How Can Menopause Affect Your Mental Health?
Menopause affects women in a variety of ways. Leading up to menopause, women may experience hot flashes or bouts of insomnia, but there are lesser-known side effects women may not know about, including how menopause can affect their mental health.
How can menopause affect women?
When Alice Taylor began experiencing severe panic attacks at age 45 for no apparent reason, she thought the cause must be physical, not mental. A devoted yogi for more than 20 years, she was typically calm and composed and had no history of anxiety.
"It was so bad that, at first, I thought maybe I was having mini heart attacks,” said Taylor, a London-based yoga teacher and owner of the Menopause Studio.
Her doctors performed a broad spectrum of tests but lost interest when everything appeared structurally sound. Her anxiety and panic persisted, though, profoundly affecting her ability to work, socialize or generally function.
"I couldn't trust that I wasn't going to feel breathless and unwell and tearful, and this made me not want to go out or be with friends as I felt like I would embarrass myself," Taylor said.
Taylor's symptoms affected her job performance, too.
"My boss at work used to laugh at me—she was a middle-aged woman too, by the way; so much for the sisterhood—and make a big deal about the fact that I couldn't always remember what I was going to say, often halfway through a sentence," Taylor said. "Her attitude eventually led to me leaving a job that I was good at."
Taylor experienced terrible "word blindness," or the inability to remember simple words.
"At one point, I said to my husband, 'You know, those puppies cats have. What are they called?' He suggested we might go for an early Alzheimer's test," she said.
After a couple of years and many more tests, she heard author Jeannette Winterson on the radio discussing her perimenopause symptoms—the same as Taylor's.
"I felt furious. Why hadn't the doctors thought about this? They only had to look at my age, for heaven's sake," she said.
Like many women, Taylor had no idea menopause could bring about or exacerbate cognitive or mental health issues.
"I was completely unprepared," she said. "I guess I just felt that it would be my period stopping one day, and that was it."
What does science say about how menopause can affect your mental health?
Research indicates that anxiety, depression and cognitive troubles are common, if lesser-known, menopause symptoms. Up to 58 percent of perimenopausal and menopausal women had anxiety, while 62 percent experienced depression, a 2020 study found.
About two-thirds of women experience cognitive challenges, according to the Office on Women's Health.
Some women experience new or worsening mental health issues. These conditions may include the following:
- Major depressive disorder (MDD)
- Anxiety disorders
- Manic-depressive disorder (bipolar disorder)
- Obsessive-compulsive disorder (OCD)
- Attention deficit/hyperactivity disorder (ADHD)
"These mood disturbances can affect various aspects of a person's life, from their self-confidence to interactions with loved ones and ability to perform everyday tasks," said Mache Seibel, M.D., a menopause expert in Newton Centre, Massachusetts.
Learn how mental health and menopause are related and find out about available treatment options.
What is the difference between perimenopause and menopause?
Perimenopause, which can start eight to 10 years before menopause, occurs when the ovaries begin to produce less estrogen, according to Cleveland Clinic. In the final phase of perimenopause, estrogen levels drop precipitously, and many people experience menopausal symptoms.
Some women have irregular periods during perimenopause, while others ovulate regularly until menopause starts.
A woman is in menopause once she hasn't had a period for 12 consecutive months. At this point, the ovaries aren't releasing eggs and produce very little estrogen.
Why does menopause affect mental health?
"Hormones like estrogen and testosterone play a crucial role in brain function and mental health," said Karen Toubi, D.O., an OB-GYN at Rodeo Drive Women's Health Center in Beverly Hills, California.
Estrogen, in particular, has various effects on the brain, she said:
- It influences the production, release and activity of neurotransmitters (chemical messengers thought to affect mood, energy levels and sleep, among other things).
- Estrogen promotes the neuronal growth and plasticity essential for cognition and memory.
- It enhances blood flow to the brain.
Testosterone's role is less understood, Toubi said, but it may help influence mood, sex drive and cognitive function, according to Harvard Medical School.
When hormone levels fluctuate and decline during perimenopause and menopause, these changes can affect brain function and psychological well-being. The duration and severity of these effects vary from one person to another, Toubi said. For some people, they gradually subside; for others, they persist beyond menopause.
