Insomnia and depressive symptoms during the menopausal transition: theoretical and therapeutic implications of a self-reinforcing feedback loop

Insomnia is a common and recurring condition during the menopausal transition that negatively affects both quality of life and health. Peri-menopausal insomnia has a multifactorial etiology; previous depression, hormonal changes and age/hormone-related irregularity in circadian rhythms can contribute to menopausal insomnia. Age-related poor health, pain and stress may favor the development of insomnia, while vasomotor symptoms, in particular hot flashes, may contribute to chronic forms of insomnia by activating a vicious cycle. Insomnia increases two- to threefold the risk of developing depressive symptoms during the peri-menopause. In fact, the menopausal transition is a window of vulnerability for the development of depressive symptoms, in which the risk of a major depressive disorder is 2–4 times greater than in the premenopausal period. Depression naturally has a negative impact on daily functioning, quality of life and health. Since the relationship between insomnia and depressive symptoms has been shown to be bidirectional, the aim of this review is to provide a brief overview of their association in the context of the menopausal transition. By exploring the potential pathways of their bidirectional relationship, this overview should be useful for preventive and therapeutic purposes. By treating insomnia we may be able to interrupt the self-reinforcing feedback loop with depressive symptoms, and thereby improve affective symptoms and women's wellbeing in this period of their life.