Scientific References

Menopause, Mood, Sleep, Cognition & Mental Health

The following nine peer-reviewed articles and professional guidelines inform the MoonPhase approach to menopause-informed psychiatric care. They are offered as educational resources and are not a substitute for individualized medical or psychiatric evaluation.

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1. Guidelines for the evaluation and treatment of perimenopausal depression

🩺 Link:https://pubmed.ncbi.nlm.nih.gov/30182804/

Summary:
This expert guideline provides clinical recommendations for evaluating and treating depression during the menopause transition. It supports assessing menopausal stage, depressive symptoms, anxiety, sleep, vasomotor symptoms, psychosocial stressors, medical contributors, and treatment history. It also helps distinguish when antidepressants, psychotherapy, hormone therapy, or collaborative care may be appropriate.

APA citation:
Maki, P. M., Kornstein, S. G., Joffe, H., Bromberger, J. T., Freeman, E. W., Athappilly, G., Bobo, W. V., Rubin, L. H., Koleva, H. K., Cohen, L. S., & Soares, C. N. (2019). Guidelines for the evaluation and treatment of perimenopausal depression: Summary and recommendations. Journal of Women’s Health, 28(2), 117–134. https://doi.org/10.1089/jwh.2018.27099.mensocrec

2. The MENO-D: A menopause-specific depression rating scale

🩺 Link:https://pmc.ncbi.nlm.nih.gov/articles/PMC6023883/

Summary:
This study describes the development and validation of the MENO-D, a 12-item self-report or clinician-rated scale designed to assess symptoms of perimenopausal depression. It is useful because standard depression tools may not fully capture the mood, cognitive, sleep, somatic, and hormonal-pattern symptoms that can emerge during the menopause transition.

APA citation:
Kulkarni, J., Gavrilidis, E., Hudaib, A. R., Bleeker, C., Worsley, R., Gurvich, C., & Gilbert, H. (2018). Development and validation of a new rating scale for perimenopausal depression—the Meno-D. Translational Psychiatry, 8, Article 123. https://doi.org/10.1038/s41398-018-0172-0

3. Menopause depression: Under-recognised and poorly treated

🩺 Link:https://pubmed.ncbi.nlm.nih.gov/38761367/

Summary:
This article highlights that menopause-related mental health symptoms are often missed, minimized, or treated without adequate attention to the hormonal transition itself. It discusses mood, anxiety, cognition, sleep, and neurobiological mechanisms, including the role of gonadal hormones and neurosteroids in brain function.

APA citation:
Kulkarni, J., Gurvich, C., Mu, E., & Gilbert, H. (2024). Menopause depression: Under recognised and poorly treated. Australian & New Zealand Journal of Psychiatry, 58(7), 573–575. https://doi.org/10.1177/00048674241253944

4. Sex hormones, neurotransmitters, and the adult female brain

🩺 Link:https://pmc.ncbi.nlm.nih.gov/articles/PMC4335177/

Summary:
This review explains how ovarian hormones influence neurotransmitter systems, neural plasticity, brain structure, and functional connectivity across hormonal transition periods. It provides scientific support for understanding menopause as a brain-relevant biological transition, not simply a reproductive milestone.

APA citation:
Barth, C., Villringer, A., & Sacher, J. (2015). Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Frontiers in Neuroscience, 9, Article 37. https://doi.org/10.3389/fnins.2015.00037

5. The 2022 Hormone Therapy Position Statement of The North American Menopause Society

🩺 Link:https://pubmed.ncbi.nlm.nih.gov/35797481/

Summary:
This position statement reviews the benefits and risks of menopausal hormone therapy. It states that hormone therapy remains the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause, while emphasizing individualized care based on age, timing, health history, route, dose, duration, and use of progestogen.

APA citation:
The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794. https://doi.org/10.1097/GME.0000000000002028

6. The 2023 Non Hormone Therapy Position Statement of The Menopause Society

🩺 Link:https://pubmed.ncbi.nlm.nih.gov/37252752/

Summary:
This position statement reviews evidence-based nonhormonal treatments for vasomotor symptoms. It is useful for women who cannot use hormone therapy, choose not to use hormone therapy, or need additional treatment options. It includes discussion of SSRIs/SNRIs, gabapentin, fezolinetant, cognitive behavioral therapy, and other nonhormonal approaches.

APA citation:
The North American Menopause Society. (2023). The 2023 non hormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590. https://doi.org/10.1097/GME.0000000000002200

7. Risk for new onset of depression during the menopausal transition

🩺 Link:https://pubmed.ncbi.nlm.nih.gov/16585467/

Summary:
This study, known as the Harvard Study of Moods and Cycles, found that the menopausal transition is associated with increased risk for new-onset depressive symptoms, especially in the presence of vasomotor symptoms. It is one of the foundational studies supporting perimenopause as a window of mood vulnerability.

APA citation:
Cohen, L. S., Soares, C. N., Vitonis, A. F., Otto, M. W., & Harlow, B. L. (2006). Risk for new onset of depression during the menopausal transition: The Harvard Study of Moods and Cycles. Archives of General Psychiatry, 63(4), 385–390. https://doi.org/10.1001/archpsyc.63.4.385

8. Mood and Menopause: Findings from the Study of Women’s Health Across the Nation

🩺 Link:https://pmc.ncbi.nlm.nih.gov/articles/PMC3197240/

Summary:
This review summarizes findings from SWAN, a major longitudinal study of midlife women. It supports the finding that risk for high depressive symptoms and depressive disorder may increase during and after the menopausal transition, while also emphasizing that risk is shaped by multiple factors including prior depression, vasomotor symptoms, sleep, stress, and life context.

APA citation:
Bromberger, J. T., & Kravitz, H. M. (2011). Mood and menopause: Findings from the Study of Women’s Health Across the Nation over 10 years. Obstetrics and Gynecology Clinics of North America, 38(3), 609–625. https://doi.org/10.1016/j.ogc.2011.05.011

9. Depression in the menopause transition: Risks in the changing hormone milieu

🩺 Link:https://pmc.ncbi.nlm.nih.gov/articles/PMC6214217/

Summary:
This review discusses depression risk during the menopause transition, including the relationship between changing reproductive hormones, vasomotor symptoms, sleep disruption, prior depression history, and psychosocial stress. It is helpful for understanding why midlife mood symptoms often require a more nuanced assessment than standard depression screening alone.

APA citation:
Freeman, E. W. (2015). Depression in the menopause transition: Risks in the changing hormone milieu. Women’s Midlife Health, 1, Article 2. https://doi.org/10.1186/s40695-015-0002-y

10. Perimenopause, Menopause, and Mental Health: A Conversation with the Seleni Institute
The Positive Pause, Episode 46 · National Menopause Foundation

A conversation about the emotional and mental health dimensions of perimenopause and menopause, including mood, sleep, identity, and the importance of making these experiences easier to discuss in healthcare and everyday life. Featuring Seema Bajaj and Dr. Mary Riddle of the Seleni Institute.