Menopause is the cessation of ovarian function, resulting in permanent amenorrhea. It typically takes place between the ages of 45 and 50, with an average age of 47 [1,2]. Postmenopausal problems, particularly hormonal changes, can occur due to decreasing estrogen levels, leading to adverse changes in the vagina and bladder [3,4]. Women spend one-third of their lives in the postmenopausal stage, experiencing depression, fatigue, hot flushes, night sweats, and reduced self-confidence and libido [1-4].

Depression is a prevalent mental disorder characterized by sadness, loss of interest in activities, and decreased energy [5]. The prevalence of depressive disorders among the elderly varies between 10% and 20%, with 45% in India [6]. Estrogen plays a role in depression, as estrogen receptors in the brain modulate neurotransmitter turn-over [7].The Disability Adjusted Life Year (DALY) measure provides a more comprehensive assessment of the burden of illness resulting from psychiatric and behavioral disorders [7]. By 2020, projections indicate that the overall DALY burden for neuropsychiatric disorders will rise to 15%, proportionately larger than that of cardiovascular disease [4-6].Depression is the most common psychiatric morbidity in the elderly, with a prevalence rate of 60/1000 [8]. The psychological and physiological manifestations of depressive illness in the postmenopausal age period are complex and not clearly understood [6-8].

Dementia is a chronic organic mental disorder characterized by impairment of intellectual functions, memory, personality deterioration, judgment and impulse control, and abstract thinking [9-11]. Some women may be at risk for the development of depression, cognitive impairment, and an early onset of dementia due to endocrine events during the menopause transition and perimenopause stages.Hence, the study aims to evaluate bio-endocrinal profiles and to determine correlation between depression and bio-endocrinal profile and understand bio-endocrine role in dementia development.

The Department of Biochemistry, in collaboration with the Department of Gynecology and Obstetrics (Mahila Chikitsalaya) and the Department of Psychiatry at SMS Medical College and Attached Hospitals, Jaipur, Rajasthan, India, conducted the present cross-sectional, comparative study. We collected 100 consecutive cases of depressed postmenopausal women from patients who met the study's criteria and were seeking treatment at the Department of Gynecology and Obstetrics, Mahila Chikitsalaya, SMS Medical College and Hospital, Jaipur, India. We enrolled the cases after obtaining informed consent from the participants. We screened the patients using a specially designed screening device that addressed all inclusion and exclusion criteria. A consultant psychiatrist from the Department of Psychiatry at SMS Medical College & Hospital, Jaipur, who served as our study group, diagnosed the patients with depressive symptoms according to ICD-10. This was done after the screening. We used Beck's depressive inventory, a self-assessment inventory in Hindi, to assess the severity of depression in all subjects (patients and controls) and employed the HMSE to evaluate cognitive functioning. On We divided patients into two groups based on their HMSE score: those with dementia and those without.  control group consisted of 100 healthy postmenopausal women who were either accompanying patients or from society.

Criteria for Selection: Experimental Group: Inclusion criteria: postmenopausal women, aged 45 to 60. Consultant psychiatrists diagnosed melancholy cases in accordance with the ICD-10. Patients who are literate should understand the nature of the examination should be comprehensible to patients who are literate. Patients who are willing to participate in the study should be considered.

Patients who have a severe neurological or somatic condition are excluded. There must be evidence of a comorbid psychiatric disorder that is distinct from depression and dementia. There should be a history of psychiatric disorders that do not include depression and dementia. e may exhibit signs of a psychiatric disorder. first-degree relative. The individual is undergoing hormonal treatment currently or has had a history of hormonal treatment previously.

Control group: Compelling inclusion and exclusion criteria; comparable normal, healthy, literate postmenopausal women (aged 45–60) who are willing to participate in the study.

Study instruments: Form of consent

Upon enrollment in the study, we provided the patient with this Hindi-composed form. We obtained written consent from each patient individually, in the presence of their relatives, to convey that the tests were not routine and that they required sincerity in their endeavors (Appendix I). Performa screening: This involves asking a few basic questions about the patients to determine the inclusion and exclusion criteria (Appendix II).All enrolled subjects underwent the following laboratory tests: After an overnight fast, we collected 5 mL of venous blood from the anti-cubital vein using aseptic techniques in ordinary vials and 1 mL in EDTA vials. We separated the serum and conducted subsequent investigations to measure serum estrogen (estradiol), progesterone, TSH, FSH, and LH. We used an automated immunoassay analyzer [Immulite 1000 and ARCHITECT System] and commercially available reagents and kits. We scrupulously adhered to the manuals accompanying the kits.

Statistical analysis:

We represented the descriptive variables as mean, standard deviation, and percentages. We employed the student "t" test to determine the statistical difference between the categories. We implemented Pearson correlation coefficients (r) to conduct correlation analysis. We deemed the results significant when the p-values were less than 0.05. We used the SPSS 10 computer software for all calculations.

