The Depression Screening Test We Don't Talk About: Your Own Reproductive History

Just as routine cancer screening and blood tests can identify a predisposition to conditions such as diabetes mellitus, understanding that one may be predisposed to developing depression during midlife could provide an opportunity to take preventive measures, prepare for potential symptoms, and seek appropriate support at an earlier stage.

During perimenopause and menopause, a significant proportion of women experience psychological changes, including depression and anxiety alongside vasomotor and other physical symptoms. However, a lack of awareness, information, and accessible resources can leave women struggling to understand and manage these changes, often navigating their symptoms alone, both personally and professionally.

This raises an important question: can women be better prepared for the psychological changes associated with perimenopause and menopause?

Women are approximately twice as likely as men to meet the diagnostic criteria for depression and anxiety disorders, with this vulnerability appearing to increase during key reproductive life stages, including menarche, the postpartum period, and the menopausal transition. A subset of women may be particularly sensitive to fluctuations in reproductive hormones, with individual differences in how the brain responds to these hormonal changes influencing mood and affective behaviour. This pattern suggests that PMDD, postpartum depression, and perimenopausal depression may share an underlying biological vulnerability related to sensitivity to hormonal fluctuations. Consequently, women with a history of PMDD or postpartum depression may be at heightened risk of developing depression during perimenopause, potentially more so than women whose previous episodes of depression were unrelated to reproductive hormonal changes.

Researchers at OLVG Hospital in Amsterdam followed 180 women (median age 51) attending menopause outpatient clinics. Everyone completed validated questionnaires: the PSST for a history of premenstrual mood symptoms, the EPDS-Lifetime for a history of perinatal depression, and a detailed clinical review of medical records to identify non-reproductive depression (depression unrelated to any hormonal transition). Current depressive symptoms were measured with the IDS-SR, a well-validated 30-item scale.

The researchers used linear regression models to see which type of prior depression best predicted current depressive symptom severity, first looking at each one alone, then putting all three into the same model together to see which held up once the overlap between them was accounted for.

On their own, all three types of prior depression were linked to more severe depressive symptoms during the menopausal transition. But once the researchers accounted for overlap between them, PMDD remained most strongly linked to symptom severity, and perinatal depression also remained significantly linked; however, non-reproductive depression was no longer independently associated.

Clinically, that means asking a patient "have you had depression before?" may be less useful than asking "did it happen around your period, or after giving birth?"

The authors suggest this kind of reproductive mood history could help clinicians flag who might benefit from closer monitoring or even preventive support heading into perimenopause.

This was a cross-sectional study of women already attending specialist menopause clinics, and depression history was assessed retrospectively, which can introduce recall bias. The authors are clear that larger, prospective, community-based studies are needed to confirm the pattern.

Reference

Schipper, M., Morssinkhof, M.W.L., van Dijken, D.K.E., Roggeveen, Y., & Broekman, B.F.P. (2026). Prior reproductive and non-reproductive depression, and depressive symptoms in menopausal transition. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2026.122361