The years leading up to menopause (perimenopause) and menopause itself can bring about significant changes not only to the body but also to the mind (1). Despite being common, many of these changes are still not discussed or treated adequately.

Reminder: Worldwide, there are over 1 billion people aged 48 or older. Menopause is an important conversation that needs to be had.

Unfortunately, there remains a harmful cultural narrative that women should expect to become less competent with age and thus many who experience troubling mental health symptoms do not attribute it to menopause and continue to suffer in silence. No one deserves that! The mental health conversation may be increasing overall, but the conversation regarding menopause and mental wellbeing seems to still be sidelined. Particularly due to the increasing age of the working population, more and more women are expected to work while suffering from menopausal symptoms.

So, let's talk about menopause and mental wellbeing.

What changes occur?

Just as every person is uniquely different, so are the experiences with menopause. You may experience severe changes in mental well-being or perhaps no changes at all (2). Some possible mental health symptoms could include:

• Mood swings
• Brain fog or mental fatigue
• Anxiety or panic attacks
• Sadness or depression
• Irritability or anger

How is menopause associated with changes to mental health?

The mental health-related changes that may emerge during the menopause transition (perimenopause) are likely due to a combination of:

• Fluctuating hormones
• The length of exposure to estrogen throughout the lifetime
• Genetics
• Overall wellbeing
• Social determinants of health (such as financial hardship and stress) (3).

A closer look at the role of hormones

The transition phase to menopause, which is known as perimenopause, can last anywhere between four- and eight years on average (2). That’s a decent amount of time! The hormone estrogen fluctuates intensely and irregularly during this period. Since estrogen is an important component of brain function, shifts in estrogen levels may affect the neurotransmitters serotonin, norepinephrine, and dopamine, which are linked to positive feelings (4). No wonder your moods feel dysregulated, right?

This is not a surprise when we consider that shifts in hormone levels can cause mood changes at other times, such as PMS during a menstrual cycle or postpartum depression post-pregnancy. One of the many joys of our reproductive system…not!

A closer look at the impact of other life events

Shifts in mental well-being are partly attributed to the changes that accompany this time in life, such as shifts in family structure, losses and role transitions, stressful life events and a lack of social support. There can clearly be a lot happening. In addition to this, there can be a strong stigma that accompanies entering menopause. After all, we celebrate puberty but not its reversal. Why is that? Why don’t we celebrate this new chapter of life? Internalised stigma from much of the negative messaging that surrounds menopause can impacts your mood and contribute to feelings of stress, loss and sadness. Additionally, menopausal symptoms such as hot flashes and poor sleep may have an adverse effect on your mental health.

Let’s break down the symptoms

Brain fog

Approximately two-thirds of women report cognitive difficulties during their menopause transition, meaning some kind of difficulty with memory, attention or forgetfulness (5). This is commonly referred to as “brain fog” or “mental fatigue”. Forget why you walked into a room? How about where you left the car keys? What about what you were wanting to say in that sentence? While changes to cognitive functioning can feel scary and even devastating, it's not necessarily permanent. In general, these changes improve as you progress through menopause, which means that what you are experiencing is not an indication of deterioration, but rather a temporary hindrance.

Mood changes and depression

Although mood fluctuations are prevalent during the menopause transition, you could also experience depression. Estimates suggest that anywhere between 19 to 36 percent of women might experience depression during this phase. Depressive episodes are two to four times more likely to occur during menopause than at other times of life (6, 7). Depression is characterized by constant sadness, hopelessness, low energy, and little interest in once enjoyable activities. There is a higher risk of depression for women who enter menopause before age forty-five or who have a history of mental health concerns (7).

Anxiety

Changes in mental health have been clearly linked to menopause, yet anxiety has received far less research attention, despite being associated with significant distress (8). In midlife women, anxiety is common with approximately 51% reporting a symptom of anxiety in the past 2 weeks (9) You are even more prone to experience panic attacks during the menopause transition (10). Those with a pre-existing low level of anxiety prior to menopause and those experiencing hot flashes are more likely to experience a high level of anxiety (11).

Know when to see your doctor

We know this can all sound a bit doom and gloom, but mood fluctuations and many of the changes to mental health that may occur during this time are treatable. If you feel that your mental state is impacting you, your normal daily activities, or your relationships, it’s best to speak with your healthcare provider.

So, what can you do?

There are some methods to combat the mental health-related changes associated with menopause:

1. Have a complete physical and mental health evaluation – this is important as it can rule out anything more sinister
2. Exercise – incorporate daily exercise! This has been shown to release chemicals that boost mood (12)
3. Mindfulness exercises –breathing exercises, yoga or meditation can significantly enhance mental wellbeing (13)
4. Consider the role of stress – many of us may underestimate the amount of stress we’re experiencing - checking in with yourself and try incorporating deliberate moments of self-care
5. Get adequate sleep –Poor sleep is directly linked with worse mental health (14)
6. Quit smoking – quitting smoking has been shown to improve mood and relieve stress, anxiety and depression (15).
7. Forge new connections – people who are more connected have better mental health!
8. Psychological therapy – this can provide support, coping strategies and proven approaches to improve mental health such as CBT (16)
9. Speak to your doctor about medications – the use of medication replacement therapy (MRT) such as estrogen may help improve mood. Your doctor may also recommend antidepressants.
10. Remind yourself - some of the changes to mental well-being such as brain fog will improve as you progress through menopause. Things will get better!

Wrap up:

It is a myth that menopause is only associated with physical symptoms. Menopause can be associated with very real mental health consequences, and this may have devastating impacts on your quality of life. While there are some solutions to help improve your mental well-being, if you are struggling, it's best to see a healthcare provider.

Zoe Sever is Unfabled's Clinical Lead. Zoe brings a wealth of knowledge from her broad spanning background, having started her career in Nursing and transitioning to Sexology and Research. She holds a Master’s in Sexual and Reproductive Health and is currently pursuing a PhD in Women’s and Reproductive Health at Oxford University. On a mission to empower individuals with cycles to better understand their bodies, Zoe is helping us to banish shame, stigma and demystify reproductive health.

References:
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