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Aside from hot flashes and your period stopping, no one really tells you what to expect from menopause. The symptoms of menopause are often dismissed, the way many things primarily affecting middle-aged women are.
Yes, that’s unhelpful and uncool. While menopause is a normal life transition, it can also wreak havoc on your life. People don’t often understand the serious ways menopause can impact mental health — or that many people suffer in silence.
A quick clarification: The difference between menopause and perimenopause
Though you often hear people talk about “menopause” as the time you start losing your period, it actually refers to the point when your periods have permanently stopped — or, for people who don’t have a uterus, when hormone levels have dropped to a certain level.
Perimenopause is the time leading up to menopause. It marks the start of the menopausal transition — typically during the 40s or early 50s. Hormone levels change, periods may change and people can experience a whole host of symptoms.
Mental health issues are actually more common during perimenopause, says Dr. Amritha Bhat, a UW Medicine psychiatrist specializing in women’s mental health.
Why does menopause affect mental health?
So you’ve raged at your partner again for no obvious reason, spent hours looking for your phone only to find it in the freezer (?!) or started waking up in the middle of the night in a full-on panic attack. What gives?
Probably your hormones. Like puberty, postpartum and other times of major hormonal shifts, perimenopause and menopause can lead to mental health struggles.
Depression and anxiety symptoms are some of the most common during perimenopause and menopause, Bhat says. Sleep problems, brain fog, mood swings and forgetfulness can also happen.
Every 4 in 10 women have mood changes during perimenopause, according to the American College of Obstetricians and Gynecologists. It’s like having PMS, only you can get it at any time, not just when your period is due (great).
Not only are hormones changing during this time, but life is changing, too. It’s a time when many people become empty nesters, start caring for aging parents or experience other major transitions. It’s an opportunity to start a new phase of life — and while that can ultimately lead to some good places, it can also cause a lot of stress.
The impact of hormone changes on mental health varies. You may only notice a minor impact that doesn’t interfere with your day-to-day, or you may feel like life is derailed.
“A subset of people seem to be extra sensitive to changes in hormone levels,” Bhat says. “These people might have had premenstrual dysphoric disorder or postpartum depression and are at more risk for developing perimenopausal depression.”
So, yes, if you have experienced mental health issues in the past, they’re more likely to crop up again during menopause, adds Dr. Susan Reed, professor of Obstetrics & Gynecology at the UW School of Medicine.
Research also shows that health disparities impact people during menopause, resulting in outcomes such as Black women entering menopause earlier and having more severe symptoms than white women.
What helps anxiety and depression during menopause?
Whether your mental health is suffering a little or a lot during perimenopause or menopause, you deserve help — and there are plenty of ways to get it.
“Our group did a research study looking at models of care for mood disorders in our OB-GYN patients, and what we learned is that patients do best with their treatment when they have a choice on what to try first,” Reed explains.
Talk with your doctor
The first step is to talk with your regular doctor about how you’re feeling and see what they think will help. Doctors will often first give you a mental health screening test to help assess how much your mood changes are impacting your life. They can also help with medications.
Hormone therapy and other medications
Taking supplemental estrogen can help with physical menopause symptoms like hot flashes as well as mental health concerns (though for treating depression, hormones are only helpful during perimenopause, Bhat notes). And there are many options for how to take it: as a pill, with a patch, or with a cream or gel you apply to your skin or vaginally.
Nonhormonal therapies for symptoms of menopause include some antidepressants taken at very low doses and a medication called gabapentin. A brand new medication for hot flashes is fezolinetant: it has yet to be fully studied for mood but does seem to improve quality of life and sleep, Reed says.
Try therapy
Therapy may not be for everyone, but it could be helpful if you are interested and willing to make the commitment. And you don’t have to have a diagnosed mental illness to see a therapist — plenty of therapists specialize in helping people work through everyday problems.
Make lifestyle changes
Will making some adjustments to your lifestyle completely cure you of mental health issues? No, and serious side-eye to anyone who thinks it will. But finding ways to take a little better care of yourself can take the edge off your symptoms.
You know the drill: Keep your body healthy with regular movement and nourishing food. Go to the doctor whenever you have a health issue. Sit less, hydrate more and build a relaxing morning routine, plus practice good sleep hygiene by not using your phone before bed and trying to stick to a regular nighttime routine. Keep in touch with your friends and, if needed, seek out new connections.
What do you do if your symptoms are dismissed?
Unfortunately, it’s a reality that you may have your symptoms dismissed, even by your doctor and even though what you’re experiencing is very real.
If you don’t feel like you’re being taken seriously, go to a different doctor.
“Quality of life depends on good mood, and you deserve to have a good quality of life as you go through these life changes,” Reed says.
