There has been much controversy over the relationship between menopause and depression. Earlier psychiatric terminology had a special term, “involutional melancholia,” to refer to depression presenting in women in association with the menopausal years (Burrows & Dennerstein, 1981). These midlife years also coincide with other stressors for women, including their children reaching the developmental stage of independence and leaving home, ill health of elderly parents, health problems for the spouse or for women themselves, confrontation with ageing, the need to re-evaluate life expectations and goals, work stressors, and so on. In addition, it was not clear whether chronologic ageing predisposed women to depression.

Psychological symptoms are frequently reported by mid-aged women (Boulet et al., 1994; Dennerstein et al., 1994b). Mood problems are known to be among the three most common problems reported to specialist menopause clinics (Sarrel & Whitehead, 1985). They are also reported in association with other phases of exogenous and endogenous change in ovarian steroid hormones (see Chapter 7). The greatest sense of well-being has been found to occur during the follicular and ovulatory phases of the menstrual cycle (Dennerstein et al., 1994a). The majority of reproductive-age women report that symptoms of tension and depression increase in the premenstruum (Dennerstein et al., 1988). Some of these women find the symptoms problematic enough to seek medical intervention. A small minority of women (<5%) in the peak reproductive phase experience severe cyclical premenstrual depression and meet criteria for premenstrual dysphoric disorder (American Psychiatric Association, (APA), 1994).