Perimenopause, the multiyear transition from regular menses to their complete cessation, places women at increased risk for depression, with 45-68% of perimenopausal women reporting depressive symptoms.

Erratic levels of the reproductive hormone estradiol play a role in this increased vulnerability for depression, but not all women have moods that fluctuate with estradiol levels. Women with wider hormonal-related mood fluctuations are more vulnerable to stress and more likely to experience depressive symptoms. 

Gordon et al. [Psychoneuroendocrinology] tested the effect of Mindfulness-Based Stress Reduction (MBSR) on women’s perimenopausal depressive symptoms, and then explored whether the program might prove especially helpful for women with elevated hormonal-related mood fluctuations.

The researchers randomly assigned 104 mediation-naïve Canadian healthy perimenopausal women (average age = 49 years; 89% Caucasian; early menopause = 69%, late menopause = 31%) to MBSR or a wait-list control. MBSR was taught by experienced MBSR teachers and delivered in 2.5-hour group sessions over an 8-week period, with a 7-hour silent retreat in the sixth week. 

Baseline urine estradiol levels and daily moods were assessed over a period of 30-50 days prior to randomization, and the researchers calculated a standardized mood sensitivity to estradial changes based on these data. Self-report measures, histories of trauma, and recent stressful events were also assessed at baseline.

Depressive symptoms were assessed at baseline, immediately after intervention, and every two weeks during a 6-month follow-up. Perceived stress, anxiety, mindfulness, resilience, and sleep quality were assessed at baseline, immediately after intervention, and at 2-, 4-, and 6-month follow-up. Participants with high levels of self-reported depressive symptoms were assessed for major depression in structured clinical interviews.

The results showed that the MBSR group showed significantly greater reductions in depressive symptoms (d = -0.34), perceived stress (d = -0.55), and anxiety (d = -0.53), and greater increases in mindfulness (d = -0.46) and resilience (d = -0.30) than controls at postintervention and throughout follow-up.

The subgroup of participants displaying elevated mood sensitivity to estradiol benefited most from MBSR. Women in early perimenopause benefitted more than those in late perimenopause from MBSR, and decreases in depressive symptoms were dose-dependent on home meditation practice.

The study shows MBSR is more effective in reducing depressive symptoms in perimenopausal women than a wait-list control. Women early in menopause and women sensitive to hormonal-related mood changes appear to gain the most benefit from MBSR practices.

The study is limited by the absence of an active comparison group, support group, or clinical monitoring program that might improve depressive symptoms in a similar fashion.

Reference:

Gordon, J. L., Halleran, M., Beshai, S., Eisenlohr-Moul, T. A., Frederick, J., & Campbell, T. S. (2021). Endocrine and psychosocial moderators of mindfulness-based stress reduction for the prevention of perimenopausal depressive symptoms: A randomized controlled trial. Psychoneuroendocrinology.

Link to study