Menopause is not characterized by an excess of affective illness; however, minor depressive and other psychological symptoms may be more frequent in perimenopause. It remains controver sial whether there is a causal connection between the onset of menopause and disturbances in mood. A psychoendocrine hypothesis suggests that some women have an increased vulnerability to normal hormone changes associated with menopause, and is supported by evidence that estrogen has spe cific beneficial effects on mood. Cultural factors influence the response to physiological changes that occur during menopause. Sociocultural models emphasize social status and familial roles of women in middle-age, but are unable to adequately explain the complexity of the relationship between culture and meno pause-related distress. Research has yet to establish how endocrine or other biological factors differ across cultures, and how cross-cultural variations in genetics, fertility patterns, diet and environment shape the subjective experience of menopause.
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