Heightened menopausal symptoms mediate the associations between stress and depressive symptoms among midlife women

Menopause. 2025 Jul 15. doi: 10.1097/GME.0000000000002596. Online ahead of print.

ABSTRACT

OBJECTIVES: Investigate associations between stress, cortisol, menopause symptoms, and depression in a sample of midlife women. Because stress has been associated with greater menopause symptoms, we examined this as a mediator for the association between stress and depressive symptoms.

METHODS: Data from a cross-sectional study of 118 women (40-64 y old) were analyzed. Participants completed in-person visits and self-reported questionnaires, including the Menopause-Specific Quality of Life questionnaire, the Perceived Stress Scale, and the Center for Epidemiological Studies Depression Scale. Saliva samples were collected at 4 intervals upon waking (wake, 30 min, 45 min, and 60 min after waking), and one sample before bed, as a measure of cortisol. Both the diurnal cortisol slope and the cortisol area under the curve with respect to ground (AUCg) were used to characterize cortisol secretion and exposure. A multivariate analysis of variance determined differences in menopause symptoms and depression outcomes. Mediation models examined the indirect effects of menopause symptoms on associations between perceived stress and depressive symptoms.

RESULTS: Women with moderate stress had significantly lower cortisol awakening responses (P = 0.047), poorer psychosocial (P < 0.001), physical (P < 0.001), and sexual (P<0.001) menopause symptoms, and depression symptoms (P < 0.001) compared to women with low stress. Mediation analyses (95% CI) between stress and depression demonstrated significant positive indirect effects of psychological (B = 0.247; 0.117, 0.355), physical (B = 0.120; 0.049, 0.210), and sexual menopause symptoms (B = 0.042; 0.006, 0.106).

CONCLUSIONS: Cross-sectional data revealed that greater stress was associated with poorer outcomes of menopause symptoms, depressive symptoms, and a lower cortisol awakening response. The association between stress and depression was mediated by the psychosocial, physical, and sexual menopause symptoms, and future longitudinal studies should seek to confirm these findings.

PMID:40663582 | DOI:10.1097/GME.0000000000002596