Menopause and mental health

Not only does the menopause transition habitually initiate psychological symptoms, including anxiety, low mood and a lack of motivation, but a woman's preceding mental health condition can be exacerbated during this time, says Kate Organ, Consultant clinical pharmacist, menopause and mental health specialist.

Worsening pre-menstrual symptoms (PMS) can occur during the perimenopause which starts to impact quality of life and the ability to function. This leaves women feeling scared and concerned with what they are experiencing, both physically and mentally during the peri-menopause and post-menopause.

The erratic hormonal fluctuations during the peri-menopause and the general decline in oestrogen, progesterone and testosterone over the menopause transition impact neurological pathways in the brain linked to serotonin (the hormone involved in mood regulation) and cortisol (the hormone involved in our response to stress and danger) causing our body to act in 'emergency mode'. Consequently, anxiety, low mood, feeling chronically stressed, emotional lability, low energy levels, poor concentration, increased irritability, feelings of not being able to cope or being overwhelmed and short-term memory issues are all very common.

It's important to understand that up to 75% of women develop these psychological symptoms. They are a consequence of reproductive hormone imbalance and therefore can be effectively treated with hormone replacement therapy (HRT), rather than using psychotropic medication designed to treat mental health conditions

Many women who I see in our menopause clinic describe how their psychological symptoms have been detrimental to their quality of life, affected their ability to work and have negatively impacted relationships with friends and family. Women often describe withdrawing from their social life, fighting with partners, or suffering with crippling anxiety which prevents them from driving, attending social events or going for work promotions. Up to 7 in 10 women of menopausal age going through divorce acknowledge the menopause as a contributing factor in their relationship collapse.

Psychological symptoms of the menopause

The hormonal changes that occur during the peri-menopause and menopause can directly influence our mental wellbeing and can often cause troubling mental health-related symptoms. Many women will not have experienced a mental health condition before reaching their peri-menopause and the feelings of severe anxiety, low mood, poor concentration, fatigue, lack of interest or enjoyment in normal life which can arise during this time can be a concern. These symptoms can often go on for some time before being associated with female hormone imbalance, even misdiagnosis with anxiety or depression is common. The most effective treatment is, of course, to correct the hormone imbalance causing the symptoms. Many women are wrongly offered antidepressants rather than HRT as first-line treatment if a holistic approach and investigation of other symptoms associated with the menopause is not assessed.

The symptoms related to the menopause transition, which are often similar to those of a mental health condition, can be hard to differentiate without a good understanding of both hormone health and mental health. Women suffering from the psychological symptoms often describe their mood changes as quite fluctuating on a cyclical or daily basis. They feel their symptoms are hormone related and they have insight or awareness of the symptoms and the impact on their lives, which often differentiates their symptoms from a chronic mental health condition.

Lifestyle adjustments

For many women, starting HRT can relieve many of these symptoms, however, of course, not every woman is able to use HRT or chooses to do so. For all women there are some useful lifestyle adjustments that have been shown to improve mental wellbeing and help reduce menopausal symptoms.

Diets rich in phytoestrogens, including soya, tempeh, beans and pulses, with plenty of additional plant-based nutrients and antioxidants are beneficial. Adopting a healthy approach to movement, daily exercise and time spent outside improves mood and relieves stress. Socialising regularly or having strong family relationships is a known protective factor. Finding an enjoyable form of meditation, exercise such as yoga / Pilates, or partaking in relaxing hobbies such as gardening, all help to enrich lives with techniques and habits that improve mental wellbeing.

Talking to a healthcare professional who is knowledgeable of both mental health and the impact of hormone changes during the peri-menopause and beyond is important to receive the most effective evidence-based treatment options.

For more information, please visit: www.menopausespecialists.com.

RDPI runs a number of CPD-accredited courses around the menopause and male wellbeing, including (the Menopause Mind).