2015) using the key terms menopause, climacteric, reproductive period, depression, and mood disorders. References of included studies and reviews were also screened; authors were contacted to maximize synthesized evidence.

Study Selection  A total of 12 323 articles, without language restriction, were screened by pairs of reviewers to identify observational studies related to the study hypothesis; 14 studies were eligible for meta-analysis.

Data Extraction and Synthesis  Pairs of reviewers independently extracted information on study design and type of analysis by participants’ characteristics and methods of depression ascertainment. Study quality was assessed using the Newcastle-Ottawa Scale, and fixed- or random-effects models were implemented.

Main Outcomes and Measures  Pooled-effect estimates for depression, defined by psychiatric evaluation or validated instruments, by age at menopause and duration of the reproductive period.

Results  The 14 studies included in the meta-analysis represented 67 714 women. An inverse association (reported as odds ratio [OR]; 95% CI of 2-year increments) with depression in postmenopausal women was shown for increasing age at menopause (0.98; 0.96-0.99 [67 434 unique participants; 13 studies]) and duration of the reproductive period (0.98; 0.96-0.99 [54 715 unique participants; 5 studies]). Menopause at age 40 or more years compared with premature menopause was associated with a 50% decreased risk for depression (3033 unique participants; 4 studies). Pooling of studies examining severe depression showed a 5% decrease in risk of severe depression with increasing (2-year increment) age at menopause (52 736 unique participants; 3 studies); sensitivity analysis of studies controlling for past depression revealed similar results for age at menopause (0.98; 0.96-1.00 [48 894 unique participants; 3 studies). No heterogeneity or publication bias was evident in the main analyses.

Conclusions and Relevance  Longer exposure to endogenous estrogens, expressed as older age at menopause and longer reproductive period, is associated with a lower risk of depression in later life. Identifying women at higher risk for depression due to early menopause who could benefit from psychiatric intervention or estrogen-based therapies could be useful in the clinical setting.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1.
Flowchart on the Selection of Eligible Studies
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Association Between Age at Menopause and Postmenopausal Depression

Thirteen studies (15 arms) reported the association of age at menopause as a continuous variable (2-year increments) with depression in postmenopausal women (P < .001). Odds ratios (ORs) in the individual studies are indicated by the data markers (shaded boxes around the data markers reflect the statistical weight of the study); 95% CIs are indicated by the error bars. The pooled-effect estimate with its 95% CI is depicted as a diamond.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Association Between Duration of Reproductive Period and Postmenopausal Depression

Five studies explored the effect of the duration of the reproductive period (continuous by 2-year increments) on depression in postmenopausal women (P = .007). Odds ratios (ORs) in the individual studies are indicated as data markers (shaded boxes around the data markers reflect the statistical weight of the study); 95% CIs are indicated by the error bars. The pooled-effect estimate with its 95% CI is depicted as a diamond.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

3,213 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Menopause

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: Is This Woman Perimenopausal?

brightcove.createExperiences();