For some women depression in their 40s can be hormonal as Ursula Hirschkorn – writing in The Telegraph, 30 June 2015 – found out, and since being treated with tailored Hormone Replacement Therapy her quality of life has vastly improved.

“I never saw it coming. Though I’d suffered some postnatal depression years earlier, I’d always considered myself a pretty even-tempered, upbeat sort of person, not one to wallow or mope about. Then I turned 41, and almost overnight my life imploded.”

The number of women suffering from depression linked to hormonal fluctuations is unknown since the condition often goes undiagnosed, according to Dr Mike Savvas, consultant gynaecologist at Kings College Hospital, London.

“Very often, depression and anxiety in women of all ages can have a hormonal basis,” he says. “This type of depression often fluctuates according to the menstrual cycle. It includes both premenstrual syndrome, postnatal depression and depression leading up to menopause and it tends to get worse in the 30s and 40s. But it often goes unrecognised, or is treated with antidepressants.”

Nor is it known why hormonal fluctuations cause these symptoms, says Dr Savvas. But Hormone Replacement Therapy (HRT) with oestrogen (plus a progestogen for women who still have their wombs), normally prescribed for menopausal symptoms such as hot flushes and vaginal dryness, can be highly effective in treating younger women with cyclical depression and is safer and more effective than anti-depressants. “Of course,” he adds, “you need to assess the patient to ensure the depression has a hormonal basis.”

The anxieties raised about the risks of HRT from previous studies have for the most part been shown to be unfounded, he argues. Current NHS advice is that combined HRT is linked to a slight increase in the risk of breast and some other cancers, deep vein thrombosis and pulmonary embolism (blockage in the pulmonary artery). In women who start it more than 10 years after menopause, it can increase the risk of heart disease and stroke. HRT is not suitable for everyone but for most women taking it for five years or less, the benefits outweigh the risks, says the guidance.

Testosterone therapy may help improve a flagging libido, meanwhile, but is usually only prescribed by specialists and is no longer available in the UK in a form licensed for women. British Menopause Society Guidelines advise doctors to use instead a very low dose of the gel licensed for testosterone deficiency in men. Very high doses can cause masculine characteristics such as facial hair growth, and little is known about the long-term effects, says Dr Savvas, “although given at levels within a woman’s normal range it is unlikely to cause problems.”

Read Ursula’s story on The Telegraph website.