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Major depression during and after the menopausal transition: Study of Women's Health Across the Nation (SWAN)

  • J. T. Bromberger (a1), H. M. Kravitz (a2), Y.-F. Chang (a3), J. M. Cyranowski (a4), C. Brown (a4) and K. A. Matthews (a5)...

It is unclear whether risk for major depression during the menopausal transition or immediately thereafter is increased relative to pre-menopause. We aimed to examine whether the odds of experiencing major depression were greater when women were peri- or post-menopausal compared to when they were pre-menopausal, independent of a history of major depression at study entry and annual measures of vasomotor symptoms (VMS), serum levels of, or changes in, estradiol (E2), follicular stimulating hormone (FSH) or testosterone (T) and relevant confounders.


Participants included the 221 African American and Caucasian women, aged 42–52 years, who were pre-menopausal at entry into the Pittsburgh site of a community-based study of menopause, the Study of Women's Health Across the Nation (SWAN). We conducted the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) to assess diagnoses of lifetime, annual and current major depression at baseline and at annual follow-ups. Psychosocial and health factors, and blood samples for assay of reproductive hormones, were obtained annually.


Women were two to four times more likely to experience a major depressive episode (MDE) when they were peri-menopausal or early post-menopausal. Repeated-measures logistic regression analyses showed that the effect of menopausal status was independent of history of major depression and annually measured upsetting life events, psychotropic medication use, VMS and serum levels of or changes in reproductive hormones. History of major depression was a strong predictor of major depression throughout the study.


The risk of major depression is greater for women during and immediately after the menopausal transition than when they are pre-menopausal.

Corresponding author
*Address for correspondence: Dr J. T. Bromberger, Ph.D., University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. (Email:
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Avis NE, Brambilla D, McKinlay SM, Vass K (1994). A longitudinal analysis of the association between menopause and depression. Results from the Massachusetts Women's Health Study. Annals of Epidemiology 4, 214220.
Bromberger JT, Matthews KA, Schott LL, Brockwell S, Avis N, Kravitz HM, Everson-Rose SA, Gold EB, Sowers M, Randolph J Jr. (2007). Depressive symptoms during the menopausal transition: the Study of Women's Health Across the Nation (SWAN). Journal of Affective Disorders 103, 267272.
Burger HG, Dudley EC, Hopper JL, Groome N, Guthrie JR, Green A, Dennerstein L (1999). Prospectively measured levels of serum follicle-stimulating hormone, estradiol, and the dimeric inhibins during the menopausal transition in a population-based cohort of women. Journal of Clinical Endocrinology and Metabolism 84, 40254030.
Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL (2006). Risk for new onset of depression during the menopausal transition. The Harvard Study of Moods and Cycles. Archives of General Psychiatry 63, 385390.
Freeman EW, Sammel MD, Lin H, Nelson DB (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry 63, 375382.
Freeman EW, Sammel MD, Lui L, Gracia CR, Nelson DB, Hollander L (2004). Hormones and menopausal status as predictors of depression in women in transition to menopause. Archives of General Psychiatry 61, 6270.
Hunter M (1992). The southeast England longitudinal study of the climacteric and postmenopause. Maturitas 14, 117126.
Kaufert PA, Gilbert P, Tate R (1992). The Manitoba Project: a re-examination of the link between menopause and depression. Maturitas 114, 143155.
Kendler KS, Gardner CO (2010). Dependent stressful life events and prior depressive episodes in the prediction of major depression. Archives of General Psychiatry 67, 11201127.
Kuh DL, Wadsworth M, Hardy R (1997). Women's health in midlife: the influence of the menopause, social factors and health in earlier life. British Journal of Obstetrics and Gynaecology 104, 923933.
Maarten LW, Knottnerus JA, Pop VJ (2002). Menopausal transition and increased depressive symptomatology: a community based prospective study. Maturitas 42, 195200.
Matthews KA, Bromberger JT, Egland G (1990). Behavioral antecedents and consequences of the menopause. In The Menopause(ed. Korenman S. G.), pp. 115. Serono Symposia: Norwell, MA.
Matthews KA, Wing RR, Kuller LH, Leilahn EN, Plantinga P (1994). Influence of the perimenopause on cardiovascular risk factors and symptoms of middle-aged healthy women. Archives of Internal Medicine 20, 23492355.
McKinlay SM, Jefferys M (1974). The menopausal syndrome. British Journal of Preventive and Social Medicine 28, 108115.
Neugarten BL, Kraines RJ (1965). ‘Menopausal symptoms’ in women of various ages. Psychosomatic Medicine 27, 266273.
O'Connor VM, Del Mar CB, Sheehan M, Siskind V, Fox-Young S, Cragg C (1994). Do psychosocial factors contribute more to symptom reporting by middle-aged women than hormonal status? Maturitas 20, 6369.
Randolph JF, Sowers MF, Bondarenko I, Gold EB, Greendale GA, Bromberger JT, Brockwell SE, Matthews KA (2005). The relationship change in reproductive hormones and vasomotor symptoms during the menopausal transition. Journal of Clinical Endocrinology and Metabolism 90, 61066112.
Schmidt PJ, Murphy JH, Haq N, Danaceau MA, St Clair LS (2002). Basal plasma hormones levels in depressed perimenopausal women. Psychoneuroendocrinology 27, 907920.
Schmidt PJ, Nazli H, Rubinow DR (2004). A longitudinal evaluation of the relationship between reproductive status and mood in perimenopausal women. American Journal of Psychiatry 161, 22382244.
Sowers MF, Crawford S, Sternfeld B, Morganstein D, Gold EB, Greendale GA, Evans D, Neer R, Matthews KA, Sherman S, Lo A, Weiss G, Kelsey J (2000). SWAN: a multi-center, multi-ethnic, community-based cohort study of women and the menopause. In Menopause: Biology and Pathobiology(ed. Lobo R., Kelsey J. and Marcus R.), pp. 175178. Academic Press: San Diego, CA.
Spitzer RL, William JB, Gibbon M, First MB (1992). The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Archives of General Psychiatry 49, 624629.
Weissman M (1979). The myth of involutional melancholia. Journal of the American Medical Association 242, 742744.
WHO (1996). Research on the Menopause in the 1990s. WHO Technical Report Series: 866. World Health Organization: Geneva, Switzerland.
Williams JB, Gibbon M, First MB, Spitzer RL, Davies M, Borus J, Howes MJ, Kane J, Pope Jr. HG, Rounsaville B (1992). The Structured Clinical Interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Archives of General Psychiatry 49, 630636.
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