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Current Opinion in Obstetrics &... Dec 2020Perimenopause is a time of reduced fertility, and yet unintended pregnancies can occur making comprehensive contraceptive counseling essential for these women. Concern... (Review)
Review
PURPOSE OF REVIEW
Perimenopause is a time of reduced fertility, and yet unintended pregnancies can occur making comprehensive contraceptive counseling essential for these women. Concern over potential contraceptive risks has unnecessarily limited access and use of certain hormonal methods in this population. This review summarizes the available data on the use and effectiveness of contraceptive options during perimenopause.
RECENT FINDINGS
All contraceptive options may be appropriate during perimenopause and no method is contraindicated based on age alone. Combined hormonal contraception has the added benefit of relieving perimenopausal symptoms including controlling menstrual irregularities. Progestin-only methods have the advantage of being taken either alone or in combination with estrogen replacement therapy to address both perimenopausal symptoms and contraceptive needs. Nonhormonal options exist for those wishing to avoid hormonal methods.
SUMMARY
Extensive contraceptive options are available for perimenopausal women as they transition into menopause. Consideration of patient preference, medical co-morbidities, and perimenopausal symptoms will allow women to use the option that best serves her needs.
Topics: Contraception; Contraceptive Agents; Female; Humans; Menopause; Perimenopause; Pregnancy; Pregnancy, Unplanned
PubMed: 33002952
DOI: 10.1097/GCO.0000000000000667 -
Journal of Ethnopharmacology Feb 2020Xiaochaihutang (XCHT) is a traditional Chinese medicine prescription for thousand years in China. Our previous researches show that XCHT has antidepressant-like effects...
ETHNOPHARMACOLOGICAL RELEVANCE
Xiaochaihutang (XCHT) is a traditional Chinese medicine prescription for thousand years in China. Our previous researches show that XCHT has antidepressant-like effects in several depression models, but effect and mechanism of XCHT in perimenopausal depression are still vague.
AIM OF THE STUDY
To reveal the antidepressant-like effect and mechanism of XCHT in perimenopausal mice.
MATERIALS AND METHODS
Perimenopausal depression model is executed by ovariectomy combined with chronic unpredictable mild stress (OVX-CUMS). Tail suspension test (TST), forced swim test (FST), elevated plus-maze (EPM), novelty suppressed feeding (NSF) and locomotor activity are used to assess antidepressant-like effects of XCHT. The Level of estradiol (E), follicle-stimulating hormone (FSH), gonadotrophin releasing hormone (GnRH), corticosterone (CORT), adrenocorticotrophic hormone (ACTH) and corticotropin releasing hormone (CRH) are evaluated by ELISA. Antidepressant mechanisms of XCHT in OVX-CUMS mice are analyzed by 5-hydroxytryptamine (5-HT), tryptophan hydroxylase 2 (TPH2) and estrogen receptor α and β (ERα/β).
RESULTS
The results show that OVX-CUMS significantly increases the immobility time in TST and FST, increases latency to feed, decreases food consumption in NSF and both the time spend and number of entries in open arms in EPM. While, oral administration of XCHT can significantly normalize above depression-like behaviors in OVX-CUMS mice. Moreover, XCHT also remarkably normalized levels of 5-HT, 5-HIAA, E, GnRH, CORT, ACTH and CRH in OVX-CUMS mice. Finally, the expression of ERβ and TPH2 are decreased by OVX-CUMS in prefrontal cortex and hypothalamus, and XCHT can restore these decrease.
CONCLUSION
Current findings suggest XCHT can alleviate perimenopausal depression-like behaviors, restore 5-HT and hormones in OVX-CUMS mice, which may be related to normalizing the functions of HPA/HPO axis and enhancing expression of ERβ and TPH2 in prefrontal cortex and hypothalamus.
Topics: Animals; Antidepressive Agents; Behavior, Animal; Brain; Depression; Disease Models, Animal; Drugs, Chinese Herbal; Estrogen Receptor beta; Feeding Behavior; Hormones; Locomotion; Maze Learning; Mice; Ovariectomy; Perimenopause; Serotonin; Stress, Psychological; Tryptophan Hydroxylase
PubMed: 31629860
DOI: 10.1016/j.jep.2019.112318 -
Journal of Women's Health (2002) Feb 2019There is a new appreciation of the perimenopause-defined as the early and late menopause transition stages as well as the early postmenopause-as a window of...
