Sometimes evidence proves what was long-suspected to be true. A new study, just published in JAMA Psychiatry shows women who took hormone replacement therapy early in the menopausal transition had almost half the risk of developing clinically significant depressive symptoms compared to women who took a placebo. The study also confirmed that women of this age and stage are at high risk of significant depression, with almost one third of women in the placebo group developing symptoms and signs of the condition over the 12 month study period. Previous research had suggested that hormone therapy could help manage existing depression in menopausal women, however according to the Canadian researchers, this study, conducted among initially euthymic women was the first to show hormone therapy’s role in preventing the affective disorder. More than 170 perimenopausal and early post-menopausal women were randomly assigned to receive transdermal oestradiol (0.1mg/day) and intermittent oral micronized progesterone or placebo patches and tablets for 12 months. They were assessed regularly for depression using a validated depression scale (CES-D). Women on placebo were more likely to record a score that equated with significant depression at least once over the study period (32.3%) compared with women taking the hormone therapy (17.3%). Interestingly, women who had had what the researchers called ‘stressful life events’ in the six months prior to enrolment in the trial actually had greater benefit from the hormone therapy. Whereas other possible confounders such as baseline vasomotor symptoms, a history of depression, and baseline oestradiol levels did not appear to affect the protective benefit of the therapy. The progesterone was given for 12 days every three months, to induce vaginal bleeding so the finding that this adverse effect was more common in the hormone therapy group was hardly surprising but of note the two groups did not differ in other adverse effects including headaches, bloating, breast tenderness, weight gain and GI symptoms. An accompanying editorial sounded a few warnings about the study including the fact that the oestrogen dose was higher than currently recommended for treating women with hot flushes and the progestin dose was less than that recommended to protect the endometrium. The two editorial authors, including Dr Martha Hickey, from the University of Melbourne also cautioned that using hormone therapy to prevent depression might result in prolonged hormone exposure with the known risks associated with this, and is not currently recommended for this indication. However, the study authors were cautiously enthusiastic about their findings saying, “If confirmed in a larger sample of early perimenopausal women, the findings of this study…suggest that hormone therapy may also be indicated for the prevention and/or treatment of depressive symptoms appearing in the early menopause transition, regardless of whether menopausal symptoms are present.” Ref: JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.3998
Expert/s: Dr Linda Calabresi