photo by Rodnae Productions for Pexels
by Andrea M. Darcy
In your late thirties or older, or put into medical menopause, and feeling a mess lately? Anxious, depressed, all over the place? The menopause and mental health connection is worth learning.
Is your issue just depression? Or is it actually just menopause? The answer is not that simple and is often… both.
Menopause and mental health
Research on menopause and mental health has been surprisingly slow. But it is recognised that for some, menopause can put their mental health at risk from the moment their hormonal profile starts to decline. This is generally the case if you already had mental health issues in the past.
“The vast majority of women who develop significant mood issues during perimenopause have had them in the past. It’s relatively rare for someone with no history of depression or anxiety to suddenly develop a severe case of it at menopause”. (Dr. Hadine Joffe, Professor of Psychiatry in Women’s Health at Harvard Medical).
Perimenopause and depression
It’s been discovered that it’s early on in our hormonal transition that we are most sensitive to depression. According to a recent review of research around menopause and mental health:
“longitudinal studies, conducted across the world and in diverse populations, confirm that women are two to five times more likely to experience a depressive disorder during the peri versus the late premenopausal years”.
Anxiety in perimenopause
Anxiety is also a common complaint during perimenopause. But the research explaining its direct link is still flimsy, not helped by the fact that hot flashes mimic many of the symptoms of panic attacks. But it’s thought to be related to declining progesterone levels.
With less progesterone circulating, it can contribute to feeling tense and stressed. Meaning your body takes it as a sign to produce more of the anti-stress hormone cortisol, leaving you in an anxious state. Which, in a vicious cycle, the body can take as a sign to produce even less progesterone.
Why is menopause depression controversial?
As pointed out by the 2018 large-scale review of menopause research, “For many decades, there has been an ongoing debate about whether the menopause transition and/or post-menopause is associated with an increased risk for depressive symptoms or disorder”.
The debate has been focussed on just how exactly declining hormones could cause depression. A strange argument, given that almost all mental health issues are routinely identified as both biological AND environmental.
We recognise, for example, that a teen is depressed not just because of hormones, but also because of the general stress of being a teen, such as having to find their identity.
Menopause and mental health – how it works
The review thankfully steps in to finally clarify just this. That when we look at menopause and mental health —
“–we need to accept that “multiple psychosocial and biological factors are involved.”
Physical symptoms of perimenopause and depression
When looking at the ‘biological factors’ it’s important to note that many of the physical side effects of peri/menopause are themselves standalone causes of anxiety and depression.
One common menopause side effect is insomnia or disrupted sleep, which has a very strong causal link with depression. Poor sleep is of course not helped if one also has night sweats.
Loss of libido is another commonly reported perimenopause symptom. Which can cause a loss of identity and relationship issues. Both of which are directly related to anxiety and depression.
Then there is dealing with memory loss and the foggy thinking that can also be a symptom. And navigating hot flashes. Which can all affect our daily coping, as well as things like our work performance.
New life stressors during middle age
As for ‘psychosocial factors’, there are new life stressors in middle age that can play a part in mental health struggles. For starters, we are still dealing with a society that doesn’t fully embrace ageing women. Meaning we can be left feeling suddenly invisible and irrelevant.
Other very real new stressors at middle age include:
Depression around ageing
By your early forties, you might start to notice that your perfect hair is suddenly lank, your skin is dry in a way it never was. There is a blonde fuzz growing all over your neck and jawline, and a paunch starting where you used to have abs.
Not everyone takes ageing quickly in stride. Some of us are simply more body-aware and aesthetic than others, or with jobs that rely on us to look a certain way. While once even after very little sleep we could look presentable, we might feel that everything suddenly takes an exhausting amount of work to maintain. And it can affect our self-esteem. And low self-esteem is a common contributor to depression.
But my friends are doing just fine
There are factors that might have made you more sensitive to mental health issues during menopause. One of these is suffering from premenstrual syndrome or premenstrual dysphoric disorder (PMDD).
A study of over 400 women found that “women who reported premenstrual syndrome at baseline were at greater risk of menopausal hot flushes, depressed mood, poor sleep, and decreased libido.”
What if menopause is making me a bad person?
Feeling, well, more… bitchy lately? Viral article “Me, Drugs, and the Perimenopause”, by award-winning Times columnist Caitlin Moran, is a must read.
It points out that maybe we are just becoming aware of what was always there, and that that’s okay. So go easy on your good self. At Caitlin shares:
“Since the age of 13, when my ovaries cranked into action, I have been regularly bathed in oestrogen, progesterone and testosterone. You can Wikipedia what these hormones/drugs do. I can tell you what their primary effect is. They make you a bit stoned and lovely…we’re kind of high on nature’s sexy Valium. However, as your perimenopause gathers pace, you experience what I can only describe as increasing sobriety.
Of course, this is the cliché of the suddenly furious menopausal battle axe, that somehow the menopause has “made her angry”. No. It’s that the menopause has stopped her being so blithe and forgiving. It’s uncovered her actual personality and thoughts, underneath all the hormones. This is a very important distinction.”
What should I do if I think my mental health issues are menopause related?
Sure this is you? What now?
1. Don’t assume your mood issues are all menopause, see a doctor for a checkup.
Assuming your mental health issues are the menopause means you could overlook other very real issues causing mental health problems.
- An overactive thyroid gland, a common middle-aged health issue, is a common cause of anxiety.
- And contraception coils are now linked to mood disorders, with one research study finding this is particularly true when the coil is replaced later in a woman’s life.
2. Take a holistic view of your health.
While it’s easy to develop ‘menopause tunnel vision’ and make it the thing to blame everything on, it’s actually not a helpful perspective.
Remember that mental health issues surface in menopause for those who generally already had issues. And that there are many issues in middle aged, both physical and mental, that all need attention if we are to feel mentally balanced.
A small but interesting study from Iran found that menopausal women were less likely to experience moderate depression or severe anxiety if they had a consistent exercise regime.
3. Seek menopause support and treatment.
There is more help out there than ever before. Whether that is going the natural route, and trying supplements like black cohosh, or trying a HRT regime? If you are suffering, it’s worth looking into your options. And if your mental health is a mess, then don’t keep putting off getting support.
Can therapy help me with menopause and mental health?
Absolutely. For starters, it provides a safe space to vent your frustrations if your issues aren’t being taken seriously by those around you. But it also helps you build coping skills for handling low moods.
And it helps you navigate the social stressors of ageing, including the identity change that menopause can feel like. It’s a wonderful addition to your menopause treatment, whether that includes a HRT regime or not. The NHS recommends cognitive behavioural therapy (CBT) as a good start.
Want to talk to someone about how menopause is affecting you? We connect you to expert talk therapists who understand what you are going through and can help.
Andrea M. Darcy is a mental health and wellbeing writer with training in coaching and person-centred therapy. She is fairly certain if it was men who were suffering with menopause there would long have been specialist clinic on every corner, with the research around menopause and mental health would have been done decades ago.