For anyone living with PMDD, the transition into perimenopause and menopause may raise questions about what lies ahead for mental health. This editorial pulls together findings from several large, well-known studies to explore how menopause affects mood, anxiety, and overall well-being — and it specifically flags a history of PMDD as a key risk factor for developing depression during this life stage.
Several major studies are reviewed. The SWAN study, which followed over 3,300 women for 13 years, found that the risk of depressive symptoms roughly doubled during perimenopause, even in women who had never experienced depression before. The Penn Ovarian Aging Study found that about 1 in 4 previously non-depressed women developed major depression during perimenopause. Another study found the risk was especially high among women with severe hot flashes and those with a prior history of PMDD.
The editorial also covers anxiety and suicide risk during menopause, noting that sleep disruption — which affects up to 60% of women in this phase — plays a major role in worsening mood. On the treatment side, it discusses hormone therapy, antidepressants, cognitive behavioral therapy (a type of structured talk therapy), exercise, and sleep interventions, all of which showed benefits in the studies reviewed. One small trial found that an estrogen skin patch led to symptom remission in 68% of perimenopausal women with depression, compared to 20% on placebo.
The key takeaway is that late perimenopause appears to be a particularly vulnerable time for mental health, and people with a history of PMDD may be at higher risk. The authors advocate for routine mental health screening during gynecology visits and a team-based approach combining hormonal, psychological, and lifestyle strategies.
Key findings
- SWAN study (N=3302): Odds of depressive symptoms increased 1.5- to 2-fold during perimenopause compared to premenopause (adjusted OR 1.82), peaking in late perimenopause; women with no prior depression history had elevated risk of new-onset MDD (HR 1.59, 95% CI 1.15–2.20)
- Penn Ovarian Aging Study (N=436): 26.2% of previously non-depressed women developed MDD during perimenopause, with risk peaking in late perimenopause (adjusted OR 4.29)
- Cohen et al. (N=460): Women transitioning to perimenopause were twice as likely to develop MDD, with risk concentrated among those with severe vasomotor symptoms and a history of PMDD
- Transdermal estradiol RCT (N=50): 68% remission rate for depressive symptoms in perimenopausal women vs. 20% placebo (P < 0.001) after 12 weeks
- Sleep disruption affects up to 60% of peri- and postmenopausal women and is a critical mediator of mental health decline
- Veterans study (N=291,709): Menopausal hormone therapy was associated with a 41% increased risk of suicide attempts (HR 1.41) and more than two-fold increased risk of death by suicide
Methods, briefly
Editorial/narrative review synthesizing findings from multiple major longitudinal studies (SWAN, N=3302; Penn Ovarian Aging Study, N=436; Cohen et al., N=460; Gibson veterans study, N=291,709) and randomized controlled trials (Soares et al., N=50; McCurry et al., N=106). No original data collection; reviews published evidence on depression, anxiety, and suicide risk during menopausal transition.
Limitations to keep in mind
- Editorial format without systematic search methodology or formal quality assessment of included studies
- Many cited studies relied on self-reported symptoms rather than diagnostic criteria for anxiety disorders
- Some referenced RCTs had small sample sizes (e.g., N=50 for estradiol trial)
- Limited discussion of racial/ethnic diversity—some cited studies had homogeneous samples (mostly Caucasian, well-educated)
- Does not provide a comprehensive analysis of PMDD-to-menopause transition specifically
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