Coexistent Depression and Vasomotor Symptoms Common in Older Women

Depressive symptoms in older women can be attributed to vasomotor symptoms.

Depressive symptoms in older women are common and are associated with social and financial insecurity and vasomotor symptoms (VMS), according to an Australian study.

A team of investigators headed by Berihun M Zeleke, MD, MPH, of the Women’s Health Research Program, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, conducted a questionnaire-based, cross-sectional study of community-dwelling older women, 65 and older (n=1,534, mean age 71.5 [SD 4.1]) recruited from a national database.

The questionnaires elicited information about comprehensive sociodemographic characteristics, including age, current relationship status, residential location, working status, and being a caregiver. To assess financial security regarding housing, women were asked if they were confident about continuing to be able to afford to live in their current situation. The researchers also asked about current systemic hormone therapy (HT) or vaginal estrogen use, as well as pelvic floor dysfunction (urinary or fecal incontinence and pelvic organ prolapse).

The researchers used the Menopause-Specific Quality of Life Questionnaire (MenQOL) to assess vasomotor symptoms and vaginal dryness during intercourse during the past month. VMS included 3 items: hot flashes, night sweats, and sweating. The symptoms were rated according to the “degree of bother caused by the symptom.”

Chronic medical conditions (cardiovascular, pulmonary, musculoskeletal, and metabolic diseases) were also included in the questionnaire.

Depression symptoms were assessed using the Beck Depression Inventory-II (BDI-II), and the total score was categorized as no/minimal (BDI-II score 0-13), mild (14-19), moderate (20-28), or severe (29-33) and were further categorized into a binary outcome of minimal-to-mild (BDI-II score <20) and moderate-to-severe (BDI-II score ≤20). 

Participants were also asked to report use of psychotropic medications, including antidepressants, benzodiazepines, antipsychotics, and mood stabilizers.

The researchers found that the mean (SD) body mass index (BMI) of participants was 27.9 (5.9) mg/m2, with 32.4% being obese (BMI ≥30). Most participants were white (97.6%), living in metropolitan areas (66.0%), and currently partnered (52.8%). Only 39.2% were educated beyond high school and 13.5% reported being in paid employment. Of the participants, 7.5% were not confident of their housing security status.

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Almost half (47.25%) of participants were classified as having symptomatic pelvic floor dysfunction, and approximately one-quarter (22.5%) reported having vaginal symptoms during intercourse during the past month. Of note, 83.5% of women had at least 1 chronic medical condition. 

Overall, 34.2% (95% CI, 31.9%-36.7%) women had any VMS and of these women, 30.3% (95% CI, 28.0%-32.7%) had mild VMS, while 3.9% (95% CI, 3.0%-5.0%) had moderately to severely bothersome VMS. 

When the researchers examined women with VMS by age, they found that the prevalence of any VMS was 41.0% (95% CI, 37.3%-44.9%) in women age 65 to 69, 31.9% (95% CI 27.9%-36.2%) in patients 70 to 74, and 25.1% (95% CI 20.9%-29.8%) in women 75 to 79.