Vasomotor Symptoms and Their Association with Depressive and Anxiety Symptoms in Peri- and Postmenopausal Women: A Systematic Review of Observational Studies

Background and Objectives: Vasomotor symptoms (VMS), including hot flushes and night sweats, often co-occur with depressive and anxiety symptoms during the menopausal transition. This systematic review assessed the observational evidence for a quantitative association between VMS burden and affective symptoms in peri- and postmenopausal women. Materials and Methods: PubMed and PubMed Central were searched from database inception to 30 June 2025 for English-language, open-access observational studies reporting VMS and depressive and/or anxiety outcomes in peri- or postmenopausal women. Two reviewers independently screened records and full-text reports, and extracted data were independently verified. Study characteristics, symptom measures, prevalence or severity data, and quantitative association estimates were extracted. Owing to substantial heterogeneity of exposure and outcome measures, a structured narrative synthesis was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) guideline. Risk of bias was appraised at item level using the Joanna Briggs Institute checklists and the Newcastle–Ottawa Scale, and the certainty of the evidence was rated using the GRADE approach. Results: Twelve studies involving approximately 9900 women from seven countries were included. In studies reporting adjusted estimates, greater VMS burden was associated with higher odds of depressive symptoms, with adjusted odds ratios ranging from 1.67 to 2.99; one longitudinal cohort reported an odds ratio of 2.95 for a worsening depressive-symptom trajectory. Evidence for anxiety was directionally concordant but considerably weaker: anxiety was assessed as a distinct outcome in only five of the 12 studies, none of which reported an adjusted effect estimate, and two of which were rated at high concern for risk of bias. Two studies were rated at overall low concern for risk of bias, seven at moderate concern, and three at high concern. Several studies suggested partial mediation through fatigue or poor sleep, whereas others supported direct or bidirectional associations. Conclusions: Greater VMS burden is consistently associated with depressive symptoms and, on a smaller and less certain evidence base, with anxiety symptoms. Certainty of the evidence was rated low for depression and very low for anxiety; the predominance of cross-sectional designs, the heterogeneity of instruments, largely unaddressed confounding, and the possibility of reverse causation preclude any causal inference. Women presenting with bothersome VMS may benefit from case-finding for mood and anxiety symptoms where a pathway to assessment and treatment exists, and prospective studies should test whether VMS-directed interventions improve affective outcomes.