Four Years of Menopausal Symptoms Treated as Anxiety: A Narrative Review of Diagnostic Overlap and the Quality of the Supporting Evidence
DOI:
https://doi.org/10.5281/zenodo.22237578Keywords:
Perimenopause, Diagnostic Overlap, Depression, Misattribution, Evidence QualityAbstract
Fatigue, poor concentration, disturbed sleep, irritability and low mood in a woman in her forties will satisfy the criteria for a
depressive or anxiety disorder. They are also the commonest features of the menopausal transition. The two descriptions are not
distinguishable on symptoms alone, which is the whole difficulty. Objectives: To review the published evidence on the overlap between menopausal symptoms and common mental disorder: how far the diagnostic criteria coincide, what is known about misattribution, what treatment response shows, and how good the supporting evidence actually is.
Material and Methods: Narrative review of clinic cohorts, audits, prescribing data, society guidance and industry-sponsored
surveys indexed in PubMed and the major obstetric, primary care and psychiatric journals. No new patient data were generated;
every estimate quoted is one published by the original investigators, and the sponsorship of each source is stated.
Results: In a cohort of 978 women attending a menopause clinic, the five most prevalent symptoms were fatigue (96 per cent),
memory problems (93 per cent), difficulty concentrating (91 per cent), irritability (90 per cent) and feeling tense or nervous (90
per cent); hot flushes and night sweats ranked 18th and 14th. Seven of the eight items on the PHQ-8 depression scale may be
produced by the menopausal transition. In an audit of women diagnosed with depression at a tertiary centre, 78 per cent had
significant perimenopausal symptoms that had been overlooked, 82 per cent were treated with antidepressants, and 45 per cent
reported satisfactory symptom management.
Conclusion: The overlap is genuine and clinically important. The evidence describing it is unusually weak: single-clinic cohorts
without control groups, an audit in one hospital, and surveys funded by companies selling hormone therapy. Both statements need
to be made together, because the strength of the argument does not match the strength of the data.
Abbreviations: CBT – Cognitive Behavioural Therapy, HRT – Hormone Replacement Therapy, MENQOL – Menopause-Specific
Quality of Life questionnaire, PHQ-8 – Patient Health Questionnaire 8-item, SSRI – Selective Serotonin Reuptake Inhibitor, VMS
– Vasomotor Symptoms.
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