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It has long been stated that women in menopause do not experience more depression or mood disorders than at other times in life. However, as research continues to investigate this little understood life transition, important facts are emerging. It is, of course, necessary first to differentiate the episodes of mood alterations which may occur on an episodic or cyclic basis, closely related to significant hormone changes and those that manifest sustained physical and emotional change that is severe enough to be considered an illness. The hormone shifts of the menstrual cycle, and later menopause, have not been found to be a primary cause of psychiatric illness which is typically present on a daily basis.

The primary hormone involved in depression, mood changes, PMS-like symptoms, anxiety and nervousness related to the menstrual cycle is progesterone. Progesterone comes from the ovaries before and after menopause. It is also produced, in lower amounts, in the brain and peripheral nerves. During the childbearing years the main job of progesterone is to prepare and maintain the uterus for pregnancy. Progesterone also affects brain function and it is here that its role in menopause symptoms is prominent. It produces a sense of calmness. The common symptom complaints perimenopausal women make are: irritability, impatience, depression/low mood/weepiness, and anger out of proportion to the situation, feeling overwhelmed and anxious and feeling less able to cope than before. After starting on progesterone, I often hear "I feel more like myself again." Progesterone also has a sedating, anti-anxiety effect and promotes more restful, restorative sleep.

Studies of menstrual mood disorder are finally accumulating in number and understanding is growing. In a longitudinal study evaluating the relationship between hormone status and mood in perimenopausal women, blood work was done every 3 to 6 months for an average of 5 years. For the 2 years surrounding a woman's final period, her risk of experiencing the onset of depression was 14 times higher than for the preceding 31 years. Results of other well-done studies are consistent with these findings. In another study of 231 women without any depressive history were followed over an eight year period, starting when they were nearing menopause. The probability that they would have high depression scores was 4 times greater during the menopausal transition than during perimenopause. The list of studies and supporting findings goes on.

Unfortunately, the role of progesterone has long been ignored or undervalued. I give credit to Dr. John Lee for first bringing progesterone "out of the closet" about 15 years ago, although many of his beliefs don't always hold up to close scrutiny. Then again, in 2004, with the publication of The Sexy Years by Suzanne Somers, millions of women began to learn that there are better alternatives for hormone therapy and uses that mimic our own body's functioning with very satisfactory results.