Menopause is a natural and inevitable stage in a woman's aging process, caused by the depletion of ovarian follicles. Menopause is defined as the complete cessation of menstrual bleeding for at least 12 months (Soules et al., 2001). This is usually not sudden, but is a gradual process in which a woman goes through perimenopause before postmenopause (2019). Perimenopause usually begins around the age of 47 and is characterized by fluctuating levels of sex hormones in a woman's body, with some individuals experiencing menopause-related symptoms such as hot flashes, night sweats, urogenital symptoms, sleep disturbances, mood changes, and depression (2019; Brown et al., 2024). The menopausal transition commonly coincides with midlife stress, role changes, and health problems, which can increase the risk of depression (Bromberger et al., 2015). Studies have found that during the menopausal transition, the risk of depressive symptoms or depressive disorders doubles to quadruples (Brinton et al., 2015; Cohen et al., 2006).

Depression is the primary cause of disease-related disability among women worldwide (Kessler, 2003). Depression impairs a woman's normal functioning (relationships, ability to work) and overall quality of life. It is also an indicator of self-harm and suicide risk (Alam et al., 2020; Clayton and Guico-Pabia, 2008). Menopausal women's mental health is receiving more attention, with studies focusing on major depressive disorder and subthreshold depressive symptoms (Brown et al., 2024). Depressive disorders usually require a clinical interview with a health professional for diagnosis. Depressive symptoms are more prevalent but do not constitute a clinical depressive disorder. They are usually assessed by self-report questionnaires. Many epidemiologic studies have favored the use of more convenient self-report questionnaires to explore depressive symptoms in menopausal women compared to the rigorous diagnostic procedures for depressive disorders. However, the results of the studies are inconsistent. The estimated prevalence of depression among menopausal women is 10.7 % in Australia (Almeida et al., 2016), 36.3 % in China (Zeng et al., 2019), and 42.47 % in India (Yadav et al., 2021). To date, no meta-analysis has synthesized the global prevalence of depression in menopausal women.

The menopausal transition usually begins around the age of 47, and the average life expectancy of women is about 81 years, which means that women may be in menopause for more than one-third of their lives (Gatenby and Simpson, 2024). Accurately estimating the global prevalence of depression among menopausal women will be a critical step towards raising awareness, determining the burden, facilitating the allocation of health resources and improving the mental health of menopausal women. Therefore, the aim of this study was to determine the global prevalence of depression in menopausal women through a systematic review and meta-analysis.