Mental Health at Menopause

Pauline M. Maki, PhD

In clinical practice and research studies, midlife women report a worsening of mood as they transition through the menopause. The risk of major depressive disorder (MDD) also increases as women transition through the menopause, though this risk is primarily observed in women with a history of MDD. New guidelines recommend that antidepressants and psychotherapies remain as front-line treatments for MDD during the menopause transition. Treatment of vasomotor symptoms (VMS) in women with MDD is key, as these symptoms can exacerbate mood problems. VMS increased risk for elevated depressive symptoms but not clinical depression. Estrogen therapy (ET) may have direct benefits to mood when administered to perimenopausal women with clinical depression, but is ineffective in postmenopausal women. ET may also prevent the development of depressive symptoms during the menopausal transition. Unfortunately, there is little data on the role of combination estrogen plus progestin therapy on clinical depression during the transition. Hormonal contraceptives—particularly when used continuously—have shown some benefits for mood regulation and could be helpful for women experiencing depressive symptoms while approaching menopause. Further research is needed to clarify the role of HT and contraceptives on mood during the menopausal transition.


Dr. Pauline M. Maki is Professor of Psychiatry, Psychology and Obstetrics & Gynecology and serves as Senior Director of Research at the Center for Research on Women and Gender at the University of Illinois at Chicago. Dr. Maki received her Ph.D. from the University of Minnesota and postdoctoral training at the Johns Hopkins University School of Medicine and the National Institute on Aging. For the past 20 years, she has led a program of NIH-funded research on women, cognition, mood and dementia, with a particular focus on the menopause. She uses multiple methods including clinical trials of hormonal and non-hormonal treatments for vasomotor symptoms, cohort studies of the natural history of cognition and brain function across the menopausal transition, and neuroimaging studies.

Dr. Maki is Past President of the North American Menopause Society (NAMS), Current Trustee of the International Menopause Society, Chair of the Society for Women’s Health Research Interdisciplinary Network on Alzheimer’s Disease, and Immediate Past Head of the Neurocognitive Working Group of the Women’s Interagency HIV Study. She won the 2018 Woman in Science Award from the American Medical Women’s Association and the Thomas B. Clarkson Outstanding Clinical and Basic Science Research Award from the NAMS. She has won a number of NIH awards for her research and service, serves as a research and career mentor to many students and junior faculty, serves on executive committees for several women’s health advisory boards, and is a frequent international and national speaker.