by Andrea Blundell
Around 35 or over, and feeling a mess lately? Anxious, depressed, all over the place? The menopause and mental health connection is worth learning.
Menopause and mental health
After generations of women suffering in silence, menopause is finally in the spotlight.
It’s now clear that menopause can affect mental wellbeing. And that your mental health is at risk from the moment your hormonal profile starts to decline.
For some women, this period of “perimenopause” is about three to five years. But for other women, it’s a rollercoaster of a decade or even longer.
Why is menopause depression controversial?
We don’t question why a teenager going through puberty, a premenstrual woman, or a woman who has just given birth are moody. And yet a woman of a certain age with a totally changing hormonal balance who dares to be moody has been seen as a giant mystery.
A 2018 large-scale review of menopause research points out that, “For many decades, there has been an ongoing debate about whether the menopause transition and/or postmenopause 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.
How menopause affects mental health
This recent overview thankfully goes on to clarify that when we look at menopause and mental health —
“–we need to accept that “multiple psychosocial and biological factors are involved.”
Fluctuating hormones, related to our genetics, can for some women affect moods in and of themselves. For others it’s the side effects of these hormonal changes, such as less sleep and lower energy, which also have a knock on effects on mood and wellbeing.
And just how our bodies are affected can also be related to what sort of health we were already in, and what kind of life we are leading.
Then there are life stressors that play a part. These can be menopause related. Like, say, dealing with a society who still doesn’t fully embrace ageing women. Or worse, leaves you feeling suddenly invisible and irrelevant.
Or they can be pre-existing stressors having to do with your relationships with others, your workplace, or unresolved past trauma.
Perimenopause and depression
The review discovered that it’s early on in our hormonal transition that we are must sensitive to depression.
“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 is also a common complaint during perimenopause. While the research is not quite there yet on this front, it’s thought to be related to declining progesterone levels. You can suddenly, with less of it, feel tense and stressed. Meaning your body takes it as a sign to produce more of the anti-stress hormone cortisol. Which unfortunately, in a vicious cycle, the body takes as a sign to produce even less progesterone.
The physical affects of ageing
By your early forties, you might start to notice unavoidable signs of hormonal changes on your body. Your wild 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.
Not everyone takes ageing quickly in stride. Some of us are simply more self-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, which can then lead to depression.
Physical symptoms and depression
photo by Megan Boekhorst
Hot flashes, night sweats, loss of sex drive, and sleep issues… for some women menopause comes on like a storm.
Memory loss and foggy thinking can also be a symptom. Much like hormones can cause ‘mommy brain’ after the birth of a child, they can cause ‘menopause brain’.
And all of these symptoms can be incredibly stressful. Particularly if it’s affecting your daily life, such as your work performance.
Would we be expected to see it as ‘normal and natural’ and ‘just get on with it’ and act fine if we were hot and sweating from a fever, or had sleeplessness from an illness? And yet women are expected to act like these symptoms don’t even exist.
But my friends are doing just fine
It is true that some women have a very short or uncomplicated menopause. But keep in mind that many women still feel pressured to pretend or deny when it comes to menopause. Or they simply aren’t comfortable discussing their experience.
There are, however, factors that might have made you more sensitive to mental health issues during menopause. One of these is suffering from premenstrual syndrome.
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 less patient? More annoyed with a world that is often disappointing?Viral article “Me, Drugs, and the Perimenopause”, by award-winning Times columnist Caitlin Moran, is a must read.
It points out that maybe you are just becoming aware of what was always there, and that that’s okay. So go easy on your good self.
“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.”
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.
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.
Still have a question about menopause and mental health? Ask below.
Andrea Blundell is a mental health and wellbeing writer and the lead writer of this site. She finds it rather shocking we are only now beginning to talk about menopause, and is fairly certain if it was men who were suffering and not women there would long have been specialist clinic on every corner.