PMWs with depression had significantly elevated serum TSH levels. Depressed PMW had significantly lower serum estrogen levels. In both groups, serum progesterone and FSH levels were not significantly comparable. While the serum LH and calcium levels were significantly reduced in depressed PMW (Table 1).

A highly significant positive correlation was observed between Beck's score and TSH levels in depressed PMW.In depressive PMWs, a highly significant negative correlation was observed between Beck's score and estrogen levels. No significant correlation was observed between Beck's score and serum progesterone levels in either group.In both groups, there was no significant correlation between serum FSH, LH, calcium levels, and Beck's score (Table 2).

Table 1: Comparison of different hormones and calcium of Non-depressed PMW andDepressed PMW

Table 2: Correlation between Beck’s Score and hormones of Non-depressed & Depressed group

The study found that depressed postmenopausal women (PMW) had significantly higher serum TSH levels compared to healthy controls, with a highly significant positive correlation between serum TSH levels and Beck's score in the depressed group. This finding is consistent with previous research [12-15], which found that a higher number of patients with unipolar depression have subnormal T3 and T4 levels and an increase in thyroid stimulating hormone (TSH) levels when compared with healthy controls.

In elderly women, subclinical hypothyroidism is a strong indicator of risk for arteriosclerosis and myocardial infarction [15]. Even mild thyroid failure can have clinical effects such as depression, memory loss, cognitive impairment, and neuromuscular complaints [14,16]. Researchers have found a subtle impairment in myocardial function, and an increased cardiovascular risk due to elevated serum total cholesterol and low-density lipoprotein cholesterol [15,16].

The study also found that depressed PMWs had significantly lower serum estrogen levels, with a highly significant negative correlation between serum estrogen levels and Beck's score [13,14]. The brain contains estrogen receptors, which modulate neurotransmitter turn-over and stimulate serotonergic activity by regulating receptor number and function.

Previous studies [18,19] have found no significant association between depressive symptoms and absolute levels of estradiol and FSH, but this study supports the idea that estrogen deficiency may increase the susceptibility to depression. The study also discovered that the withdrawal of hormones during the placebo month led to a decrease in circulating estrogen levels into the postmenopausal range and an increase in depression scores in all women, indicating more dysphoric moods.

The present study findings infer that the administration of estrogen in doses conventionally used to treat menopausal symptoms enhances mood in non-depressed women but is therapeutically ineffective for mood disturbances of a clinical magnitude. High pharmacological doses of exogenous estrogen can effectively alleviate severe depressive illness in women.

The study compares serum progesterone and FSH levels in perimenopausal and postmenopausal women, finding no significant association between the two. The results contradict previous study [20], which found higher anxiety, depression, and somatic symptoms in perimenopausal and postmenopausal patients with anxiety-depression disorders, while E2 and progesterone levels were lower. The study also found no significant correlation between serum FSH levels and Beck's score in both groups. The findings align with previous research, which found that changes in estradiol and FSH levels were associated with depressive symptoms. According to the study, changes in hormone levels during the reproductive years are more important in determining the etiology of depression and a woman's vulnerability to developing it. The actual rate of hormonal changes might also be relevant in predicting depression. However, few studies [21,22] have examined differences in estradiol and FSH levels between depressed and non-depressed postmenopausal women, with small sample sizes limiting the ability to detect significant effects.

The study analyzed data from the Menopause Weight Management Program (MWMHP) to examine changes in hormone levels across the entire menopause transition. The study revealed that the serum LH levels of depressed postmenopausal women were significantly lower, yet there was no significant correlation between serum LH and Beck's score in the depressed PMW and non-depressed groups. This finding is consistent with previous studies [23,24,25].

The study also found that depressed postmenopausal women have a basal LH concentration about 33% lower than age-matched controls. This could be due to functional abnormalities at the hypothalamic level or an altered sensitivity state at the neuronal receptor site. Environmental risk factors for depression include stresses of family and job, marital discord, sexual discrimination, and victimization of sexual abuse.

Serum calcium levels showed a significant difference between control and depressed PMW, with a mean value of 8.30 ±0.98 mg/dl in depressed PMW compared to 8.93 ± 0.94 mg/dl in normal PMW. The findings are in line with [26,27], who found that rapid bone loss occurs with the onset of menopause, with life-time losses reaching 30% to 40% of the peak bone mass in women.

A study [28] suggested that depression in women occurs most frequently during times of profound hormonal change, such as the climacteric, after pregnancy, and in association with the ever-changing hormone levels of the menstrual cycle. Researchers observed a significant negative correlation between serum TSH and the HMSE score of depressed PMW, whereas the control group showed no such association.

The present studysuggests a connection between menopause and depression, yet additional research is necessary to comprehend the underlying causes. Understanding the biological changes during menopause could help develop better treatment options and reduce the burden of the disorder. Adequate calcium intake and serum estrogens can maximize bone density post-menopause. Future studies should consider confounding factors as well as the impact of treatment on peripheral biochemical markers. A prevention model for depression should focus on improving social networks and educational programs.

Conflict of interest:

There is no conflict of interest among the present study authors.

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