Menopause is a natural transition in a woman’s life when the ovaries stop working completely. This means you can no longer become pregnant and will experience a drop in the production of certain hormones that are produced by your ovaries before menopause, specifically oestrogen, progesterone and testosterone.
These hormones support a variety of functions in your body and consequently, the decrease in their production due to menopause can produce a wide range of symptoms that can affect your mental health, physical health and wellbeing.
Symptoms of menopause can broadly be grouped into physical and psychological symptoms. There are over 40 documented menopause symptoms, which can have a significant impact on your quality of life and ability to function at work as you did before.
Common psychological symptoms include low mood, irritability, depression, anxiety and cognitive decline. Cognitive decline can include brain fog, forgetfulness, and difficulty focusing and concentrating.
Oestrogen is important for a variety of different aspects of your health and wellbeing, including the health of your bones, cardiovascular system and brain function.
Consequently, menopause increases your risk of certain long-term health conditions, including osteoporosis, heart disease and cognitive decline — around twice as many women compared with men develop the brain disorder Alzheimer’s disease.
A survey by the British Menopause Society found that over half of women going through menopause, aged between 45 and 65 years, experience mood changes that affect their mental health, such as depression and anxiety. Furthermore, between 45% and 68% of women going through perimenopause also present with symptoms of depression.
Your risk of experiencing mental health effects due to menopause is higher if you have previously experienced depression or anxiety, have had postnatal depression, and/or experience low mood due to hormonal changes during your periods.
Other stresses in life, such as financial struggles, marital issues, and/or juggling looking after children and elderly parents can also increase your risk and/or exacerbate mental health challenges during menopause.
Menopause has both indirect and direct effects on your brain.
Your brain contains an abundance of oestrogen receptors, that is, proteins on the surface of cells that bind oestrogen. Stimulation of these receptors by oestrogen helps regulate your mood. Menopause, therefore, has a direct effect on your brain chemistry as lower oestrogen levels mean these receptors have less stimulation, leading to a decline in your mental health.
Also, when your oestrogen levels go down, your cortisol levels go up. Cortisol is a stress hormone and consequently, higher levels will increase feelings of anxiety.
The physical effects of menopause can also indirectly affect your mental health. For example, night sweats can disturb your sleep so you wake up feeling tired and struggle to concentrate. This can make you feel less effective, and reduce your confidence and self-esteem, which consequently leads to low mood, anxiety and/or depression.
Hot flushes can cause stress and anxiety, for example, if you’re worried about having a hot flush during a work meeting or presentation. During perimenopause, you may also find yourself feeling on edge about how your periods will affect your day-to-day routine as they become less predictable ie heavier and/or more irregular.
If you’re struggling with the physical or mental symptoms of menopause, it’s important to think about ways you can help yourself. Are there any changes you can make to your lifestyle to help you cope better?
Consider these questions:
In addition to making small changes to your lifestyle, it can help to connect with other women who are going through menopause and can support you through your symptoms.
It is also important to speak to your employer, colleagues and/or HR at work to ensure that you’re provided with appropriate support as you transition through menopause.
If after trying the above lifestyle changes, you’re still struggling, then it’s important to see your GP for advice and help.
There are many treatment options available, including over-the-counter medications such as St John’s Wort and menopause supplements containing isoflavones, and complementary therapies such as reflexology and cognitive behavioural therapy (CBT).
You can also speak to your GP about hormone replacement therapy (HRT). If HRT isn’t suitable, there are other prescription medications that may help with your mood, such as antidepressants, including selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).
Dr Wendy Molefi is a GP and Menopause Specialist at Spire Harpenden Hospital, where she leads a Menopause Clinic. She holds Advanced Menopause Specialist accreditation from the British Menopause Society and a Master's degree in Mindfulness-Based Cognitive Therapy (MBCT) from the University of Oxford. Dr Molefi has a special interest in the psychological impact of menopause on women’s quality of life and brings a holistic and preventive approach to her clinical practice and menopause service. She is also the owner and founder of the private menopause clinic, Vital Wellness Clinic.
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.