Do those hot flashes make you depressed or is depression causing or worsening your hot flashes?

You know that you have not been feeling yourself lately. You are not your usual upbeat, positive self. You lash out at others or retreat from being around anyone. What could be causing these feelings of depression? Is it menopause and hormones? Since many women will experience their first bout of depression during mid-life, it is natural to assume menopause is to blame.

Perimenopause and depression
Perimenopause, or the years leading up menopause, may affect women and increase the risk of depression. During perimenopause fluctuating hormone levels, especially estradiol, leave some women dealing with a variety of symptoms. In particular, hot flashes or night sweats and sleep disturbances affect your well-being. But are the hormones really to blame?

Which comes first, hormones or depression?
Doctors are still working to learn whether menopause itself is a direct cause of depression. Changes in hormone levels and the related hot flashes and sleep disturbances make it difficult to function and perform daily tasks. Ask anyone who has not slept well and she will tell you how difficult it is to concentrate the next day. It is also a challenge to deal with even minor stressors. The stressors in turn affect how the body reacts to menopause. So while some experts insist hormones cause depression during menopause, others point out that risk factors such as stress affect hormonal functions.

Sleep quality and hot flashes
Hot flashes and night sweats have a direct impact on daily life, and more importantly, on getting a good night’s sleep. Even if hot flashes occur during the day, the hormone level changes still impact the body’s ability to control temperature and overall performance. Insomnia is increasingly tied to quality of life and health; those unable to get regular restorative rest are more prone to poor physical and mental health.

As Dr. Hadine Joffe explained at a recent talk, “Hot flashes and sleep disturbance are strongly associated with depression in perimenopausal women, and women with menopause associated depression commonly experience hot flashes and sleep disturbance concurrent with their depression.” One of the keys to understanding what is happening within your own body is to know your personal history and share that information with your doctor.

Talking to your doctor about menopause and depression
*Keep track of your menopausal symptoms and look for any patterns that might help pinpoint the cause of your depression.
*How long have you had hot flashes and insomnia?
*Did you experience depression before menopausal symptoms?
*Have you ever been diagnosed with depression in the past? How often?
*Do you notice that your symptoms are getting worse?

Record as much information as you can to share with your doctor. Based on your own health history, your doctor can make a proper diagnosis and discuss the best treatment options available should treatment be necessary. Once your doctor understands what is triggering your menopausal depression, you can both work together to find ways to manage your menopause. Depression may occur during perimenopause but it does not have to take over your life.

‘Menopause, Depression & Hormones: What’s the Connection?’ Hadine Joffe, MD, MSc. Department of Psychiatry, Division of Sleep Medicine, Massachusetts General Hospital, Boston, MA as presented at the NAMS 22nd Annual Meeting in Washington, D.C. Sept 2011.

‘Depression in Midlife Women: Identification & Treatment’ Teri Pearlstein, MD, Psychiatry & Human Behavior, Alpert Medical School at Brown University, Providence, RI as presented at the NAMS 22nd Annual Meeting in Washington, D.C. Sept 2011.

Menopause, Your Doctor, and You