Mental Health and the Menopause

menopause

Menopause, and perimenopause, bring changes to a woman’s body with various physical symptoms, but the years leading up to it, and the transition itself, also affect the mind and a person’s mental health.

During menopause, mood changes such as sadness, lack of concentration, irritability, lack of motivation, aggressiveness, and stress are common and cause emotional strain.[1] These mood changes combined with distressing physical symptoms can result in the onset of mental health disorders such as depression and anxiety.

Additionally, if an individual has a pre-existing mental health condition, menopause is known to potentially exacerbate symptoms.

In this article, we will uncover the connection between menopause and mental health, the most commonly associated conditions, and tips to help cope with this transitory time in a woman’s life.

Effects on Mental Health

Menopause is defined as marking the end of the menstrual cycle, twelve months after a woman’s last menstrual period. Perimenopause is the time leading up to menopause when estrogen and hormone levels drop. Perimenopause can last anywhere between four and twelve years.

The key hormones which control the female reproductive system are estrogen and progesterone. These hormones are produced in the ovaries. During menopause, these hormones – particularly estrogen – drop, while the levels of follicle-stimulating hormone (FSH) and luteinising hormone (LH) increase.[2]

The fluctuations in the hormone levels cause biochemical changes to the brain and nervous system, resulting in various physiological and psychological symptoms. These symptoms can be mild or acute and may be emotionally distressing.

Symptoms include:

  • Physical Symptoms: insomnia, hot flushes, fatigue, night sweats, and memory loss.
  • Mood changes: sadness, lack of concentration, irritability, lack of motivation, aggressiveness, and stress.
  • Mental Health Disorders: depression and anxiety.

Women may experience similar symptoms due to hormone fluctuations through premenstrual syndrome (PMT), premenstrual dysphoric disorder (a severe form of premenstrual syndrome), and postpartum depression. All these conditions are driven by hormonal changes in the body.

Decreased estrogen levels are particularly significant in affecting mood changes as estrogen modulates neurological processes related to our stress response, cognition, and emotional regulation.

​Most women transition without experiencing mental health issues; however, an estimated 20%[3] of women experience psychological difficulty.

It is rare for someone with no history of mental health disorders to develop a severe mental health issue during this time. Most women who experience significant mood difficulties have suffered from a similar issue in the past.[4]

It is important to note that midlife, when menopause typically occurs, is a time of flux and stress for many women that may contribute to the onset of depression and anxiety. Women at this time in their lives may feel burdened with life changes, which could include:

  • caring for children
  • caring for aging parents
  • grown children leaving home or returning home
  • career changes
  • changes in romantic relationships
  • concerns about the health of a partner or family member
  • growing older

Menopause and Depression

Women appear to be vulnerable to depression during perimenopause and in the years after menopause. Clinical trials are yet to find a clear link between depression and menopause; however, research shows that rates of depression significantly increase during these years.[5]

Women with a history of clinical depression, postpartum depression, or severe PMS in their younger years are more likely to experience a relapse of these symptoms during these years.

In rare instances, the estrogen changes and associated menopausal psychosocial stresses can contribute to the vulnerability of developing major depressive disorder (MDD).[6]

Menopause and Bipolar Disorder

Research suggests that hormones play a role in the development of bipolar disorder. The hormone fluctuations during menopause have been shown to increase the severity of symptoms in some women. One in five women already suffering from bipolar disorder reported severe emotional distress as they transitioned.[7]

Research has additionally demonstrated that it is usually the depressive episodes, rather than the manic, which become more pronounced and acute during menopause. This is most likely due to the decrease in estrogen levels.

Menopause and Schizophrenia

Estrogen has antidopaminergic properties, which are the main qualities of any antipsychotic medication. The decrease in estrogen levels during menopause effectively removes this protective aid and can aggravate or trigger psychotic conditions such as schizophrenia.[8]

Schizophrenia is typically diagnosed in young adulthood; however, there is a second peak in diagnosis among women around menopause. Those with pre-existing schizophrenia may experience an increase in symptoms or a deterioration of their illness and may require a new level of treatment.

Coping with Mood Changes

As well as the fluctuating hormone levels, physical health changes are common during the menopause years, and these can additionally contribute to our mental health. Here are some tips to help protect your mental health during the perimenopause and menopause years:

  • Remember it is temporary – the physical and physiological shifts during menopause can be frightening. It would be easy to think that they will not pass; however, the symptoms will fade over the years and not be present all the time.
  • Be aware – mood changes are likely linked to hormone levels, a lack of sleep, stress, or other co-occurring health issues.
  • Making lifestyle changes – eat a healthy, balanced diet, increase exercise, sleeping well, socialise with positive peers, and control stress levels. All are factors that can help to reduce potential symptoms.
  • Ask for helptalk to friends and family to share your challenges and receive support if you are struggling. If the symptoms are severe and persistent, speak to your GP or a medical professional, as numerous treatments are available to help alleviate symptoms.

Menopause is a period which all women go through as they reach mid-life. Menopause affects all women differently, with a range of symptoms ranging from mild to acutely distressing. If you or a loved one is suffering from mental health issues during menopause, do not struggle alone – seek help today.

If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).

 

Sources: 

[1] “How Can Menopause Affect Your Mental Health? – Mental Health UK”. Mental Health UK, 2021, https://mentalhealth-uk.org/blog/how-can-menopause-affect-your-mental-health/.

[2] “The Reproductive Endocrinology Of The Menopausal Transition.”. Reference.Medscape.Com, 2021, https://reference.medscape.com/medline/abstract/21419147.

[3] “Menopause And Mood Disorders: Overview, Pathophysiology, Etiology”. Emedicine.Medscape.Com, 2021, https://emedicine.medscape.com/article/295382-overview#a1.

[4] “Menopause And Mental Health – Harvard Health”. Harvard Health, 2020, https://www.health.harvard.edu/womens-health/menopause-and-mental-health.

[5] Bosworth, H. B. Depression Increases In Women During Early To Late Menopause But Decreases After Menopause. 2021.

[6] Albert, Kimberly M., and Paul A. Newhouse. “Estrogen, Stress, And Depression: Cognitive And Biological Interactions”. Annual Review Of Clinical Psychology, vol 15, no. 1, 2019, pp. 399-423. Annual Reviews, doi:10.1146/annurev-clinpsy-050718-095557. Accessed 6 July 2021.

[7] “Women With Bipolar Disorder”. Webmd, 2021, https://www.webmd.com/bipolar-disorder/guide/bipolar-disorder-women.

[8] Gupta, Rina et al. “Menopause And Schizophrenia”. Menopause International, vol 18, no. 1, 2012, pp. 10-14. SAGE Publications, doi:10.1258/mi.2012.011116. Accessed 6 July 2021.

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