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Menopause is a normal biological process that occurs most often between the ages of 45 and 55, after which a woman ceases to have periods. It is also a period of hormonal fluctuations during which a woman may experience different physical and psychological manifestations. Even though the common signs of menopause include hot flashes and night sweats, little is said about the effects on mental health. The psychological changes at this stage are as important as the physical.

Women who go through the menopausal period undergo mood swings, anxiety, depression as well as other emotional instabilities. These changes may occur in a person’s mental health and impact daily functioning, interpersonal relationships, and general well-being. Knowledge of the mental health issues related to menopause is therefore important so that women can handle this phase well.

Menopause is the physiological state that occurs in a woman when she has not had a menstrual period for 12 months and is regarded as the final stage of a woman’s reproductive life [1]. It is a natural biological process that involves various stages:

Perimenopause: This is the stage that precedes menopause, and it is characterized by fluctuating hormonal levels. It can start several years before menopause when the ovaries begin to secrete lesser estrogen. Women may develop problems with menstrual cycles including irregularity and may develop signs such as hot flashes, mood swings, and sleeping disorders.

Menopause: This is the time when a woman has not had her menstrual period for one full year or in other words has not had her period for 12 months. The ovaries have ceased to release eggs and secrete considerably lesser amounts of estrogen and progesterone. At this stage, the women are likely to experience some of the symptoms such as hot flushes, night sweating, and dryness of the vagina [1].

Post-menopause: This stage is the period of life after the onset of menopause. Hot flashes and night sweating may improve in some women, but this is followed by other problems due to low estrogen levels, including osteoporosis and heart disease.

How Are They Related

Hormonal changes during menopause are not only a shift in the physical state but also affect the psychological state. This transition is characterized by hormonal changes as well as physical symptoms, which may cause different emotional issues. Some of the common symptoms that have been reported by women during menopause include anxiety, irritability, and sadness which may impact the mental health of the women. Fluctuations in hormone levels especially estrogen and progesterone have both a direct and indirect impact on brain chemistry concerning mood and stability [2].

Besides hormonal changes, menopause is accompanied by other important life transitions, for example, children growing up, job promotions or demotions, parents growing old, and changes in marital status. These stressors can add to the stress associated with menopause, which means that this is a time of the life cycle that needs both physical and mental health to be considered.

Hormones And Mood

Estrogen and progesterone are known to play critical roles in mood regulation:

Estrogen: This hormone has a direct impact on the serotonin and norepinephrine systems in the brain which are responsible for the regulation of mood, anxiety, and sleep. Estrogen has been found to increase serotonin levels in the brain and when the levels of estrogen drop during menopause, it results in low serotonin levels leading to conditions such as irritability, anxiety, and depression.

Progesterone: More commonly known as the ‘relaxing hormone’ it has a calming impact on the brain. Lack of it during the menopausal period may lead to high levels of anxiety and poor stress management.

It has been found that the presence of these hormones in the body can be a cause of mood swings and instability, and can make one more vulnerable to developing mood disorders. This is the reason why women are likely to feel more sensitive, incompetent, or lost during this period.

Emotional Symptoms Of Menopause

The hormonal fluctuations during the menopausal period can cause various emotional changes. Some of the most common include:

Mood Swings: Mood swings from being happy to easily irritated or sad can be common. These swings can be severe and can happen at any time without any provocation thus making women feel so emotionally unstable [2].

Irritability: Every woman who is going through a menopausal period may have a heightened response to even minor irritations. This is because estrogen has an influence on serotonin which is responsible for moods and therefore when estrogen levels are low a woman may be easily irritated or frustrated.

Anxiety: Anxiety, concern, and apprehension are some of the emotions that can be experienced during the menopausal period. This may include generalized anxiety, panic attacks, or specific anxieties that a woman has never experienced before menopause.

Sadness and Depression: It is common to experience some form of sadness or hopelessness during menopause. This can sometimes result in clinical depression, particularly among people with a history of mood disorders.

Memory and Concentration Issues: Also known as “brain fog”, women might have trouble focusing or remembering things, which can be frustrating and anxiety-inducing.

Studies have found a positive correlation between menopause and worsening of mental health. This is by the North American Menopause Society (NAMS) which estimates that up to 20% of women suffer from depression during the menopausal period, while 30-50% suffer from mood swings and increased irritability. 

