The transition to menopause is stressful for many women. In addition to the unpleasant symptoms that often accompany it, menopause is a clear biological sign of aging, and women may mourn the end of their reproductive years even if they have no interest in having children. The hormonal changes that are part of menopause can make depression more likely. As a result, women in perimenopause and menopause are at an increased risk of depression. In fact, women’s risk of depression can double or even quadruple during this time.

Hormone replacement therapy can offer some relief for women experiencing depression connected to menopause, according to a study published recently in JAMA Psychiatry. Researchers studied the effectiveness of a hormone patch delivering estrogen and progesterone through the skin — transdermally — and found it may actually prevent clinical depression.

During perimenopause and menopause, the risk of depression can double or even quadruple.

Transdermal estradiol, TE, with or without progesterone had been found to ease symptoms of depression during menopause in small studies, explained Susan Girdler, one of the authors. “So we were interested in testing the hypothesis that you can administer TE and decrease the risk of ever developing depression in the first place,” she told TheDoctor. The team identified two factors that predicted which women were most likely to reap the mood benefits of transdermal estradiol: the stage of menopause they were in and the recent life stress, if any, they had experienced.

Nearly 175 women who did not have depression were enrolled in the study. The women, all perimenopausal or early postmenopausal, were randomly assigned to be given the hormone patch or a placebo for 12 months. Participants were interviewed at enrollment, one month after enrollment and than every other month during the 12-month study period.

Nearly a third of the women who received the placebo instead of the hormone patch developed clinically significant depressive symptoms, while only 17.3 percent of women receiving the patch did. Women in the early stages of menopause were more likely to see mood benefits from the hormone patch than those in the later stages of the transition.

Women in the study who had experienced one or more stressful life events — such as the death of a loved one, serious illness, divorce or financial hardship — in the six months prior to study enrollment also experienced more mood benefits with the patch than did those who had not experienced such stress.

The bigger message is that women should talk to their doctors about what is going on in their lives, whether they are a candidate for hormone therapy or not. “A stigma still surrounds reporting that you are feeling depressed,” says Girdler. Other interventions, such as therapy and antidepressants, can also help. “Women do not have to suffer with depression,” Girdler, a professor in the Department of Psychiatry at the University of North Carolina at Chapel Hill, insists. “They should talk to their provider and get the help they need.”

The study and a related editorial are published in JAMA Psychiatry.