Nighttime Hot Flashes May Spark Mild Depression

Hypoestrogenic women who perceive a high number of nighttime hot flashes and experience/have sleep disruption are more vulnerable to menopause-associated depressive symptoms, according to a study recently published in The Journal of Clinical Endocrinology & Metabolism.

Researchers led by Hadine Joffe, MD, MSc, of Brigham and Women’s Hospital and Dana Farber Cancer Institute at Harvard Medical School in Boston, Mass., point out that “[d]epressive symptoms increase when estradiol levels change markedly in association with both natural and surgical menopause” and that hot flashes are the “hallmark” symptom of menopause, occurring in up to 80% of women.

So the authors evaluated 29 healthy, premenopausal women between the ages of 18 and 45 and gave them a GnRH agonist (GnRHa) to simulate the decline in a woman’s estrogen levels during menopause. The women took the GnRHa to suppress estrogen production in the ovaries for a four-week period, a treatment that mimics menopause and induces menopausal symptoms to varying degrees of intensity. Before and after the four-week timeframe, researchers monitored the participants’ sleep with polysomnography and checked their hormone levels. The participants completed mental health interviews at the beginning and end of the study.

“When women were awake long enough to later recall nighttime hot flashes, that perception contributed to mood disturbance in women whose estrogen levels had fallen,” Joffe says. “The association was independent of sleep disruption that the women experienced.”

The study found that women who reported experiencing frequent nighttime hot flashes were more likely to experience mild symptoms of depression than those who reported fewer or no nighttime hot flashes. Although researchers also monitored the women for physiological signs of nighttime hot flashes during the sleep study, they found only the women’s perception of hot flash frequency—not the measured number of hot flashes—was linked to changes in mood.

Women who experienced sleep interruption also were more likely to exhibit symptoms of depression than women who got more sleep. Daytime hot flashes had no effect on the participants’ mood. “The results of our research suggest menopausal women who report experiencing nighttime hot flashes and sleep disruption should be screened for mood disturbances,” Joffe said. “Any treatment of mood symptoms in this population also should incorporate efforts to address sleep and nighttime hot flashes.”

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