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Transdermal estrogen and oral progesterone prevent depression in peri/postmenopausal women
Clinical Question
Is hormone replacement therapy with estrogen and progesterone effective for preventing symptoms of depression in perimenopausal and early postmenopausal women?
Bottom line
Hormone replacement therapy with transdermal estrogen and episodic oral progesterone for 12 months significantly reduced clinically relevant depressive symptoms in initially euthymic perimenopausal and early postmenopausal women. The benefit was most pronounced in women in the early perimenopausal transition and in those women who reported an increased number of stressful life events prior to treatment. Neither severity of vasomotor symptoms nor a history of depression affected the likelihood of a treatment benefit. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Foundation
Setting: Outpatient (specialty)
Synopsis
These investigators identified women (N = 172), aged 45 to 60 years, who were medically healthy and euthymic at study enrollment according to standard diagnostic criteria. Eligible women randomly received (uncertain allocation concealment) 0.1 mg transdermal estradiol daily for 12 months and 200 mg oral micronized progesterone daily for 12 days every 2 to 3 months or matched placebo. Depressive symptoms were assessed using a validated diagnostic tool at months 1, 2, 4, 6, 8, 10, and 12. Individuals who assessed outcomes remained masked to treatment group assignment. Complete follow-up occurred for 76% of participants at 12 months, with 85% follow-up for at least 4 visits. Using intention-to-treat analysis, clinically significant depressive symptoms developed in fewer women assigned to active treatment than to the control group (17.3% vs 32.3%; number needed to treat = 6.6; 95% CI 3.6 - 46.5). In secondary analysis, mood benefits were most evident among women in the early perimenopause transition and among those with an increased number of stressful life events in the 6 months preceding study enrollment. Baseline estrogen levels, vasomotor symptom severity, history of depression, and history of abuse did not affect treatment effects. Adverse effects due to vaginal bleeding occurred significantly more often in the treatment group, but drop-out rates were similar between the 2 groups.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Novel way to treat depression. Ketamine is also becoming an important drug for depression as standard antidepressants frequently are not effective for many patients.
Sounds like Big Pharma looking to increase sales to me.
good poem
What happens after the first year??!
Another study debunking the flawed "women's health study" (WHI) study that harmed so many menopausal women.