Women approaching middle age may notice the symptoms of menopause that their mothers, grandmothers, and female friends of the same age frequently talk about. Many of these discussions include mention of increased anxiety, stress, fears of getting older, losing sexual attractiveness and interest, infertility, and how to cope with what’s often an emotional rollercoaster.
Learning about the mental health effects of menopause is important because knowledge is power. For example, many women aren’t aware that the transition can take seven to 14 years, according to the National Institute on Aging. Knowing what can happen and how to effectively cope with the associated mental health effects and hormonal changes can result in a better quality of life.
So, what are some of the mental health effects of menopause? How do the hormonal changes that occur just before and during menopause affect women?
Does Menopause Impact Mental Health?
Besides changes to the body, hormonal changes during menopause may lead to increased mood disorders, depression, and anxiety. Women experience hormonal changes throughout their lives, which can contribute to mood changes at varying life stages. But medical experts say that female hormones play a big part in mood disorders.
While many women can accept the differences caused by hormonal changes and cope with them effectively, some women are more vulnerable to mental health issues during menopause. They may require specific support and treatment for their mental health problems.
If there is one symptom most menopausal women (up to 80 percent) experience, it’s hot flashes. While better known as “vasomotor symptoms” or “VMS,” hot flashes are often physically uncomfortable and irritating and may cause emotional distress. Hot flashes are intense and sudden heat sensations in the face, chest, and neck. There may also be sweating, chills, rapid heartbeat, and skin reddening, along with the heat. Night sweats are hot flashes that occur when sleeping.
What Are the Mental Symptoms of Menopause?
Shifting hormonal changes in menopause may cause mood changes. The most common mental symptom of menopause is depression. Although typically temporary, women who have had difficulties with depression and anxiety before may have symptom resurgence. According to a 2011 study, the likelihood of women experiencing a major depressive episode is two to four times greater when they are peri-menopausal or in the early post-menopausal stage.
Mental symptoms of menopause vary from one woman to the next. While hormonal changes can influence many menopausal symptoms, other factors also come into play. These include the woman’s stress levels, personal history (especially depression), and lifestyle.
Women with recurrent depression are at increased risk (up to 4.5 times more likely) to have another depressive episode when they begin menopause than other women at this life stage. The study found that any history of major depression was a “strong predictor of major depression” during the study period.
Take stress, for example. When a woman undergoing menopause experiences stress, some menopausal symptoms can worsen. These include problems with sleep, mood changes, and hot flashes.
A woman’s sensitivity to stress can also increase due to lowered estrogen levels. (Low estrogen levels can lead to an increase in levels of the stress hormone cortisol.)
What do the mental symptoms of menopause look like? Women experiencing such symptoms may display emotional changes. These include, but are not limited to, low self-esteem, sadness, anxiety, memory lapses, trouble finding words or concentrating, aggression, and irritability. These mental symptoms can wreak havoc on everyday life, performance at work, and relationships.
It is important to note that most women will experience mental symptoms of menopause. Research shows that there may be greater susceptibility to depression in women resulting from the neuroendocrine effects of plummeting estrogen levels. Women also tend to experience more frequent exit and loss events during this time, along with the somatic symptoms from hormonal changes.
During menopause, significant changes occur in women’s lives. Affected areas include relationships, other health conditions, children leaving home, retiring, or being asked to retire early, financial hardships, losing a loved one or elderly parents, and other work and personal life stressors. These can all affect women emotionally, mentally, and physically.
Emotional Changes During Menopause
While much is known about the link between depression and menopause, there is less knowledge about the connection between menopause and anxiety. Women who suddenly experience anxiety in menopause sometimes describe feeling a sense of doom and panic prior to a hotflash. This is called an “aura,” and the symptoms that accompany it (trembling, heart palpitations, sweating, etc.) can seem similar to those experienced in a panic attack. (Doctors also say there is some evidence that women may experience panic attacks in menopause and afterward.)
Besides anxiety and depression, specific emotional changes that may occur during menopause include:
- Concentration difficulty
- Loss of motivation
In short, the stereotype of menopausal women being angry, irritable, and moody has a kernel of truth, though not absolute. These emotions can indeed be rooted in their experience of symptoms of menopause in the transition from fertility to infertility. For example, mood swings and mood disorders can be caused by deficient estrogen levels. The large-scale decline of circulating estrogen leads to less of an ability to synthesize serotonin in the brain.
Other brain chemicals stimulated by estrogen—dopamine, melatonin, and norepinephrine—play a role in a woman’s emotional wellness. Chemical imbalance can trigger anxiety in menopause, a feeling of steady unraveling, or the perception that life is reeling out of control.
Again, extreme emotional changes don’t occur in every case of menopause, but knowing they can happen is essential to self-care during this season of life. There is also a significant need to recognize, prevent, and treat mental illness in perimenopausal women, since the association between morbidity and mood disorders in a woman’s midlife can be significant.
Another point to remember is that not all treatments for depression, anxiety, hormonal changes, and mood disorders during menopause will always be appropriate or effective. What is known is that VMS during perimenopause can signal the existence of dysregulated neurotransmitters and hormones and foreshadow oncoming depression. Therefore, treatment from medical professionals requires a case-by-case evaluation.
Interestingly, medical experts say that making some lifestyle changes may help women ease or reduce at least some of the symptoms of menopause. These lifestyle changes are, for the most part, easy to do and can be done with others, including:
- Limiting caffeine
- Cutting down on alcohol
- Getting consistent, good sleep
- Support groups
- Enjoying relaxing activities
Can Menopause Cause Irrational Behavior?
Coping with the symptoms of menopause can be challenging for many women. Besides the irrefutable knowledge that their bodies are changing and emotions seem all over the place, there is the need to deal with sleep loss due to night sweats. According to sleep experts, failure to get the recommended 7-9 hours of sleep daily can lead to mood changes, weight fluctuations, problems with the heart, and other issues.
But can menopause trigger irrational behavior? That depends on how long disrupted sleep goes on. Prolonged sleeplessness and insomnia can lead to mental fog, memory problems, and cognitive decline. People who have experienced prolonged sleep deprivation may act irrationally, with symptoms that include hallucinations, disorientation, and paranoia.
When to Seek Help
If your quality of life (or that of someone you care about) is deteriorating due to symptoms of menopause and none of the current coping mechanisms are working, it may be time to see treatment. Schedule an appointment with your doctor. They should be able to help you get back on track to feeling more like yourself again. They may even refer you to a therapist who can help you process your emotions and the changes you’re experiencing, so that life becomes manageable again.