For years, menopause and depression have been closely linked. But now a new paper in The Lancet disputes the commonly held notion that menopause consistently raises risk for mental health problems.

Hormonal fluctuations, as any woman who has gotten their period can attest, can affect one’s mood and well-being. Combine that with midlife stressors, like raising teenage children and caring for aging parents, and researchers claimed to see a rise in depression among women in menopause. But that notion is really an overstatement, says Lydia Brown, a psychologist in Melbourne, who co-authored the new study.

“I assumed that menopause really does lead to quite a substantial, increased risk of depression,” Brown said. “You have all these factors, social, psychological, and hormonal, that are all at play at the one time, and together, that could increase the risk of depression.”

It’s not the hot flashes

But after reviewing a dozen studies of menopausal women who reported depressive symptoms or major depressive order, the researchers found no compelling evidence that menopause caused a universal increased risk for either condition. To reach that conclusion, they focused only on prospective studies, which looked at groups of women over time.

They also tried to distinguish what women actually meant when they said they suffered from depression.

Researchers found that many of those who became depressed were women who’d already suffered with depression or other mental health issues previously or who were dealing with specific life events. One study, for instance, found that women who suffered frequent “hot flashes” and recent stressful life events had an increased risk of depression, whereas if they hadn’t had a stressful life event, their risk of depression was not elevated, Brown said.

Researchers also found some studies described menopausal women as suffering from depression yet they only had depressive symptoms, a lower level of depression than a full-blown “mental health disorder,” which is a more severe and enduring condition and one that is typically diagnosed by a clinician, Brown said.

“Some studies did find a bit of an increase of risk of depression, some didn’t, and others found it was more about risk factors. It wasn’t that all women are universally and uniformly at risk of depression,” Brown said. “We’re not saying it’s not an issue. But we are saying it’s a lot more nuanced than that.”

And it means women like herself no longer have to fear menopause as this dark, depressing place, she said.

Not every menopausal woman experiences depression

The message of the paper is that we don’t want women to panic, because they should understand that depression is not a universal problem associated with the menopause transition. It’s a subgroup problem, said Hadine Joffe, interim chair of the department of psychiatry and executive director of the Connors Center for Women’s Health at Brigham and Women’s Hospital. She is also a co-author on the paper.

“It’s hard to message these things to the public, because we don't want to underestimate. We also don't want to overestimate,” Joffe said. “We want to make sure that menopause, itself, isn't associated, in a universal way, with this adverse problem, because it isn't.”

But the powerful media images out there would have you believe otherwise, she said. She noted that if you Google “menopause” and “mood,” you get a joke about “The Seven Dwarfs of Menopause: Itchy, Bitchy, Sleepy, Sweaty, Bloated, Forgetful and Psycho!”

“We don’t want people to be terrified, and anticipate dread, but we also want them to be prepared if they are in that vulnerable subgroup,” Joffe said.

Rachel Weiss, a psychotherapist and founder of Menopause Café, a community for people to discuss menopause-related issues, said she started the cafe in 2017 because no one was talking about menopause. Now, the pendulum has swung the other way, and the topic has become sensationalized, with media coverage treating it like a medical disease for which people need to take medication, and celebrities telling horror stories about their own menopausal experiences.

“It's completely scaring the pants out of people who are in their 40s or 30s and thinking, ‘Oh god, what's going to happen to me when I'm 50? I'm gonna go mad,’ “ Weiss said. “I enjoyed the Lancet papers because they seem to me to be resetting that pendulum to somewhere in the middle.”

Weiss said she didn’t want to downplay the challenges of menopause, including lack of libido, trouble sleeping and physical changes like less hair and more wrinkles.

“Like with depression, or like with anxiety, the menopause is an added stress,” Weiss said. “If you're only just keeping your life together, juggling all those balls, as we do, and you have on top of that depression, anxiety, or neurodiversity, then menopause can often be the straw that breaks the camel's back.”

Brett Thombs, a professor in the faculty of medicine at McGill University and director of the DEPRESsion Screening Data Project, went so far as to call the paper a clarion call for people in the mental health field to rethink their beliefs around menopause and depression.

“People have been saying that women are at high risk for mental disorders during menopause for decades, as if it’s fact, and from the evidence they’ve laid out in this paper, it just isn’t true,” Thombs said.

Indeed, there has been a growing concern in the research community that menopause has been pathologized too much and that women might be approaching midlife feeling more apprehension than is warranted by the research, said Tania Perich, a psychologist and researcher at Western Sydney University whose focus is depression and bipolar disorder.

“I was shocked at how little research had been done — because 50 percent of people go through menopause,” she said. “So for us, I think there’s just not enough research that’s been conducted for us to draw any definitive conclusions.”

While she welcomed the Lancet paper, Perich said she doesn’t want it to minimize the impact menopause has on women. Sometimes the hormonal changes of menopause are linked with depression, and women who experience that should seek treatment and support.

“I have clients that come to me and are certain that their depression is caused by menopause,” she said. “I would never turn around to my client and say, ‘Oh, no, it’s definitely not menopause’ because of research.”