Other factors—age, overall health, individual differences and life circumstances—can also affect symptoms, according to Kevin Alten, M.D., an OB-GYN based in Cambridge, Ohio.
Women with a history of psychiatric disorders, including premenstrual dysphoric disorder and postpartum depression and anxiety, are more likely to have emotional or cognitive problems with menopause.
Some people, like Taylor, experience mental health challenges for the first time during the transition.
Can menopause cause anxiety and heart palpitations?
Natalie Trice had experienced anxiety before, but nothing like the crushing sense of dread she woke with every morning when she entered perimenopause. It was exhausting and overwhelming, she said, with anxiety spiraling during the day and an inability to sleep at night.
"It just became this kind of self-perpetuating cycle of tiredness and anxiety," said Trice, a PR coach based in Exeter, United Kingdom.
She had no other symptoms, such as hot flashes, night sweats or irregular periods, and initially chalked it up to stress. After reading other women's comments on social media, she realized it might be related to hormones.
Anxiety can be a menopause symptom or a distinct disorder, such as generalized anxiety disorder, social anxiety disorder or panic disorder. People with frequent, persistent, and excessive worries, fears or panic attacks that interfere with daily life may have an anxiety disorder, according to Mayo Clinic.
Anxiety can have psychological and physiological effects, like many other mental health conditions. The physiological side effects of menopause may include symptoms such as the following, according to Mayo Clinic:
- Heart palpitations
- Trembling
- Feeling weak or tired
- Sweating
- Rapid breathing
- Trouble sleeping
- Gastrointestinal issues
How can menopause affect depression?
Women in perimenopause and the first few years of the postmenopausal period are twice as likely to experience depression, including major depressive disorder, compared to the general population, according to the North American Menopause Society (NAMS).
Most people occasionally feel depressed. People with depressive disorders such as MDD have multiple symptoms for at least two consecutive weeks.
The symptoms of depression include the following:
- Low energy
- Insomnia
- Loss of interest in previously enjoyable activities
- Sadness
- Irritability or anger
- Agitation
- Appetite changes
- Low libido
- Difficulty concentrating
- Gastrointestinal issues
- Unexplained pains
The many possible causes of depression include genetics, biological elements and psychosocial factors. Hormone fluctuations and stressful life events that occur alongside menopause may increase the risk, especially for predisposed people, according to a 2018 study.
What's the connection between ADHD and menopause?
Menopause and ADHD are closely intertwined. ADHD symptoms tend to worsen during the change.
That's partly because people with ADHD tend to have lower than average dopamine levels, according to Children and Adults With Attention-Deficit/Hyperactivity Disorder (CHADD). As estrogen levels decrease during perimenopause and menopause, dopamine levels drop, too.
Hester Grainger received a combined ADHD diagnosis (inattentive and hyperactive) at age 43, about two years before she entered perimenopause. At first, she didn't realize what was happening.
"I just felt that life started getting more overwhelming, and I was coping less," said Grainger, an ADHD coach and co-founder of Perfectly Autistic in Reading, United Kingdom.
When she spoke with her doctor, she learned several symptoms of menopause and ADHD overlap, including, but not limited to, the following:
- Brain fog
- Finding it harder to cope with challenges
- Feeling overwhelmed
- Memory problems
- Difficulty concentrating
Menopausal women with ADHD are also more susceptible to hormone-related mood changes such as depression and anxiety, according to CHADD.
"My ADHD symptoms have gotten much worse, unfortunately. I can forget what I am saying mid-sentence; I am much more easily distracted than I was before; and I find that I am even more emotional than before if that is possible," Grainger said. "Brain fog has always been with me and is part of my ADHD, but now it feels more constant and harder to shake."
What helps anxiety during menopause?
Menopause anxiety treatment usually involves a holistic and multifaceted approach. It takes a combination of lifestyle changes, medication, hormone replacement therapy (HRT) and, sometimes, counseling or cognitive behavioral therapy (CBT).
The same is true of treatment for other psychiatric conditions.
"Lifestyle changes are highly underrated," Seibel said, including for people on medications or HRT.