Anxiety is also common, with 40-45% of women reporting worsening anxiety symptoms during the menopausal transition.

The NHS (National Health Service) notes that women are at a two to four times higher risk of developing major depressive disorder during menopause than at other stages of their lives. Further, it is also a period of heightened risk of anxiety disorders.

Some key statistics include:

  • Mood swings are common in women in perimenopause; nearly 70% of the women reported increased irritability.
  • The Journal of Women’s Health established that the likelihood of developing depressive symptoms rises by 28% during perimenopause.
  • Women with a history of depression or anxiety are even more likely to have a relapse or worsening of their symptoms during menopause. 
  • According to the Harvard Medical School, women who have had major depression have a five times greater chance of developing depressive symptoms during the menopausal period.

Such statistics explain why there is a need to encourage people to embrace and support women going through the menopausal stage since the effects are not only physical but also emotional and psychological. Women may not easily associate their symptoms with menopause and hence may feel confused and distressed.

Case Study 1: Sarah, a 48-year-old marketing executive, developed severe mood swings and irritability during the perimenopausal period. She realized that she was getting irritated easily and was even becoming rude to her colleagues something she had never been before. Such behavior affected her interpersonal communication with professional associates and she experienced guilt and anxiety about her actions. After finding out that mood swings are associated with menopause, she consulted a counselor and was able to find ways how to deal with it and handle conflicts at the workplace.

Case Study 2: Maria, a 50-year-old mother of two children, had anxiety about daily functioning. Before she had a schedule and was never disorganized, she started to get what she described as “brain fog” where she could not remember things and got more frustrated. The emotional stress that the cancer brought about made it hard for her to interact with her family and friends, thus leading to loneliness. She learned that all these symptoms were due to menopause through her doctor. She went to a support group of women facing similar problems as her, so she felt that she was not alone.

Case Study 3: Nina is a 52-year-old teacher who had sudden episodes of sadness and tearfulness during the menopausal stage; she sometimes felt that she had lost something. These feelings influenced her concentration and interactions with her learners in the class. When she consulted her doctor about her symptoms, she was able to seek proper treatment such as HRT and counseling on the emotional symptoms that she was experiencing and this made her life more comfortable.

It is quite clear that menopause can be a stressful event for many women, especially because of hormonal fluctuations and the symptoms that come with it. Some of the effects of estrogen include the ability to regulate the body’s stress hormone known as cortisol and since estrogen levels in a woman’s body reduce with age the body becomes unable to control stress. 

During menopause, levels of estrogen are low and this can cause an increase in the stress response and feelings of tension, anxiety, and overwhelm [2].

Also, the physical changes that are associated with menopause such as hot flashes, night sweating, and sleeping disorders add to the stress. For example, a patient may suffer from night sweats and therefore cannot have a good night’s sleep, and this will make him or her irritable during the day. Such lack of rest may lead to stress and the stress, in turn, causes the symptoms to worsen because of poor sleep.

External Stressors During Menopause

Menopause usually occurs when a woman is already experiencing other stressors in other aspects of her life. This life stage can include:

Family Dynamics: It is important to note that during the menopausal years, the woman may be facing other issues within her family like the children growing up and out of the house or parents getting old and requiring care. Such changes may create feelings of loss, a sense of responsibility, and additional stress.

Work Pressures: A lot of women are in their productive years when they are going through the menopausal stage. It is difficult to achieve work-life balance and cope with menopausal symptoms at the same time. Stress at work, together with mood swings or memory problems, can influence productivity and satisfaction at work.

Societal Expectations: Women are expected to be young and energetic most of the time due to the pressure that society puts on them. Menopause conflicts with these expectations and makes women feel insecure about aging, body image, and changing roles. This pressure from society can be an added factor that contributes to stress during the menopausal period.

The Stress-Mental Health Connection

Stress during the period of menopause can cause several psychological disorders. Stress that is prolonged can alter the chemicals in the brain such as serotonin and dopamine which are important in controlling mood and emotional well-being. It also shows that stress and hormonal fluctuations can increase women’s susceptibility to developing anxiety, depression, or worsening mood swings.

When the body’s stress response is frequently activated, it can lead to:

Increased Anxiety: Stress arising from the management of the symptoms of menopause coupled with other societal pressures may cause increased anxiety. This may manifest in terms of worry, nervousness, or even panic attacks.

