Hot flashes are unpleasant, but not awful. Also, hot flashes are easy to treat with hormones. (Well, the treatment is estrogen, but if you have a uterus, you shouldn’t take estrogen without also taking progesterone, because the uterine lining is overstimulated and can develop cancer.)
I had trouble with depression when i was perimenopausal, and i agree that it’s harder to recognize mood disorders. Mine got bad enough that i was going to talk to my doctor about it, though, when on a whim i asked him for hormones for the hot flashes. (I’d known i had hot flashes for a while. The whim was deciding maybe they bothered me enough to try treating them.) An hour after i took the first pill, i thought, “oh shit, I’ve had PMS from hell for most of the last year.”. I am still taking the estrogen to treat depression. The hot flashes were never really a big deal to me.
There were a couple of giant studies on post-menopausal hormone replacement that scared a lot of people away from taking them. But that’s because the results were misinterpreted in the popular press.
The studies were set up to test whether it was a good idea to give estrogen to menopausal women with heart disease. It was known that heart disease is less common in premenopausal women than in men, or post menopausal women. So doctors wondered whether you could treat heart disease in older women with estrogen. And the answer was a resounding “no”. It turns out if you give estrogen to a 70 year old women who hasn’t menstruated in a decade and has heart disease, it’s likely to exacerbate her heart disease, not help. Their “all cause mortality” increased, with more stokes, heart attacks, and Brady cancer.
But… When they picked apart the data, younger women in the study, those closer to menopause, for better with supplemental estrogen. They did have more breast cancer, but their all-cause mortality was lower than the women who didn’t take estrogen.
Since you have a family history of breast cancer, you’d want to discuss that with your doctor. And maybe it wouldn’t be worth the risk even if you had hot flashes. Or maybe, if they were really bad, it would be worth taking a little estrogen for a couple of years, and then tapering off. But you’d know if you were having hot flashes. And there are other treatments for mood disorders that don’t affect the breasts, like SSRIs. (That stands for “selective serotonin reuptake inhibitor”. Estrogen is a non-selective serotonin reuptake inhibitor.)