How menopause affects your mental health

Menopause and mental health go hand in hand, but many women do not realise it.

1 in 3 women experience menopausal and perimenopausal symptoms. This affects not only the person experiencing it, but also partners, family members, friends and colleagues. In many women, menopause can affect how we perceive ourselves and cause identity changes.

People are living longer and going though menopause earlier. And although conversations around the menopause have begun to speed up recently, it can still be a taboo topic. Many people are reluctant to talk about menopause due to a lack of knowledge, stigma and embarrassment. And there still remains an uncertainty of how to ask for support or understand what support is available.

But menopausal women are the fastest growing workplace demographic, with 8 in 10 in work. 1 in 4 women suffer serious symptoms. This can sometimes lead to a reduction in hours or leaving work altogether. Opening up the discussion and raising awareness can help remove the barrier to access support. This can also make the transition into menopause easier for those affected.

The 3 stages of menopause

There are 3 different stages of menopause - perimenopause, menopause and post menopause.

Perimenopause is the time leading up to menopause when a woman may start to experience changes. This can be years before menopause. Symptoms can be both physical and psychological and can last for 4 to 8 years.

Noticing changes but feeling unsure about the reason behind them can be a confusing time. And it can often be a blanket term for women experiencing mental health changes.

Menopause is the biological stage when hormones change and menstruation stops. The average age a woman reaches menopause is 51 years but it usually occurs between the ages of 45 to 55 years.

Most women experience changes in menstrual cycles as a sign of menopause. First they can become irregular (perimenopause) and later stop completely. Menopause can also happen earlier due to reasons such as surgery to remove ovaries, cancer treatments or genetics. In this case it is referred to as Premature Ovarian Insufficiency (POI), which is experienced by 110,000 women between 12 and 40 in the UK.

Post Menopause is the time after menpopause. When we talk about people being menopausal, we mean someone who is in the stages of this transition.

The science around menopause

Our hormone levels change throughout our lives and during menopause, the following hormones can be out of balance.

Oestrogen

Oestrogen levels fluctuate during the menstrual cycle and fall completely after menopause. This affects serotonin, dopamine and noradrenaline (the chemicals between the brain and nerve cells.)

Below shows some of the things oestrogen does:

• Triggers the release of an egg

• Nourishes the tissues of the body
• Regulates bone turnover and cholesterol
• Maintains brain power as well as keeping the liver, brain and heart healthy.

What are the symptoms?

Leading up to the menopause, you might experience these symptoms:

How to manage symptoms of menopause and choose the right support?

There are several approaches to menopause treatment.

In the UK a healthcare practitioner will use NICE guidelines to determine the type of medical interventions they are able to offer.

The main medical treatment is HRT. But non medical approaches can also be very effective at managing symptoms.

These include:

• Herbal therapies - milk thistle, red clover, St John's Wort
• Acupuncture
• Yoga
• Homeopathy
• Aromatherapy
• Reflexology
• Life coaching
• Cognitive behavioural therapy

Always talk to a qualified herbalist or nutritional therapist first.  

Lifestyle changes including a balanced diet, reduced alcohol and caffeine consumption, and increased exercise and supplements can also be effective for managing symptoms.

HRT is often talked about, but what actually is it?

HRT (Hormone Replacement Therapy) replaces hormones that a woman no longer produces due to menopause and perimenopause. When considering HRT it’s important to understand the benefits and risks associated.

HRT can be a replacement of Oestrogen, Progesterone or a combination of both. HRT comes in various forms such as tablets, patches, gels, implants, cream/pessary.

All HRT has Oestrogen.

If you still have a womb then you will have progesterone. Often the treatment depends on the stage of menopause and symptoms, whether you are still having periods and your medical history.

Main side effects of HRT

The main side effects of taking oestrogen include:

• Bloating
• Breast tenderness
• Nausea
• Vaginal bleeding
• Leg cramps
• Headaches
• Indigestion

The main side effects of taking progesterone include:

• Mood swings
• Headaches
• Breast tenderness
• Depression
• Acne
• Abdominal pain
• Back pain
• Swelling in other parts of the body
• Vaginal bleeding

Health practitioners usually recommend that you continue the medication for 3 months if possible to see if the side effects reduce or pass.

Benefits of HRT

There are many known benefits to including HRT therapy. This includes relief of menopausal symptoms such as hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive. HRT can also prevent thinning of bones that can lead to fractures and osteoporosis.

