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In the years leading up to menopause, a person can experience a multitude of symptoms, including emotional shifts such as depression. Now, a new study has quantified the risk of depression during the transition, known as perimenopause showing that women in this stage are about 40% more likely to experience the mental health condition than premenopausal women.”Our findings show just how significantly the mental health of perimenopausal women can suffer during this time,” said Dr. Aimee Spector, corresponding author of the study published Tuesday in the Journal of Affective Disorders, in a news release. “We need greater awareness and support to ensure they receive appropriate help and care both medically, in the workplace and at home.”Related video above: Doctor on managing the symptoms of menopauseSpector is also a professor of clinical psychology of aging in the division of psychology and language sciences at University College London.Perimenopause typically occurs about three to five years before menopause, a day that marks 12 months without menstruation and signals the end of a woman’s reproductive life. The transitional stage is a natural process prompted when the ovaries gradually stop working, according to Johns Hopkins Medicine. During this time, estrogen and progesterone levels can fluctuate, leading to mood swings, irregular menstrual cycles and other symptoms such as depression.The authors conducted the study which is a review of seven studies totaling 9,141 women to provide an estimate for the risk of developing clinical, diagnosed depression or depressive symptoms at different menopausal stages. The women, who were from the United States, Australia, China, the Netherlands and Switzerland, had provided information on their moods and interest in doing activities.The authors didn’t find a significant difference in risk of depression for postmenopausal women compared with premenopausal women.”These findings are consistent with what is known about the vulnerability women have for depressive symptoms during perimenopause,” which has been shown in past research, said Dr. Stephanie Faubion, medical director of The Menopause Society and the Penny and Bill George Director for the Mayo Clinic’s Center for Women’s Health in Minnesota. Faubion wasn’t involved in the study.A systematic review of the existing literature on perimenopausal depression is what drove The Menopause Society’s 2018 recommendations for the evaluation and treatment of depression during perimenopause.Monitoring your moods in transitionCultural factors or lifestyle changes have sometimes been used to explain depressive symptoms women experience during the years before menopause, but the combined data from global studies indicate the findings can’t be attributed to those factors alone, said lead study author Yasmeen Badawy, who was a masters student in the division of psychology and language sciences at University College London when she conducted the research. Badawy is now an associate graduate mental health worker at the Barnet, Enfield and Haringey Mental Health NHS Trust in London.”It appears to (be) the variability in hormone levels rather than absolute levels that can trigger these symptoms in vulnerable individuals,” Faubion said. “It is also likely that a variety of factors play a role, including genetics, the environment, level of education, access to care and other social determinants of health, and level of social support.”Estrogen, for one, has been found to affect the metabolism of neurotransmitters such as dopamine, norepinephrine, -endorphin and serotonin, all of which have a role in emotional states, the authors said.Given these risk factors, it’s important for clinicians to be mindful that women transitioning into menopause may experience depressive symptoms or major episodes, and to ask patients about their moods, Faubion said. That’s especially necessary if they have had past issues with mood, such as depression or hormone-related mood problems such as those experienced in premenstrual or postpartum stages.”Depression is a chronic disease that is typically recurrent over the lifetime,” said Dr. Rebecca Thurston, Pittsburgh Foundation Chair in Women’s Health and Dementia at the University of Pittsburgh, who wasn’t involved in the study. “We know that these episodes can snowball if left untreated, they can become increasingly severe. This underscores the importance of not ignoring symptoms and getting them treated.”Learning your own early warning signs of a depressive episode can be helpful for the purpose of early treatment, said Thurston, who is also a psychologist treating depression in women who are in midlife. And doctors should develop and maintain relationships with mental health providers to whom they can refer patients diagnosed with depression.”I also recommend that doctors follow up with the women to ensure they are getting care,” she said. “They should also consider treating menopausal symptoms such as hot flashes if significantly interfering with a woman’s life.”A variety of either pharmaceutical or evidence-based behavioral treatments are available, and sometimes women need both, Thurston added. A previous study by the same authors found that mindfulness and cognitive behavioral therapy could be an effective treatment for nonphysical symptoms related to menopause.And having close friends can be a buffer for depressive episodes, Thurston has found as a principal investigator of the national longitudinal study of the midlife transition called the Study of Women’s Health Across the Nation, or SWAN.