Menopause and Mental Health

Menopause and mental health: Where does one begin and the other end?

Menopause and Mental Health

The interplay between menopause and mental health is not always easy to separate with each influencing the other in subtle and various ways. For many, the onset of menopause can coincide with increased emotional sensitivity or bouts of anxiety and low mood—responses not solely rooted in external circumstances, but in the body’s shifting internal chemistry. It’s not simply that menopause causes mental health challenges, nor that mental health exists apart from the changes of menopause; rather, the two can be intertwined, highlighting the importance of a biopsychosocial approach. A holistic biopsychosocial approach encompasses not only biological treatments, but factors in social issues as well as psychological support. This article explores the interplay that can happen between menopause and mental health.

Understanding perimenopause and menopause

Menopause specifically refers to the final menstrual period a woman experiences, marking the end of the reproductive years. Menopause can understood literally using the greek roots of the words. The word 'meno' means month, and 'pause' means to cease. Menopause therefore translates as the end of monthly menstrual periods.

Similarly, perimenopause can be translated as 'peri' meaning around or near, reflecting the transitional period leading up to menopause. In summary, Perimenopause is the transitional period before menopause where as menopause is defined as the cessation of menstruation for 12 consecutive months.

Signs of perimenopause

• irregular or skipping periods

• periods that are heavier or lighter than usual

• changes in mood like irritability, depression or mood swings

• low libido

• hot flashes

• night sweats

• vaginal dryness

• brain fog (trouble concentrating, easily distracted, forgetting appointments

The biology of perimenopause and menopause

During perimenopause and menopause the body's production of oestrogen and progesterone, two hormones made by the ovaries, decline. The average age of menopause is 51, however, it can actually happen anytime from the 30s until mid 50s or later. As a woman ages, the number of eggs in the ovaries decrease. This decline in egg supply eventually leads to a decrease in ovulation. It is the ovulation that produces the hormones oestrogen and progesterone, therefore, less ovulation causes less production of these hormones.

The link between hormones and mental health

During perimenopause and menopause hormone levels fluctuate and decline, namely oestrogen and progesterone. This means there are a lack of hormones stimulating the receptors. These changing hormones affect levels of neurotransmitters, including dopamine and serotonin. Dopamine and serotonin are crucial neurotransmitters in the brain, and imbalances are strongly linked symptoms of depression such as low mood, lack of pleasure and sleep disturbances. Dopamine is associated with motivation and reward, while serotonin plays a role in mood regulation, sleep and emotional processing. In some women, these shifts in hormone levels can affect mood and cognition. Research suggests that individuals in perimenopause and menopause can be at increased risk for certain mental health challenges including depression, anxiety, sleep disturbances, irritability and mood swings and cognitive changes such as brain fog, memory lapses and difficulty concentrating.

Common Mental Health Symptoms During Menopause

There are several associated mental health symptoms and conditions that can occur during menopause ranging from symptoms of depression and anxiety to mood changes as well as cognitive changes and sleep disturbances.

• Depression: The risk of developing depressive symptoms increases during perimenopause, even for those without a prior history. Symptoms may range from persistent sadness and hopelessness to loss of interest in previously enjoyed activities. While not everyone will develop clinical depression, the emotional turbulence of menopause can be distressing. The MENO-D is a free self rating scale for Menopausal Depression devised by Professor Jayashri Kulkarni and a useful tool to increase awareness and identify areas of support.

  
  

• Anxiety: Heightened anxiety, including excessive worry, panic attacks, and a sense of being overwhelmed, is also common. Hormonal changes, coupled with life stressors that often coincide with midlife (such as career changes, children leaving home, or caring for ageing parents), can exacerbate feelings of anxiety.

  
  

• Sleep Disturbances: Sleep problems, such as insomnia, frequent waking, and non-restorative sleep, are frequently reported. Disrupted sleep can be both a cause and consequence of poor mental health, creating a cycle that perpetuates mood disturbances.

