Perimenopause linked with increased risk of bipolar and major depression

Women going through perimenopause – the transition period surrounding the menopause – are more than twice as likely to develop bipolar disorder for the first time according to our research. Our study is the first to investigate the link between perimenopause and the onset of severe psychiatric conditions.

Many people think of menopause as a single event that happens around a woman’s early 50s, the average age for her last period. But it’s a gradual process that typically occurs between the ages of 45 and 55.

Perimenopause is the phase leading up to and following menopause, during which hormonal changes affect the menstrual cycle. This stage differs from person to person and can last several years. Symptoms may include hot flashes, night sweats, mood swings and irregular periods.

While physical symptoms are common, the potential effect of perimenopause on mental health – including mood changes and severe psychiatric disorders – is less understood and has been under-researched.

We were inspired to conduct our research by the patients at Professor Di Florio’s mental health clinic. It offers a free clinical service providing second opinions for people experiencing severe psychiatric disorders associated with reproductive events.

Many of the women in the clinic had never experienced severe mental health problems before menopause. But something seemed to shift during perimenopause. Suddenly many found themselves grappling with these conditions. However, upon reviewing the research, it appeared that the experiences of these women were not documented or explored in scientific literature.

To address this research gap and find answers, we conducted research using a large database called UK Biobank. This is a resource which gives approved researchers secure access to anonymous medical and genetic data from half a million volunteers. It aims to improve our understanding of how to prevent, diagnose and treat many serious conditions.

What we found

Using the data, we investigated how many participants had new onsets of psychiatric conditions during the perimenopause. We then compared this to the number of new onsets during the late reproductive stage, which are the years before the perimenopause.

The data we examined came from 128,294 women in the UK. We wanted to explore how the years around the final menstrual period may trigger serious mental health issues, including bipolar and major depressive disorders. We discovered a 112% increase in new cases of bipolar disorder. We also found a 30% rise in major depressive conditions during this time, compared to earlier stages of the late reproductive period.

Our study was the first of its kind to investigate first onsets of bipolar disorder during the perimenopause. It validates the experiences of women who were previously essentially invisible in the world of research.

Although some hypotheses exist as to why perimenopause and hormones may play a role in psychiatric disorders, much more research is required to better understand why this affects some people but not others. Researchers also need to uncover the best treatment options for these women.

We hope that our research paves the way for more research on women’s mental health at perimenopause, as well as further investigations into the underlying biological mechanisms.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.