The article by Georgakis et al in this issue of JAMA Psychiatry1 is a meta-analysis of 14 observational studies addressing the association of depression after menopause in women with both age at menopause and duration of the reproductive period. Age at menopause is used to estimate the duration of the reproductive period because there is less variability in the age range for menarche (within a 3-year window in 80% of girls)2 than for menopause (within a 7-year window for approximately 80% of women).3 The meta-analysis concludes that there is a small but statistically significant increased likelihood of depression after menopause that is inversely associated with increasing age at menopause (odds ratio [OR], 0.98, in 13 studies) and increasing duration of the reproductive period (OR, 0.98, in 5 studies), which is defined as age at menopause (defined as 1 year after final menstrual period) minus age at menarche. This translates to a 2% reduction in risk for each 2-year increase in menopausal age. Therefore, the older a woman is at the time of ovarian senescence and the greater the number of years between the age at menarche (first menses) and at menopause (defined as final menstrual period or 1 year after final menstrual period), the lower the risk that she will experience depression in her postmenopausal years.
Hadine Joffe, Joyce T. Bromberger. Shifting Paradigms About Hormonal Risk Factors for Postmenopausal DepressionAge at Menopause as an Indicator of Cumulative Lifetime Exposure to Female Reproductive Hormones. JAMA Psychiatry. 2016;73(2):111–112. doi:10.1001/jamapsychiatry.2015.2701