Depression During the Menopausal Transition: An Integrated Biopsychosocial Framework for Understanding Its Multifactorial Determinants "Beyond Hormones: Unravelling the Interconnected Pathways of Biological Change, Emotional Vulnerability, Psychological Adaptation, Social Stress, and Individual Experience Across the Menopausal Journey"

Background: The menopausal transition represents a complex biological and psychosocial phase of midlife. Although menopause is a physiological process, the transition is accompanied by fluctuating reproductive hormones, vasomotor symptoms, sleep disturbance, changes in physical health, alterations in social roles, and psychological challenges. Increasing evidence suggests that some women may experience heightened vulnerability to depressive symptoms during perimenopause. However, depression during this period cannot be adequately explained by hormonal changes alone. Objective: This review aims to examine depression during the menopausal transition through an integrated biopsychosocial framework, with particular emphasis on biological, psychological, and social determinants and their potential interactions. Methods: An integrative narrative review of published literature concerning menopause, perimenopause, depression, reproductive hormones, vasomotor symptoms, sleep disturbance, psychosocial stressors, and biopsychosocial determinants was undertaken. Evidence from longitudinal cohort studies, systematic reviews, meta-analyses, clinical guidelines, and relevant narrative reviews was synthesized conceptually. Results: Evidence indicates that depressive symptoms may increase during the menopausal transition, particularly among susceptible subgroups. Biological contributors include reproductive hormone fluctuation, altered neuroendocrine signalling, vasomotor symptoms, sleep disruption, and associated physical morbidity. Psychological determinants include previous depression, anxiety, perceived loss of control, negative attitudes toward ageing and menopause, body-image concerns, and difficulties adapting to midlife changes. Social determinants include relationship difficulties, caregiving responsibilities, occupational stress, financial insecurity, adverse life events, reduced social support, and changing family roles. These factors may interact synergistically rather than operate independently. Conclusion: Depression during the menopausal transition should be conceptualized as a multifactorial phenomenon arising from interactions among biological vulnerability, psychological processes, and social context. A biopsychosocial framework provides a clinically meaningful model for comprehensive assessment, risk stratification, prevention, and individualized management. Future research should employ longitudinal designs and multidimensional assessment models capable of examining interactions among endocrine, psychological, behavioural, and social variables.