It’s essential to understand your risks against HRT and assess these against the benefits you are going to notice. Consider the longer term benefits as well as the short term. It may not always be right the first time, as individual women respond differently. The right treatment for you is the one that makes you return to optimal health, with side effects that you can tolerate.

As you get older you may need lower doses of HRT therapy. The important part is not to suffer in silence. Taking control of your wellbeing and health increases your choice and control by encouraging you to explore your options.

Menopause and mental health

All women have very different experiences of the menopause. One common element is the changes menopause can have on both psychological and physical health. Changes in hormones can impact mental health and lead to fluctuating emotions, anxiety and depression.  

There are many different treatment options available to help manage and cope with the physiological impacts of menopause. Regular exercise, balanced diets and good sleep hygiene can all help symptoms and improve mood changes.

It is also common to feel overwhelmed, unable to cope and anxious. Some experience brain fog, forgetfulness and struggle to find the right words to have a flowing conversation. This can play havoc on their minds and knock confidence.

Common mental impacts of menopause:

Feeling Isolated

Having to deal with menopause on your own can feel lonely and confusing. There is absolutely no reason to try and brave it alone. After all, every woman will experience menopause at some stage in her life and can resonate with your transition. Seek out relevant networks that you can associate with as they may share helpful tips or just be a sounding board. Keep talking to others and seek out the resources you need.

Losing confidence

Feeling scattered, having difficulty concentrating or feeling like your memory is failing you, causes frustration and embarrassment. Questioning your ability to function on a daily basis dents confidence levels. Regain confidence and purpose by talking to a friend or mental health practitioner. Creating a mind map or writing tasks into lists are useful to help our memory function and confidence. There are also various phone apps available to help you break down activities into small chunks.

Sleep patterns

Along with changes in moods and menstrual changes, many women also experience issues getting quality sleep. This can include falling asleep, interrupted sleep, waking too early, feeling tired or irritable. Sleep is fundamental to wellbeing and poor sleep can impact mental health and take you on a downward spiral. If you’re worried about your sleep habits, speak to a professional who specialises in sleep to help you recognise current habits and sleep hygiene.

What to do if you’re struggling with your mental health through menopause?

Fluctuating moods and motivation due to hormonal changes can impact your mental health. Feelings of anxiety, stress and even depression are not uncommon. In fact 20% of women experience symptoms during this time.

Anger, aggressiveness and irritability creates an emotional rollercoaster. Monitor your mood and make a note of the factors that affect it. A cognitive behavioural approach is often seen as the most effective to improving mental health during the menopause transition. CBT allows us to understand how our thoughts are linked to our feelings, which inturn is linked to behaviour.

When experiencing hot flushes there is uncertainty and loss of control in some situations and our body may go into survival mode, fight or flight bringing with it anxiety which is frightening. Work with a CBT coach or therapist to support you.

Other things you can try include reframing your thoughts to realign with your values and what is important to you. Increase your endorphins (happy hormones) and do things you enjoy. Find a hobby, exercise regularly, put on some music and dance for a few minutes. Find ways to have a good laugh.

Breathing techniques and mindfulness can be helpful in situations of intense anxiety and uncertainty.

How do I explain what I’m going through to others?

Ensure you communicate with the people around you both at home and in the workplace. Be transparent, as there is bravery in being vulnerable. Note down your symptoms and duration which may be different to others. Share these with those who are near you.

Also, if struggling at work, speak to your employer about the type of support they offer. When we struggle to say what we feel, written communication can help you open that door to explain your situation.

How to navigate the way forward and make informed choices?

The best way to navigate this life transition is by asking yourself the following questions:

• Do I write down all the symptoms I am experiencing? (This is helpful before an appointment with a health practitioner.)
• Which symptoms affect me the most?
• How can I familiarise myself with NICE guidelines?
• Do I have a personal plan to manage my symptoms long term?
• Do I prefer a medical/ complimentary approach or a combination?
• What support do I need and how will I get that?
• How good am I at asking for help and who should I talk to?

Going through the menopause can feel like a huge life transition both physically and emotionally. Confidence and self-esteem can be impacted based on the symptoms women experience. It’s important to take time for yourself. Practice self-care and reduce overwhelm and anxiety from your busy life.

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