  
  

• Cognitive Changes: Many report issues with memory, attention, and word-finding. While these changes are usually mild and temporary, they can be frustrating and distressing, especially when coupled with other symptoms.

  
  

• Mood Swings and Irritability: Rapid, unpredictable shifts in mood, increased irritability, and feelings of anger are commonly linked to fluctuating hormone levels. These can affect relationships at home and work, sometimes leading to misunderstandings or conflict.

Practical strategies for managing mental health and menopause

While menopause is an inevitable biological transition, its impact on mental health can be managed with thoughtful strategies and supportive practices.

• Stay Informed: Educate yourself about the physical and emotional changes associated with menopause. Reliable information can demystify the process and empower you to make informed choices about your health. The All About Her Centre is an Australian healthcare team for women impacted by menopause and perimenopause. They also have a directory of menopause experts. The Jean Hailes for Women's Health answer the top 5 questions that GPs are asked about menopause and mental health.

  
  

• Prioritize Self-Care: Healthy lifestyle habits such as balanced nutrition, regular physical activity, and sufficient sleep support both physical and mental wellbeing. Gentle exercise, mindfulness, and relaxation techniques can ease stress and improve mood.

  
  

• Seek Professional Support: Don’t hesitate to consult with healthcare providers about troubling symptoms. Mental health professionals, gynaecologists, and menopause specialists can offer tailored advice, therapy, or medical treatments to address both mood changes and physical discomfort.

  
  

• Foster Social Connections: Maintain strong relationships with friends, family, and support groups. Open conversations reduce feelings of isolation and normalize the menopause experience.

  
  

• Practice Mindfulness and Stress Reduction: Techniques such as meditation, deep breathing, and yoga help manage anxiety, irritability, and other mood symptoms.

  
  

• Consider Therapeutic Options: Cognitive-behavioral therapy (CBT) and other evidence-based therapies have been shown to help with mood swings, depression, and anxiety during menopause.

  
  

• Evaluate Medical Treatments Carefully: Hormone replacement therapy (HRT) and other medications may be appropriate for some individuals. Discuss benefits and risks with a healthcare provider, considering personal and family medical history.

  
  

• Set Realistic Expectations: Accept that menopause may come with challenges, but also opportunities for personal growth and self-discovery. Celebrate your strengths and resilience throughout the process.

  
  

How can psychological support help with menopause?

Psychological support, including counselling and therapy can help women navigate the emotional and mental health challenges associated with menopause. Therapies like Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help women manage mood swings, anxiety, and other hormonal changes while also developing strategies for sleep disturbances and hot flashes. Schema therapy can help by addressing ingrained patterns of thinking and behaviour that can contribute to emotional distress and Interpersonal Therapy focuses on improving relationships and social functioning.

Seeking support for menopause and mental health

Managing mental health and menopause requires a holistic biopsychosocial approach that look not only at medical treatments, but psychological support, addressing social issues/life stressors and lifestyle adjustments.

While hormonal changes are at its core, the psychological and social dimensions are equally important. By fostering open conversations, seeking timely support, and prioritizing self-care, individuals can navigate menopause with greater resilience and wellbeing.

When to see your doctor for menopause and mental health

If you are experiencing strong emotions or symptoms of anxiety or depression, or menopausal symptoms are impacting your quality of life or getting in the way of daily activities. Your GP can not only look at medical treatments and referrals, but also assist with linking you in with psychological support.

More menopause and mental health resources

For more information on menopause and mental health, there are several organisations including Jean Hailes for Women's Health a not for profit organisation and HER Centre Australia through Monash University.

In summary, the journey through perimenopause and menopause is a uniquely individual experience, filled with both physiological and emotional changes that can significantly affect mental health. Understanding the intricate relationship between hormonal shifts and psychological wellbeing empowers individuals to approach this life stage with patience, self-compassion, and resilience.

If you would like support navigating menopause symptoms with psychological support face to face in Newcastle or via telehealth, book online today.