How menopause affects mental health

When girls go through puberty, hormones tell the ovaries to start making estrogen and releasing eggs, and the menstrual cycle begins.

When a woman approaches menopause, the process happens in reverse. Hormones alert the ovaries to stop producing estrogen, which brings an end to periods.

Perimenopause, or the transition to menopause, can begin eight to 10 years prior to menopause. Menopause itself generally starts between the ages of 45 and 55.

The lack of estrogen causes physical symptoms we typically associate with menopause —like hot flashes, night sweats and vaginal dryness. But because fluctuating and declining hormone levels also affect brain chemistry, menopause can also cause cognitive issues like forgetfulness and brain fog, as well as mental health problems like mood swings, anxiety and depression.

Rest assured, it’s not all in your head. These experiences are common, and support is available.

Hormonal changes and brain chemistry during menopause

Estrogen is a hormone that not only affects a woman’s reproductive system — it also plays a role in the production of serotonin, which regulates behavior and cognitive function.

When hormone levels drop, you may experience mood swings and feel like you can’t control your emotions. The hormonal fluctuations can trigger or worsen anxiety and depression, making you feel irritable, angry and sad.

“Some patients going through menopause tell me they cry or get irritable for no reason, or sometimes don’t feel like themselves,” says Brittany Little, ARNP, a menopause-certified practitioner with MultiCare Capital Women’s Integrated Primary Care. “It’s important to note that not all women will experience these symptoms. Many of my patients have very limited or no perimenopause/menopause symptoms.”

“Menopause can make you think you’re losing your mind and like you’re not in control of your body anymore.”

Cognitive changes are a natural part of aging that are intensified by the hormonal changes of menopause. You may have brain fog, difficulty remembering things or trouble concentrating. It can be hard to manage day-to-day tasks.

Sleep problems caused by hormone changes can also affect mental clarity and well-being. And when you’re not sleeping well, you may be too tired to exercise or make healthy food choices. Activity level and nutrition are also closely connected to mental health.

You may feel like you’re not functioning at the level you’re used to, which may make you feel more anxious and/or depressed.

“Menopause can make you think you’re losing your mind and like you’re not in control of your body anymore,” says Terry Silvestrin, ARNP, a board-certified nurse practitioner and certified menopause clinician at MultiCare. “Suddenly, you can’t spell, add or multitask. These changes can affect who you think you are and what you’re capable of.”

It’s more than just hormones

Life stressors and other symptoms of menopause can compound effects on mental health.

“There are many changes you may be experiencing during this particular time of your life that cause additional stress,” says Silvestrin. “You may become an empty nester; you might be caring for your parents; you might be going through a career transition.”

There can also be a sense of grief around your reproductive years coming to an end. And the lack of open conversation in society about menopause can contribute to feelings of isolation.

Then there are other aspects of menopause that can impact how you feel about yourself, like weight gain, lower sex drive and changing appearance.

“All of these factors can affect your self-esteem and self-confidence and therefore your mental health,” adds Silvestrin.

Coping strategies and support

The good news is getting medical care and making lifestyle adjustments can help your mental well-being as you navigate menopause.

“Menopause care is not a one-size-fits-all approach,” Little emphasizes. “It’s very personal, and we determine a personalized plan based on your symptoms, medical history and any other contributing factors.”

Menopausal hormone therapy (MHT), which supplements estrogen and progesterone levels, is effective in managing vasomotor symptoms (like hot flashes) and vulvovaginal symptoms (like vaginal dryness). With improvement of these physical symptoms, mood concerns often improve as well.

Little notes the standard recommendation of MHT use is to start within 10 years of the onset of menopause, with a duration of five years. It should not be taken beyond age 60.

“Find tools that work for you to help mitigate anxiety so that stress is manageable and not managing you.”

For some, antidepressants are another option to consider in menopause management.

“In addition to helping with anxiety and depression, antidepressants can help with other symptoms of menopause like hot flashes, night sweats, fatigue and sleep,” Little says.

Therapy and counseling are valuable tools that provide a confidential space to explore feelings, develop coping strategies and process the changes associated with menopause.

Cognitive behavioral therapy (CBT), for instance, is a well-established approach for managing anxiety and depression by teaching practical skills to modify negative thought patterns and behaviors. Little says CBT can also be helpful for cognitive issues like brain fog and forgetfulness.

The following lifestyle factors support overall mental well-being and can have a positive impact on mood, anxiety and stress management:

• Getting regular exercise
• Maintaining a balanced diet
• Prioritizing good sleep hygiene
• Incorporating mindfulness practices like yoga, meditation and breathing exercises

“It’s all about quality of life,” says Silvestrin. “Find tools that work for you to help mitigate anxiety so that stress is manageable and not managing you.”

Thriving during menopause and beyond

Menopause is a unique experience for every woman. Some experience subtle shifts, while others face more intense physical and emotional symptoms.

If you find yourself struggling with mood changes, anxiety or cognitive difficulties, it’s important to reach out to your doctor or other health care provider for guidance.

“Once menopausal, this is for the rest of your life, which may be up to a third of your lifespan,” adds Silvestrin. “So do not suffer or lose your way. Get information, options and help to regain your confidence, patience and who you are.”