There is a new appreciation of the perimenopause-defined as the early and late menopause transition stages as well as the early postmenopause-as a window of vulnerability for the development of both depressive symptoms and major depressive episodes. However, clinical recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: (1) epidemiology; (2) clinical presentation; (3) therapeutic effects of antidepressants; (4) effects of hormone therapy; and (5) efficacy of other therapies (e.g., psychotherapy, exercise, and natural health products). Overall, evidence generally suggests that most midlife women who experience a major depressive episode during the perimenopause have experienced a prior episode of depression. Midlife depression presents with classic depressive symptoms commonly in combination with menopause symptoms (i.e., vasomotor symptoms, sleep disturbance), and psychosocial challenges. Menopause symptoms complicate, co-occur, and overlap with the presentation of depression. Diagnosis involves identification of menopausal stage, assessment of co-occurring psychiatric and menopause symptoms, appreciation of the psychosocial factors common in midlife, differential diagnoses, and the use of validated screening instruments. Proven therapeutic options for depression (i.e., antidepressants, psychotherapy) are the front-line treatments for perimenopausal depression. Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms. Data on estrogen plus progestin are sparse and inconclusive.
Topics: Adult; Antidepressive Agents; Depression; Estrogen Replacement Therapy; Female; Hot Flashes; Humans; Hysterectomy; Menopause; Middle Aged; Ovariectomy; Perimenopause; Primary Ovarian Insufficiency; Risk Factors; Sleep Wake Disorders
PubMed: 30182804
DOI: 10.1089/jwh.2018.27099.mensocrec -
Journal of Affective Disorders Apr 2019Within the female life cycle, the perimenopause is considered as a critical period for the development of depression. Prevalence rates are particularly high during this... (Review)
Review
BACKGROUND
Within the female life cycle, the perimenopause is considered as a critical period for the development of depression. Prevalence rates are particularly high during this phase. Perimenopausal depression is characterized by affective symptoms as well as menopause-specific somatic complaints. Currently, a variety of questionnaires are used to assess mood during the perimenopause. The aim of this review is to determine the instruments employed to assess perimenopausal depression.
METHODS
We searched the databases PubMed, Cochrane Library and PsycINFO for human studies investigating perimenopausal depression, and subsequently screened for the assessment instruments used to measure mood and menopause. A total of 37 articles were included.
RESULTS
Altogether, 14 different instruments were applied to assess mood during menopause. The CES-D was by far the most frequently used depression scale, appearing in 16 out of the 37 studies. The methods used to identify perimenopausal status and symptoms were inconsistent.
LIMITATIONS
Due to lacking information about data and methodology, a selection bias is conceivable. Additionally, a publication bias is possible. Finally, there is inevitable subjectivity in the screening process of a systematic search.
CONCLUSIONS
The assessment of depression in the menopausal transition is highly heterogeneous, reducing the overall comparability of study results. Furthermore, menopausal complaints are not sufficiently taken into account. Accordingly, the use of a menopause-specific depression scale is highly recommended in order to account for physical and mood-related symptoms in the menopausal transition.
Topics: Depression; Depressive Disorder, Major; Female; Hot Flashes; Humans; Mass Screening; Middle Aged; Perimenopause; Prevalence; Psychiatric Status Rating Scales; Quality of Life; Risk Factors; Surveys and Questionnaires
PubMed: 30776662
DOI: 10.1016/j.jad.2019.02.029 -
Current Opinion in Obstetrics &... Apr 2023The purpose of this review is to provide an update on the most recent research regarding potential causes and treatments for perimenopausal depression. (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to provide an update on the most recent research regarding potential causes and treatments for perimenopausal depression.
RECENT FINDINGS
Erratic estrogen fluctuations and alterations in the neurosteroid allopregnanolone are important contributors to perimenopausal mood symptoms. These hormone changes augment increased risk associated with recent stressful events, as well as early life childhood events. Perimenopausal depressions have different clinical presentations and may respond to differential treatment approaches.
SUMMARY
Future research should focus on these recent findings of interindividual hormonal sensitivity, childhood trauma histories, and varying depression symptom profiles for a personalized treatment approach to perimenopausal depression.
