Menopause And Mental Health

Introduction

Mental health problems are becoming more prevalent in society. Women are twice as likely to suffer from mental health problems than men¹(Albert 2015). They can happen at any point throughout our lifetimes and can be brought on by big life events and changes. For women, some of the biggest changes they will go through is menopause. Here we will look at how menopause affects mental health. 

What is menopause?

Menopause is the process of your periods stopping permanently. You are considered to have finished menopause when you have not had a period for 12 months. It affects women between the ages of 45 and 55, with the median age being 51. Sometimes it can occur earlier, and this may be due to surgeries to remove your internal reproductive organs, cancer treatment or due to genetics.^1,2

Hormonal changes have an impact on mental health

Hormones are chemicals that help regulate important functions in your body. During the menstrual cycle, there are 4 key hormones that fluctuate throughout the month. These hormones and their basic functions are: 

• Follicle stimulating hormone (FSH)- starts the maturation of the egg
• Oestrogen- helps build up the uterine lining 
• Luteinising  hormone-LH triggers ovulation 
• Progesterone- helps maintain the uterine lining²

Menopause occurs when there is a decline in hormones, particularly oestrogen. As women age, there are fewer eggs available to go through the menstrual cycle, meaning that the ovaries function less and less. Consequently, less oestrogen is produced. This hormone can also interact with other hormones, like serotonin and dopamine-2, famous ‘happy chemicals’. This could explain why menopause can lead to low mood and depressive symptoms.³

Mood changes

Approximately 45% of women experiences changes in their mood during menopause.

This can manifest as:

• Anger
• Irritability 
• Depression
• Anxiety 
• Loss of concentration (brain fog)⁴

Women may experience these symptoms for the first time, or if they have a history of mental health problems, may have a resurgence of previous symptoms. The fluctuating hormone levels have been linked to mild mood symptoms, however, in cases of major depression, the link is less clear, and is most likely to come from those already diagnosed.⁵ Menopausal women often struggle with sleep, and tiredness can worsen these symptoms. 

Feelings of depression and anxiety

During menopause, the shifting of hormones and physical symptoms, can take a toll on their mental well-being. Depression during menopause can be harder to recognise.⁶

Signs of major depression:

• Persistent feeling of sadness, low mood or emptiness 
• Hopelessness, pessimism 
• Irritability
• Feelings of guilt or helplessness
• Little interest in hobbies or activities 
• Low energy, tired all the time 
• Feeling restless, trouble sitting still⁷

Anxiety:

• Heart beating faster than normal 
• Palpitations 
• Feeling sick or nauseous 
• Sweating 
• Dry mouth 
• Pains in your chest 
• Shaking, tremors 

If anxiety becomes too intense, this can trigger panic attacks. This is the sudden feeling of intense anxiety that is overwhelming and completely debilitating. How they appear varies between individuals, but often they can manifest as shaking, nausea, rapid heartbeats, dry mouth, and breathlessness. In severe cases, they can cause chest pain to the extent that some people believe they are having a heart attack. Fortunately, panic attacks do not tend to last long, usually only several minutes at a time.  

Dealing with physical changes

Menopause can be a huge physical and mental change for some women. It can affect the way they feel about themselves, how they view their body, and may lower their self-esteem. 

An increase in vaginal dryness can lead to pain and discomfort during sex, vaginal bleeding and impaired sexual arousal. Alongside a decrease in libido, sexual dysfunction can have a massive impact on a woman’s life, her relationship with her partner, and her quality of life.⁸ Vaginal dryness can also contribute to an increased risk of urinary tract infections (UTIs). 

Gaining weight and changing body shape is more likely due to the hormonal changes of menopause. Perimenopausal women have been shown to have more fat distributed to their abdomen than below the waist. However, ageing affects our body composition, as we lose muscle mass the older we get. 

The depleting hormones can cause noticeable changes in your hair and skin. In the first five years of menopause, 30% of collagen is lost from the skin. This results in thinner, drier skin that sags and bruises easier. There may be an increase in facial hair and hair thinning on the scalp.⁸

If you’re worried about your or your loved one’s mental health

The NHS provide  information on how to deal with panic attacks, 

Symptoms

• Changes to your periods
• Hot flushes 
• Headaches or migraines 
• Muscle aches, joint pain 
• Reduced desire to have sex 
• Vaginal dryness 
• Pain or discomfort  during sex
• Recurrent UTIs(Menopause) 

Summary

Menopause is a natural process that occurs in women between the ages of 45 and 55, during which their periods stop permanently due to hormonal changes, particularly a decline in oestrogen. These hormonal changes can have a significant impact on mental health, leading to symptoms such as low mood, irritability, anxiety, and depression. Women may also experience physical changes, including vaginal dryness, sexual dysfunction, weight gain, and changes in hair and skin. If you or your loved one is experiencing symptoms related to menopause, it is important to seek medical help and support. The NHS provides information on how to deal with panic attacks and common symptoms of menopause.