Menopause and mental health

Menopause is a natural biological process which defined as a time where a woman’s ovaries stop producing sex hormones (oestrogen and progesterone) and menstruation stops. Typically, menopause occurs around 50 years of age but it could be much younger or older than this. We hear a lot about the physical symptoms like hot flushes, thinning hair and fatigue but it is just as important to be aware of the affects on mental and emotional changes too. Here is the full list of menopause symptoms from the NHS:

  • hot flushes – short, sudden feelings of heat, usually in the face, neck and chest, which can make your skin red and sweaty
  • night sweats – hot flushes that occur at night
  • difficulty sleeping – this may make you feel tired and irritable during the day
  • a reduced sex drive (libido)
  • problems with memory and concentration
  • vaginal dryness and pain, itching or discomfort during sex
  • headaches
  • mood changes, such as low mood or anxiety
  • palpitations – heartbeats that suddenly become more noticeable
  • joint stiffness, aches and pains
  • reduced muscle mass
  • recurrent urinary tract infections (UTIs)

On average symptoms last around 4 years after your last menstrual period. 

What is perimenopause?

Perimenopause is the period of time the body is transitioning into menopause. This often occurs in your forties but for some women can start in their thirties. During this time your hormone levels are rising and falling unevenly. This means your menstrual cycles can become unpredictable and some of the menopausal symptoms like hot flushes can be experienced for the first time. 

Only once you’ve been through twelve months without a menstrual period can you officially be classified as reaching menopause. 

Emotional and mental changes during perimenopause and menopause

As you can see from the list above there are lots of symptoms that can have a significant impact on your mental and emotional wellbeing like difficulty sleeping, feeling depressed or irritable and brain fog. The physical symptoms can be uncomfortable and even at times embarrassing to deal with. This can cause an emotional strain on you, particularly if you have pre-existing mental health challenges. 

Not everyone experiences emotional upheaval during this time however. For some women perimenopause and menopause can feel like a scary time because their body is changing and they are facing the end of their reproductive years. However, others may feel relieved to be moving to a new chapter of their life without having to worry about pregnancy or menstrual cycles. 

Depression and menopause

The incidence of depression doubles during menopause and women who have struggled with depression in the past may see a recurrence in these conditions. Some research has indicated that if you’ve experienced post-natal depression or severe PMS (pre-menstrual syndrome) you are at a higher risk of experiencing depression during perimenopause. 

It is likely that hormonal imbalances can affect your mood and the lack of sleep associated with this time can depressive mood. 

Anxiety and menopause

Even under normal circumstances, women are almost twice as likely to develop anxiety as men and this increases during this time. Also, if you have had an anxiety disorder this is more likely to reoccur during this time and around 23% of women experience anxiety during perimenopause.

There is some evidence that shows women are more likely to have panic attacks during peri/menopause too. However, there is a clear overlap between menopausal symptoms and panic attacks (hot flashes, racing heart, panicky feelings) so it’s not always clear what is being experienced. A good indicator of whether it is a hot flush or panic attack is whether your breathing is affected, because this generally doesn’t happen with a hot flush. 

Other factors that can strain mental health at this time

A number of other life experiences that women experience in their forties and fifties can cause added mental and emotional strain around this time too. For example: 

  • Grown up children leaving home (empty next syndrome)
  • Relationships ending (over 60% of divorces occur for women between 40-60 years old)
  • Worries about ageing parents
  • Financial strain about supporting children at university and beyond while caring for parents

What can you do to manage mental health during menopause

  • Check in with yourself regularly and monitor your mood so you can see if 
  • Lifestyle changes like getting exercise, prioritising self care and good nutrition can minimise stress and help you feel more in control. 
  • Try and get good sleep. I know this can be difficult with night sweats b ut good quality sleep is important for reducing anxiety. 
  • Connect with other people – you are not the only person to go through this process and there are lots of people going through it at the same time. There are also menopause support groups out there if you need them. Just connecting with others and sharing your experiences can be a great support. 
  • Try avoiding caffeine and alcohol if you are struggling with your mental health during this time. Caffeine can trigger anxiety symptoms and alcohol is a depressant and can make anxiety worse. 
  • Understand this is a natural, healthy process which will pass. Look at what is ahead of you and embrace the new chapter to come.
  • Seek help if you need it – many women receive HRT (hormone replacement therapy) to help cope with hormonal imbalances and changes. If you’re feeling a lot of emotional and/or mental strain, counselling can also help you during this time and many women find talking therapy helpful to reduce anxiety and improve mood.

The positives of menopause

It is easy to focus on the negative aspects of menopause but I couldn’t write this article without a bit of balance: looking at the positive aspects of this part of a woman’s life too. 

Research has shown many women feel greater self-assurance and confidence post menopause. They are free to pursue their personal and professional goals without worrying about pregnancy, PMS and menstrual cycles, as well as being freed from the responsibilities of parenting. Many women experience pelvic pain at some point in their lives, whether it is from cysts, fibroids or menstrual cramps and symptoms either subside or disappear after menopause. The menstrual cycle can be physically and emotionally taxing and the freedom from this is a strong positive and help you feel more empowered. After menopause, you generally have half of your life left to live so it not uncommon for women to take stock of their lives and make positive changes without the self-consciousness of youth or the restrictions of having young children. Leaving negative relationships behind, starting new hobbies and challenges and switching careers are not uncommon at this point. Margaret Mead, an anthropologist from the 1950s, referred to the phenomenon as “postmenopausal zest”.

Menopause and mental health

“There is no more creative force in the world than a menopausal woman with zest”

  • Margaret Mead

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