Regular physical activity might be as beneficial as antidepressants in treating depression, a 2022 report suggested.
Diet can potentially help relieve menopausal anxiety. Eating too much processed sugar may increase depression risk or severity and accelerate cognitive decline, a 2017 study suggested.
Lifestyle changes to potentially help improve mental and cognitive health include the following:
- Exercise.
- Reduce stress.
- Practice mindfulness.
- Practice yoga or tai chi.
- Engage in cognitive tasks like reading, puzzles or learning new skills.
- Stay socially connected.
- Prioritize sleep.
- Eat a nutritious diet, including fruits and vegetables, omega-3 fatty acids and lean proteins.
- Maintain a healthy sex life (by yourself or with a partner).
What is the best antidepressant for menopause?
Despite their name, antidepressants are often prescribed for various conditions, including depression, anxiety disorders and post-traumatic stress disorder (PTSD). Medications such as atomoxetine, a serotonin and norepinephrine reuptake inhibitor (SNRI), may help people with ADHD, according to the National Library of Medicine.
Doctors may prescribe low doses of antidepressants to help alleviate hot flashes and night sweats. SNRIs and selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for vasomotor symptoms and depressive disorders.
SSRIs, SNRIs and norepinephrine-dopamine reuptake inhibitors (NDRIs) are the most frequently prescribed medications for depression.
What's the best medication for ADHD and menopause?
Along with atomoxetine, doctors may prescribe stimulants such as dexamphetamine or lisdexamfetamine for menopausal people with ADHD.
Lisdexamfetamine can be given to menopausal women without ADHD, too. Research from the University of Pennsylvania suggests lisdexamfetamine may improve symptoms such as memory, reasoning, multitasking, planning and problem-solving.
How might HRT help with mental health?
HRT involves taking estrogen or a combination of estrogen and progesterone to rebalance hormone levels. Some people believe it may alleviate some emotional and cognitive symptoms, but it is solely prescribed to deal with vasomotor symptoms, such as night sweats and hot flashes, which may be related to hormone deficiencies.
The treatment isn't for everyone and risks are involved, the most significant being an increased risk of breast cancer.
A 2002 study suggested a high correlation between HRT and breast cancer. Still, subsequent research has shown the association is much more complex than previously believed, according to Seibel and BreastCancer.org. Much of the risk depends on a person's health history, the type of HRT and the duration of treatment.
The benefits of HRT can outweigh the risks for some people under age 60 with no medical reasons to avoid it (such as a history of cancer), according to the North American Menopause Society (NAMS). The decision to use HRT should be made on a case-by-case basis.
Still, lingering misconceptions about HRT and menopause's impact on quality of life can make the treatment challenging to get, Trice said.
"One of (the doctors) said to me, 'I'm not going to give you HRT until you are on the verge of a breakdown, and if I do, you'll get cancer,'" she said. "And then he said, 'I'm going to tell all women that I speak to today the same thing.'"
After researching HRT, she spoke with a different doctor who said she could be a good candidate. Within about three months of starting HRT and adjusting her lifestyle, her anxiety "calmed down a lot," she said.
Taylor had a similar experience. It had been ingrained in her that she should handle everything "naturally." And yes, lifestyle adjustments helped, but they weren't enough.
"The more I read about menopause, the more I realized that it is far from natural to live more than a third (if we are lucky) of our lives lacking the essential hormone of estrogen," she said.
It took some time and trial and error, but she's found some relief after dialing in the correct dosage.
"Now I can see that perimenopause is a tunnel, not a cave," Taylor said. "But it's been a long tunnel; let's put it like that."
The bottom line
If you're having trouble with your mental health or other aspects of perimenopause or menopause, speak with a healthcare professional. Talking to empathetic peers and connecting with organizations such as a menopause society may also be helpful.
"Get help sooner rather than later. Talk to your friends, family and tell the relevant people at work. If someone talks to you about how worried they are about your mental health, they are probably throwing you a lifeline. Take it," Taylor said. "It isn't always easy to see what is happening to you.
"No one is trying to upset you. Everyone wants you to be well and happy, so try to listen to well-wishers. You aren't being judged."