Topics: Humans; Depression; Perimenopause
PubMed: 36912352
DOI: 10.1097/GCO.0000000000000857 -
The American Journal of Psychiatry Jan 2008
Comparative Study Review
Topics: Administration, Cutaneous; Combined Modality Therapy; Comorbidity; Depression, Postpartum; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Estrogen Replacement Therapy; Ethinyl Estradiol; Female; Fluoxetine; Humans; Imipramine; Middle Aged; Perimenopause; Progesterone; Psychiatric Status Rating Scales; Terminology as Topic; Treatment Outcome
PubMed: 18178752
DOI: 10.1176/appi.ajp.2007.07071152 -
Endocrinology and Metabolism Clinics of... Dec 2005
Review
Topics: Endocrine System; Endocrinology; Female; Humans; Perimenopause; Reproduction
PubMed: 16310630
DOI: 10.1016/j.ecl.2005.07.013 -
Sexual & Reproductive Healthcare :... Dec 2020The menopausal transition constitutes a phase of major biopsychosocial changes associated with an elevated risk for the development of depression. Perimenopausal... (Review)
Review
The menopausal transition constitutes a phase of major biopsychosocial changes associated with an elevated risk for the development of depression. Perimenopausal depression is highly prevalent and usually characterized by core symptoms of a major depressive disorder combined with menopausal complaints such as vasomotor symptoms or other physical complaints. However, a distinct definition of the condition is lacking. The aim of this review is to portray the symptoms assessed in studies on perimenopausal depression in order to provide relevant information on the current understanding of this condition. A literature search was conducted using the databases PubMed, Cochrane Library, and PsycINFO. A total of 37 studies were included. Various assessment tools have been used to measure symptoms related to perimenopausal depression. Fifteen symptoms were identified. Depressed mood was assessed across all studies. Low energy or sleep disturbances, as acknowledged symptoms of a major depressive disorder, were surveyed in most studies. However, the assessment of menopausal complaints was rather heterogeneous. While vasomotor symptoms were often measured, other menopausal symptoms such as mood swings or pain were investigated less frequently. Sexual problems were only rarely assessed. Studies on perimenopausal depression regularly include the assessment of core symptoms of a major depressive disorder, but the assessment of menopausal complaints is inconsistent. While certain symptoms are commonly measured, others are not assessed. Such inconsistencies underline an ambiguous understanding of perimenopausal depression, which in turn affects the evaluation and treatment of the condition. Thus, the use of the existing guidelines on perimenopausal depression is recommended.
Topics: Depression; Female; Humans; Middle Aged; Perimenopause; Prevalence; Quality of Life; Risk Factors; Sleep Wake Disorders
PubMed: 33010665
DOI: 10.1016/j.srhc.2020.100559 -
Medicine Feb 2019Perimenopausal depressive disorder (PDD) is a disease that plagues many perimenopausal women. There is an urgent need for a safe way to treat the disease. With few side... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Perimenopausal depressive disorder (PDD) is a disease that plagues many perimenopausal women. There is an urgent need for a safe way to treat the disease. With few side effects, acupuncture treatment for PDD has been gradually accepted. However, at present, the evidence is insufficient and relevant studies are not in-depth enough. The purpose of this study is to explore the efficacy and safety of acupuncture for PDD.
METHODS
All randomized controlled trials articles on acupuncture treatment of PDD will be searched in databases such as MEDLINE, EBASE, Cochrane Library, Springer, World Health Organization International Clinical Trials Registry Platform, China National Knowledge Infrastructure, Wan Fang, Chinese Biomedical Literature Database, Chinese Scientific Journal Database and so on. Non-RCT articles will be screened and key information will be extracted. The primary outcome is the Hamilton depression scale. Second outcomes are the Hamilton anxiety scale, Quality of life scale, changes of symptoms in traditional Chinese medicine and hormone levels.
RESULTS
This systematic review will provide the highest level of evidence and provide an evaluation of the efficacy and safety of acupuncture for PDD.
CONCLUSION
This study provides evidence for evaluating the efficacy and safety of acupuncture in the treatment of PDD.
PROSPERO REGISTRATION NUMBER
CRD42018115811.
Topics: Acupuncture Therapy; Depressive Disorder; Female; Humans; Perimenopause; Quality of Life; Randomized Controlled Trials as Topic; Research Design
PubMed: 30762808
DOI: 10.1097/MD.0000000000014574 -
The Journal of Steroid Biochemistry and... Jul 2014This review focuses on the endocrine and physiological features of the transition to menopause, known as the menopausal transition or the perimenopause. The updated 2011... (Review)
Review
This review focuses on the endocrine and physiological features of the transition to menopause, known as the menopausal transition or the perimenopause. The updated 2011 Stages of Reproductive Aging workshop (STRAW) system is presented with a discussion of the new subdivisions within stages -3 (late reproductive age) and +1 (postmenopause) and incorporation of FSH and other biomarkers in the supportive criteria. Ovarian follicle reserve and ovarian follicle dynamics are also discussed in terms of the changes that occur with reproductive aging, and the dramatic effect these changes have on the hypothalamic-pituitary-gonadal feedback system. Topics include the disruption of normal ovulatory function and related hormone secretion patterns, abnormal uterine bleeding, and the changes that occur in bone and the cardiovascular system. The review concludes with a discussion of management strategies. This article is part of a Special Issue entitled 'Menopause'.
Topics: Bone Density; Female; Humans; Menstrual Cycle; Menstruation Disturbances; Ovarian Follicle; Perimenopause; Ultrasonography
PubMed: 24134950
DOI: 10.1016/j.jsbmb.2013.08.015