Women who experience multiple traumatic events during adolescence have a significantly greater risk of depression in the years leading into menopause (known as perimenopause), according to a new study at the Perelman School of Medicine at the University of Pennsylvania.

In particular, women who had their first traumatic event in their teens are especially vulnerable to depression during perimenopause, even if they have no history of depression.

The findings suggest that the hormonal changes that occur during menopause may unmask a previously undetected risk for depression in women who experienced early traumatic events, particularly after puberty.

“Our results show that women who experience at least two adverse events during their formative years – whether it be abuse, neglect, or some type of family dysfunction- are more than twice as likely to experience depression during perimenopause and menopause as women who either experienced those stressors earlier in life, or not at all,” said lead author C. Neill Epperson, M.D., a professor of Psychiatry and Obstetrics & Gynecology at the Perelman School of Medicine at the University of Pennsylvania.

“This suggests that not only does early life stress have significant and long-lasting effects on the development and function of the regions of the brain responsible for emotions, mood, and memory, but the timing of when the event occurs may be equally as important.”

For the study, 243 women between the ages of 35 and 47 at the time of enrollment (all premenopausal with normal menstrual cycles) underwent behavioral, cognitive, and endocrine evaluations at predetermined intervals between the years 1996- 2012.

Over the 16 years, each participant completed approximately 12 assessments on cognition and mood, as well as blood samples to measure hormone levels.

Between study years 14 and 16, participants were interviewed by phone to assess menopause status; and in year 16, researchers used an Adverse Childhood Experiences Questionnaire (ACE-Q) to examine the relationship between stressful or traumatic events experienced in adolescents and health outcomes.

Among the respondents, 39.5 percent, 22.2 percent and 38.3 percent of women reported having experienced 0, 1 or 2 or more ACEs, respectively. The most commonly reported ACEs were emotional abuse, parental separation or divorce, or living with someone with alcohol or substance abuse. Most ACEs had occurred before the onset of puberty, suggesting that these traumatic and stressful events typically begin quite early in development.

The findings showed that 52 women (22.4 percent) were diagnosed with major depressive disorder (MDD) prior to experiencing any menstrual irregularity (premenopause), while 48 (20.7 percent) experienced their first MDD during perimenopause.

Notably, women who reported two or more ACEs after the onset of puberty were 2.3 times more likely to have their first experience of MDD during perimenopause, compared to those who did not experience any ACEs, but were not more likely to have been diagnosed with MDD previously.

According to the researchers, the findings suggest that the hormonal changes that occur during menopause may unmask previously undetected risk for depression in women who experienced ACEs, particularly when the events occurred after puberty.

“There’s clearly a strong link between childhood adversity and risk of depression, throughout a woman’s life, but particularly during the transition to menopause,” said senior author Ellen W. Freeman, Ph.D., a research professor of Obstetrics & Gynecology at Penn, noting that dramatic changes in hormone levels are experienced during both puberty and menopause.

“Our study points to the need for more research examining the long-term brain effects of childhood adversity, particularly around the time of puberty.”

The study is published in the Journal of Clinical Psychiatry.

Source: Perelman School of Medicine

Teen Trauma May Impact Depression Risk in Perimenopause