ABSTRACT
The focus of this chapter is the potential relationship between the onset of depression in women and the reproductive events of the perimenopause. The perimenopause is a time of considerable variability in reproductive function, which appears in some women to be associated with an increased susceptibility to depression. Elevated gonadotropin levels occur during the late perimenopause, with plasma follicle stimulating hormone (FSH) levels increasing in association with impaired ovarian function and decreased estradiol secretion. In contrast to the postmenopause, ovarian function may vary considerably in the perimenopause, with restoration of normal menstrual cycle function observed as frequently as the onset of menopause1. Moreover, during the perimenopause, levels of estradiol secretion may be reduced, normal or at times increased2,3. It is unclear, however, whether the variability in ovarian hormone secretion during the perimenopause has any causal role in the development of depression. Several questions are posed to highlight recent data suggesting that, in some women, perimenopausal reproductive events play a role in the onset of depression. Finally, recommendations for the evaluation and treatment of women with perimenopausal depression are presented.
