A substantial proportion of women transitioning into menopause experience a new onset or recurrence of depressive symptoms.  A new study from the Center for Women’s Mental Health indicates that duloxetine (Cymbalta) is effective for the treatment of depression and may also have a beneficial effect on vasomotor symptoms (hot flashes and night sweats).
Peri- and post-menopausal women have various options for the management of hot flashes, including hormone replacement therapy, SSRIs, and gabapentin. It looks as if hypnosis may also be helpful. In a recent study, researchers randomly assigned postmenopausal women to hypnotherapy or "structured attention," which was used as a control intervention.
For decades, estrogen has been used to treat menopausal symptoms, including night sweats and hot flashes. However, after studies reported that estrogen increases the risk of cardiovascular disease and breast cancer, many patients and clinicians have looked into alternative treatments for hot flashes, including selective serotonin reuptake inhibitors (SSRIs).
Various studies have shown that women with a higher body mass index (BMI) or a higher percent of body fat have more frequent or more severe menopausal symptoms. In a recent study, researchers evaluated the impact of a low-fat diet on vasomotor symptoms in a group of 17,473 postmenopausal women between the ages of 50 and 79.
The National Comorbidity Survey estimates that by the time women reach midlife, approximately 23% have experienced at least one episode of major depression and 30% have been diagnosed with an anxiety disorder. Depression and anxiety disorders are each associated with impaired functioning and lower quality of life (QOL). There is also some data to suggest that, even after a depressive episode resolves, those with a history of a affective illness have a lower quality of life than those without histories of depression, with impairment in social and interpersonal functioning.
In this study, half of women aged 45 to 60 years reported experiencing menopausal symptoms. 69% of these women reported that their symptoms have negatively  affected their lives. Among the women who endorsed menopausal symptoms, 72% had not received any treatment for their symptoms and 77% reported that they had not discussed treatment options with their healthcare providers.
Ever since 2002 when several large-scale studies called into question the safety of long-term hormone replacement therapy (HRT), there has been confusion and conflicting opinions regarding the management of menopausal symptoms. Initially there was a movement to avoid HRT altogether; now it is becoming clearer that certain women may safely use and benefit from hormonal interventions.
More than half of all women initiating treatment with hormone therapy will stop within the first year of treatment, most often because of side effects. Mood disturbance is a relatively common side effect that occurs with hormone therapy, and previous studies have suggested that progestins in the combined hormone preparations are responsible for these negative mood effects.
While phytoestrogens have gained attention as possible alternatives to hormone therapy for the treatment of menopausal symptoms, placebo-controlled studies have yielded mixed results. Pomegranate seed oil is a very rich source of phytoestrogens.  In this prospective randomized, placebo-controlled, double-blinded trial, 81 postmenopausal women received two daily doses of either 30 mg pomegranate seed oil (PGS) or placebo. The frequency of hot flashes decreased by 38.7% (P < 0.001) after 12 weeks of treatment with pomegranate seed oil and by 25.6% in the placebo group (P < 0.01). However, the difference between the two groups was not statistically significant (P = 0.17).  The authors suggest that it may take a longer period of observation to demonstrate a difference between pomegranate seed oil and placebo.
