Your mind on menopause: how "the change" impacts mental health

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Gena Hymowech is a writer from Brooklyn, NY who covers health and entertainment.

It’s an important fact we don’t talk about nearly enough: Menopause — and perimenopause, that period that starts years before menopause begins — can really affect mental health.

Aptly nicknamed "the change," menopause is a time of transition, fluctuation, and (sometimes) chaos. It can stir up complex feelings for women as they enter a new chapter of life. And along with hot flashes and other classic symptoms, the hormonal shift that occurs during menopause can have a major impact on the mind.

Estrogen and progesterone – the sex hormones produced by the ovaries — do a lot beyond regulating women's monthly cycles. They also impact mood, appetite, pain, and many other brain-body functions. So when the ovaries begin producing less and less of them during perimenopause, women can experience anxiety, depression, and other mental and emotional side effects.

Two studies published in the 2006 issue of Archives of General Psychiatry demonstrated the major shift that occurs when women enter perimenopause. One looked at 460 women age 36-45 who were premenopausal when the study started. It found that women were nearly twice as likely to show signs of depression once they entered perimenopause. And depressive symptoms were even more common among women who also experienced hot flashes.

The second study looked at 231 women ages 35-47. This time, the results were even more pronounced. Perimenopausal women were four times as likely to show signs of depression compared to premenopausal women, and their risk of getting a diagnosis of depression was two-and-a-half times higher.

It’s also worth noting: the women who were participating in both studies had never received a diagnosis of major depression before the studies began.

Ellen Freeman, PhD, was a researcher in that second study. "We are not saying that hormones are the only things that impact depression risk during this period of a woman's life," she told WebMD. "But both of these studies support the idea that hormones are directly involved."

“When estrogen levels fluctuate, the serotonin and norepinephrine levels in the brain are affected,” says Healthline. “Serotonin, norepinephrine, and dopamine … can make you feel happy by reducing anxiety and improving sleep, among other things. … Hormone imbalances — such as your estrogen rising while your progesterone is falling — can inhibit the ability of serotonin and norepinephrine to act as effective neurotransmitters. The result is mood swings that could lead to depression.” The activity of estrogen and progesterone can also cause depression and anxiety as menopause is beginning.

However, research does not always show a clear link between lack of estrogen and mood. According to WebMD, women who make estrogen are more likely to experience depression and anxiety than women who are out of menopause, despite the fact that estrogen has a positive effect on serotonin.

Beyond hormones, potential reasons for perimenopausal depression include events that provoke stress, smoking, and anxiety about going through menopause. According to the Cleveland Clinic, hot flashes can also cause sleep trouble in perimenopause, and that in turn, can result in mood swings and anxiety.

Women often describe a general feeling of "brain fog" at the onset of menopause too. According to Everyday Health, the hormonal drop can lead to memory trouble and confusion. But research shows that memory issues can get better after menopause is over.

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If you go to a traditional western medical practitioner complaining of depression or anxiety during menopause, chances are you'll walk out with a prescription for antidepressants and hormone replacement therapy (HRT). While a 2018 study in JAMA Psychiatry showed HRT could lower the odds of menopausal depression, it comes with its own risks and side effects.

If you're not comfortable with medication, there are many natural remedies that can help minimize the symptoms. For instance, many women we've interviewed have testified to the value of herbal supplements.

"My menopause symptoms brought on a bit of anxiety for me, which I don't normally have to deal with," said Noel-Marie, 48. "So when I recognized that I was getting a little punchy or anxious, I would take Calms Forte and most of the time it took that edge off and calmed me down. It's all natural and non-habit forming, and I used it when I knew I was feeling a bit off. I don't take it at all anymore."

Supplementing with B vitamins and Valerian can also help with emotional fluctuations and sleep disruptions. Avoiding caffeine and alcohol — and adding stress-reducing vitamins and herbs to your routine — can help reduce anxiety and brain fog. And overall, seeking out support — through therapy and community — improving sleep, lowering stress, and engaging in regular physical activity are always beneficial.

Ultimately, how women navigate menopause is a highly personal decision — and one that should be made with a trusted practitioner.

In addition to finding a treatment plan that works for you, it might help to know that many women come out of menopause with a much brighter outlook. Just think: once menopause is over, so is PMS.

Sherry, 60, noticed a big leveling out in her moods during the height of menopause. "I used to have horrendous mood swings— I could feel the walls caving in," she said. "But during menopause, the mood swings weren’t as severe or noticeable. And I now have total control over my moods. God knows, they fluctuate. But if I get upset about something, no one can blame it on my period. I'm just pissed."