Depression at perimenopause: More than just hormones

New research has confirmed a link between depression and the menopausal transition, or perimenopause — that time of erratic periods, chaotic hormone fluctuations, disturbed sleep, and, for some, uncomfortable hot flashes. Among the findings: little or no correlation between hormone levels and depression during perimenopause. However, a host of other factors have been implicated.

The connection

In 2006, the Harvard Study of Moods and Cycles reported that one in six participants with no history of depression developed depressive symptoms during perimenopause. In addition to hormone fluctuations, researchers have explored the possible influence of psychosocial factors, hot flashes and their impact on sleep, and genetic vulnerabilities. In 2006, the Study of Women's Health Across the Nation identified several genetic mutations that increase the likelihood of perimenopausal depressive symptoms.

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New options for managing troublesome fibroids continue to appear. Here's help in finding what's best for you.

Bulging blood vessels in the backside can be a pain, but you have many options for treating them.

Some women have a passing encounter with hemorrhoids during pregnancy. By midlife, many more of us have had one or more of the classic symptoms, which include rectal pain, itching, bleeding, and possibly prolapse (protrusion of hemorrhoids into the anal canal). Leakage of feces may also occur. Although hemorrhoids are rarely dangerous, they can be a painful recurrent bother. Fortunately, there's a lot we can do about them.

During our reproductive years, extra folic acid is essential. After that, it may be too much.

Folic acid is a synthetic form of folate, a B vitamin found naturally in various fruits, vegetables, and legumes. We need folate to produce and maintain new cells (in particular, red blood cells) and to keep nerve cells functioning properly. It also helps prevent DNA changes that may lead to cancer. In the body, folic acid and naturally occurring folate are identical in their actions, but the bioavailability of folic acid is somewhat higher than that of folate.

Q. I'm 26 and positive for HPV. Is there any point in my getting the new HPV vaccine?

A. There are 30 to 40 strains of sexually transmitted human papillomavirus (HPV). The vaccine Gardasil targets the four strains most closely linked to cervical cancer and genital warts. For women not already infected with these strains, Gardasil is almost 100% effective at preventing genital warts and cancerous or precancerous lesions of the cervix. That's why public health officials recommend that girls ages 11 to 12 be vaccinated — before they become sexually active.

Hot flashes aren't anybody's friend, but they may be getting an unfair rap for disrupting women's sleep at midlife. Studies have often reported that sleep problems increase during the menopausal transition, reinforcing the idea that hot flashes (also called vasomotor symptoms) are to blame. But even under controlled conditions in sleep laboratories, the connection between hot flashes and sleep disruption remains unclear. Moreover, in certain circumstances, vasomotor symptoms may be the result — not the cause — of nighttime awakenings. Now, a study concludes that some of the sleep problems that women typically attribute to hot flashes may instead be caused by primary sleep disorders such as apnea. The findings suggest that women may not be receiving appropriate treatment for their sleep difficulties.

To determine the cause of poor sleep in peri- and postmenopausal women, researchers at Wayne State University School of Medicine in Detroit assessed the sleep of 102 women, ages 44 to 56, who reported having trouble sleeping. The researchers found that 31 women had periodic limb movements (PLM), 23 had sleep apnea, and six had both. In other words, 53% had a primary sleep disorder. Among the entire group, 56% had measurable hot flashes. A separate analysis of the data showed that while apnea, PLM, and brief awakenings were the best predictors of poor sleep in the laboratory, on the questionnaires completed beforehand, poor sleep was more likely to be associated with anxiety and hot flashes during the first half of the night.

If you are thinking about getting pregnant, you can do many simple, effective things right now to improve your chances of conception, because lifestyle can have profound effects on the reproductive functions of women and men. This means that increasing your fertility potential is something that you both can do without outside help. In addition to adopting a fertility-boosting diet and getting into the fertility zones for weight and exercise, there are a number of lifestyle choices you can make for improving fertility naturally.

Give up nicotine, marijuana, cocaine, and steroids

Tobacco smoking has been linked to reduced fertility in both women and men. In addition, a recent British study has found an association between smoking and stillbirths, low birthweight babies, and sudden infant death syndrome (SIDS). A woman who smokes is likely to have less chance of becoming pregnant and giving birth when treated with in vitro fertilization (IVF) than a woman who doesn't smoke. This is especially true if she smokes twenty or more cigarettes a day. A mechanism that may link cigarette smoking and reduced pregnancy rates following IVF is the observation that smoking appears to accelerate the rate of egg loss. Women who smoke have the elevated hormone levels that indicate a depleted supply of eggs and prematurely aged follicles.

Ovarian cancer has long been called a "silent killer," because symptoms are thought to develop only after the disease has reached an advanced stage and is largely incurable. But health experts have identified a set of physical complaints that often occur in women who have ovarian cancer and may be early warning signs. These symptoms are very common, and most women with them do not have ovarian cancer. But for the women who do, the hope is that greater awareness will lead to earlier diagnosis and treatment.

Four symptoms are more likely to occur in women with ovarian cancer than in women in the general population. These symptoms are bloating or increased abdominal size; pelvic or abdominal pain; difficulty eating or feeling full quickly; and urinary frequency or urgency.

Why sleep is important to your health and how to repair sleep deprivation effects.

If sleep were a credit card company, many of us would be in deep trouble.

Medical evidence suggests that for optimum health and function, the average adult should get seven to nine hours of sleep daily. But more than 60% of women regularly fall short of that goal. Although each hour of lost slumber goes into the health debit column, we don't get any monthly reminders that we've fallen in arrears.