Family. Career. Coping with menstruation, pregnancy and menopause. As a woman, you certainly have plenty of issues to handle. But there's one more you might face someday: depression.

Nearly twice as many women as men develop depression and related disorders at some point in their lives. A woman's unique biological, psychosocial and cultural factors may increase her risk of depression. Explore more about what lies behind this gender gap in depression.

Biological factors affecting depression in women

The female body itself may influence the development of depression. That's because hormones and related factors may alter mood through various stages of life.

Puberty

Before girls and boys reach puberty, they share similar rates of depression. It's only after puberty that the gender disparity in depression and related disorders truly becomes pronounced. And because girls typically reach puberty before boys do, they may develop depression earlier. By age 15, for example, girls are almost twice as likely as boys to have developed depression.

Because this depression gender gap coincides with puberty and disappears after menopause, some researchers believe that hormonal factors increase a woman's risk of developing depression. On the other hand, puberty is also often associated with other changes that could play a role in depression, such as emerging sexuality and identity issues, parental conflicts and evolving social expectations. These psychosocial factors could interact with hormonal changes during puberty and result in an increased risk of depression.

Premenstrual problems

Many women know all too well the physical and emotional changes that can occur before menstruation, when abdominal bloating, breast tenderness, headache, anxiety, irritability or a blue mood herald the notorious symptoms of premenstrual syndrome (PMS). For most women with PMS, the associated symptoms are minor and short-lived. But a small percentage of women have such severe and disabling mood-related symptoms that their lives, jobs and relationships are disrupted. At that point, PMS crosses the line into premenstrual dysphoric disorder (PMDD), which tends to respond best to treatment with hormones or psychiatric medications such as antidepressants.

Although the exact interaction between depression and premenstrual syndrome remains unclear, some researchers believe that cyclical changes in estrogen, progesterone and other hormones can disrupt the function ofbrain chemicals that control mood, such as serotonin. Other research indicates that androgens ? so-called male hormones that women also naturally produce at a lower level ? may play a role. Still, because such hormonal changes occur in all women, but not all women develop depression, hormonal changes alone can't be responsible for the increased risk of depression in women. Genetic predisposition or other factors also may influence depression.

Pregnancy

Dramatic hormonal changes that occur during pregnancy, along with life, work and relationship changes, affect mood and in some cases may trigger depression during pregnancy. Other factors that can increase the risk of depression during pregnancy include previous episodes of depression or PMDD, marital strife, insufficient social support and ambivalence about being pregnant. Other issues surrounding pregnancy can also lead to depression, such as infertility, miscarriage or an unwanted pregnancy.

Postpartum depression

About half of new mothers find themselves sad, angry, irritable and prone to tears soon after giving birth. These feelings ? sometimes called the baby blues ? are normal and generally subside within a week or two. But if they don't subside quickly, if symptoms are severe, if they're accompanied by an inability to care for your baby or thoughts of harming your baby, or if you have feelings of anxiety, low self-esteem, agitation or thoughts of suicide, you might have postpartum depression. This is a serious medical condition requiring prompt treatment. Postpartum depression isn't merely a matter of being unable to cope with having a new baby. Rather, it's probably associated with major hormonal fluctuations that influence mood as well as an underlying predisposition to depression.

Perimenopause and menopause

The risk of depression may also be heightened during the transition to menopause, a stage called perimenopause, when hormone levels fluctuate erratically. And it may also be heightened in early menopause or after menopause, both times when estrogen levels are significantly reduced. Most women who experience uncomfortable menopausal symptoms don't develop depression. But for women whose sleep is disrupted for long periods of time or who have a history of depression, this is a vulnerable time. Hysterectomy with removal of the ovaries can lead to an abrupt onset of menopause with more severe symptoms, including mood changes and sometimes depression

By Mayo Clinic Staff

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