Rasgon Natalie, Shelton Stephanie, Halbreich Uriel
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Standord, CA 94305-5723, USA.
CNS Spectr. 2005 Jun;10(6):471-8. doi: 10.1017/s1092852900023166.
Perimenopause, the interval of irregular menstrual activity which directly precedes menopause, is characterized by widely fluctuating hormone levels amidst a large-scale decline in circulating estrogen. This phase in a woman's life is typically accompanied by physical discomforts including vasomotor symptoms, such as headaches, insomnia, and hot flushes, as well as genital atrophy. Not surprisingly, studies suggest a significant increase in mood lability for women during this time. While some evidence points toward an exacerbation of bipolar mood symptoms and an increase in schizophrenic psychosis during perimenopause, the majority of research conducted on perimenopausal mental disorders has focused on unipolar depression. Studies vary widely in methodology, definitions of menopausal status, and degrees of depression among subjects; however, the majority of findings indicate an increased susceptibility to depression during the perimenopausal transition. This greater susceptibility may be due to neuroendocrine effects of declining estrogen levels, the subjective experience of somatic symptoms resulting from this hormonal decline, and/or the more frequent occurrence of "exit" or "loss" events for women during this stage of life. At this time, more research is needed to address questions of prevalence, risk, and etiology for depression and other major mental disorders as related to the physiological and psychosocial changes associated with perimenopause.
围绝经期是紧接绝经前的月经活动不规律时期，其特征是在循环雌激素大规模下降的同时，激素水平大幅波动。女性生命中的这一阶段通常伴有身体不适，包括血管舒缩症状，如头痛、失眠和潮热，以及生殖器萎缩。不出所料，研究表明在此期间女性情绪不稳定显著增加。虽然一些证据表明围绝经期双相情感症状会加重，精神分裂症性精神病会增加，但关于围绝经期精神障碍的大多数研究都集中在单相抑郁症上。研究在方法、绝经状态定义以及受试者抑郁程度方面差异很大；然而，大多数研究结果表明围绝经期过渡期间患抑郁症的易感性增加。这种更高的易感性可能是由于雌激素水平下降的神经内分泌效应、这种激素下降导致的躯体症状的主观体验，和/或女性在生命这个阶段更频繁发生的“退出”或“丧失”事件。此时，需要更多研究来解决与围绝经期相关的生理和心理社会变化所导致的抑郁症及其他主要精神障碍的患病率、风险和病因问题。
