Study explores connections between menopause and mood

The number of women experiencing menopause is expected to triple over the next decade, causing an increased demand for more effective treatment of symptoms such as mood changes. To address this situation, Angela Cappiello, M.D., Ph.D., chief of the Menopause Mood Disorders Clinic and co-director of the Behavioral Gynecology Program at the School of Medicine, has launched a series of studies on mood disorders in menopausal women that may offer relief for some symptoms of menopause.

"My goal is to understand the connection between the brain and the female hormone estrogen," says Dr. Cappiello, whose study is funded by the Lilly Center for Women's Health. "Female hormones may protect women from stress. Loss of estrogen could cause women to be more vulnerable to stressful life changes that usually occur around the time of menopause, including changes in employment, marriage, and children leaving home."

Dr. Cappiello is studying how healthy menopausal women respond to a serotonin depletion induced by a low tryptophan diet. She expects that menopausal women treated with estrogen will have a more stable mood and will be less sensitive to the mood changes of a low tryptophan diet. In addition, Dr. Cappiello is also testing whether the most effective treatment for depressed menopausal women is estrogen alone, fluoxetine (Prozac) alone, or the combination of both fluoxetine and estrogen.

"If we can prove that estrogen regulates serotonin function, then that will be a big finding," says Dr. Cappiello.

An estimated 30 million women are expected to reach menopause in the next 10 years, and more than one-third of a woman's life is post-menopausal, according to Dr. Cappiello. Previous research has shown that estrogen regulates brain activity and that loss of estrogen can affect mood and behavior. Approximately 85 percent of women have some kind of reaction to estrogen loss, such as mood changes, depression, hot flashes and insomnia. Fifteen percent of menopausal women suffer from more severe symptoms.

"We want women to know that treatment is available," says Dr. Cappiello who will use her study to inform women that they do not have to suffer in silence. "Research on menopause is relatively new. It is getting more attention because more and more women are becoming menopausal and there is greater interest in women's health issues."

The Menopause Mood Disorders Clinic is part of the Yale Behavioral Gynecology Program operated jointly by the departments of Psychiatry and of Obstetrics and Gynecology at the School of Medicine.