Depressive Symptoms: Stress can also be chronic and this is likely to lead to feelings of sadness, hopelessness, and depression. It may be difficult for women to find pleasure in things that used to interest them or even get motivated to do so [3].

Reduced Coping Abilities: Stress is the pressure that can be exerted on a person in his or her ability to manage everyday tasks. Some effects may include; that women may fail to control their emotions hence becoming more irritable or even tend to cry.

Managing mental health concerns during menopause requires a multidisciplinary approach. Here we briefly look upon the various methods used to deal with menopause mental health concerns effectively.

Lifestyle Changes

Leading a healthy lifestyle can go a long way in managing both the physical and emotional aspects of the menopausal period. Some effective lifestyle changes include:

Diet: A healthy diet that includes fruits, vegetables, whole grains, and lean meats is beneficial for an individual’s health. Soy, flaxseeds, and legumes are some of the foods that contain phytoestrogens which can assist in hormone regulation. Also, eliminating caffeine and alcohol as much as possible will reduce anxiety levels as well as sleep interruptions.

Exercise: Several benefits are associated with physical activity during menopause. Physical activity can also help regulate mood swings, decrease stress levels, and enhance the quality of sleep. Such exercises as strolling, practicing yoga, swimming, and weight training are not only beneficial for the body but also help increase the level of endorphins in the body thus making one feel happy.

Sleep Hygiene: The child must develop a regular sleep pattern. This entails maintaining a regular sleep schedule, having a consistent pre-sleep routine, and ensuring that the bedroom environment is conducive to sleep. Other ways that can be used to enhance sleep quality include refraining from the use of electronic gadgets at night and cutting down on caffeine consumption during the afternoon.

Stress Management Techniques

Stress reduction is one of the factors that help in the treatment of mental health disorders associated with menopause. Some effective techniques include:

Meditation: Mindfulness meditation in a way assists women to be more conscious about what they are thinking or feeling without having to label them as good or bad. Practice can help in the alleviation of stress, anxiety, and depressive symptoms since it is a means of relaxation and control of emotions.

Yoga: Yoga is an activity that involves the use of exercise, breathing, and meditation. It can relieve stress, lessen physical manifestations of stress such as muscle tension, and enhance mood and general well-being. Some of the recommended forms of yoga are Hatha or Restorative yoga since they help in calming the mind and easing anxiety.

Relaxation Exercises: These include deep breathing exercises, progressive muscle relaxation, and guided imagery that assists in calming the mind and diminishing the body’s stress response. These exercises if done regularly can help in building up the emotional strength and coping mechanisms to deal with the menopausal symptoms.

Professional Help

When lifestyle changes and self-care techniques are not enough to manage menopause-related mental health issues, professional help may be necessary:

Counseling and Therapy: Cognitive Behavioral Therapy (CBT) is a proven treatment that can be utilized in the treatment of mood swings, anxiety, and depression in women going through menopause [3]. CBT assists in the identification of negative cognitions and healthy changes in emotional processing. It is also important to note that speaking with a mental health care provider can also be a good way to talk about feelings and experiences of menopause.

Support Groups: It is helpful to attend a support group for women who are going through menopause since it helps alleviate the feeling of loneliness. Talking to people who have similar situations as you is a way of getting comfort and some tips on how to handle the situation.

Medical Interventions

For some women, medical interventions may be necessary to manage severe symptoms of menopause:

Hormone Replacement Therapy (HRT): HRT can reduce physical and emotional symptoms of menopause because estrogen and progesterone are added to the body. HRT is effective in the reduction of hot flashes, and improvement in mood and sleep [3]. However, it is recommended to speak with a doctor about the advantages and disadvantages of HRT since not everyone can use it.

Medications: In severe anxiety or depression, the doctor may prescribe drugs, for example, antidepressants or anti-anxiety drugs. Antidepressant drugs such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are usually prescribed for the management of mood disorders [3]. Other drugs such as sleep inducers may be prescribed for other sleep-related issues.

1. Harvard Medicine. The Mental Health Aspects of Menopause. https://magazine.hms.harvard.edu/articles/mental-health-aspects-menopause

2. Mental Health Foundation. Menopause. https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/menopause

3. UCLA Health. Treating the mental health side of menopause. https://www.uclahealth.org/news/article/treating-mental-health-side-menopause

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