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Let’s talk about: menopause and mental health

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Why do so many people feel low during perimenopause and menopause, and what can you do if you’re struggling? Dr Elisabeth Rosén, a Livi doctor who specialises in gynaecology and obstetrics, advises

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‘Menopause has always been a disruptive time for women, but as is the case with so many other women’s health issues, it’s been disregarded and under-researched. Now it’s a recognised phenomenon,’ says Dr Elisabeth Rosén, a Livi doctor and gynaecology specialist.

Mental health difficulties during perimenopause and menopause are so widespread that some researchers have proposed a new term to describe them: ‘menopause distress’. The symptoms are described as significant and persistent, yet different enough to other depressive diagnoses to warrant their own label.

‘Around 70% of women experience some sort of mental health impact during menopause,’ says Dr Rosén. ‘But the good news is that these symptoms tend to go away when the body gets used to the new hormone levels.’ There’s also plenty you can do to look after yourself and get professional help.

What are perimenopause and menopause, and how do I know they’re happening?

Entering menopause happens once you haven’t had a menstrual bleed in 12 months. The average age of menopause is 51. ‘Perimenopause is the time before and around menopause. It starts on average 4 years before menopause, but it can last longer than that,’ Dr Rosén explains.

Menopause happens as a result of a decline in ovarian function, which leads to a change in the production of the female sex hormones oestrogen and progesterone.

‘The most obvious sign of perimenopause is changing periods – initially shorter and shorter cycles, followed by irregular and heavy bleeds,’ says Dr Rosén. Look out for these symptoms, which are often linked to reduced oestrogen levels:

  • Sweating and hot flushes
  • Tiredness and insomnia
  • Vaginal dryness
  • A decreased libido
  • Psychological symptoms like irritability, low moods, a lack of motivation, aggression, difficulty concentrating and stress
  • A relapse of previous psychological illness

How do perimenopause and menopause impact our mental health?

The exact link between perimenopause and mental stress is yet to be established. ‘We do know that hormonal fluctuations and changing oestrogen levels can affect and interact with the neurotransmitters of the brain, which in turn impacts our mood,’ says Dr Rosén.

There are two main ways that hormonal changes are thought to have a psychological effect:

Reduced oestrogen

Oestrogen affects your mood because of its impact on the levels of serotonin in your brain. ‘Serotonin is a hormone that stabilises your mood and promotes happiness and wellbeing,’ Dr Rosén explains. ‘When the levels of oestrogen go down, so do the levels of serotonin, which explains why you might feel closer to tears, a bit low or even depressed.

‘The oestrogen drop comes in phases, which can make the psychological problems more pronounced. When the body has acclimated to the new hormone levels, your mood tends to stabilise, only to suddenly worsen again the next time the oestrogen drops.’

Reduced progesterone

The other female sex hormone, progesterone, has a calming effect. ‘Decreasing progesterone levels can lead to sleep issues, low moods, irritability and anxiety,’ says Dr Rosén.

On top of the impact of hormonal changes, many women find that the physical symptoms of menopause have a negative impact on their mood, too. ‘It’s tough to walk around worrying about sudden hot flushes, to not get the sleep you need, to be unable to enjoy sex to the same extent and to get used to a new weight, for instance,’ acknowledges Dr Rosén.

A growing body of research is now pointing to a potential link between vasomotor symptoms in particular – that’s night sweats and hot flushes – and changes in cognition and brain function in menopause. It’s possible that treatment of these physical symptoms could also relieve some of the cognitive difficulties.

What mental health problems are most common in perimenopause and menopause?

Anxiety, mood swings and depressive symptoms are common problems during this time. ‘The difficulties can be quite pronounced and often seem to appear out of the blue, which can make them more difficult to deal with,’ says Dr Rosén.

Oestrogen doesn’t only impact serotonin levels, it can also affect our cognition. As a result, during perimenopause, it’s common for people to experience:

  • Forgetfulness
  • Brain fog
  • Brain fatigue
  • Difficulty concentrating
  • Frustration as a result of the above, which can then negatively impact our mood

You are 2-5 times more likely to experience depressive disorders during perimenopause than during the late premenopausal years. For some, emotional exhaustion can make everyday tasks difficult.

‘Around 25% of people experience psychological problems they need professional help with, and many find the psychological changes during perimenopause more difficult to manage than the physical symptoms.’

How might perimenopause and menopause impact our sleep?

‘Many perimenopausal women experience sleep problems, including those who have never had issues with sleep before,’ says Dr Rosén. ‘Changes to oestrogen and progesterone levels impact other hormones that are responsible for regulating your body temperature, which can cause intense night sweats. The hormone changes themselves, as well as anxiety, can also make it difficult to sleep, and it’s not unusual to wake up suddenly in a panic.’

However, these symptoms can often be treated and alleviated, which can not only improve sleep but also prevent mental illnesses that long-term insomnia can contribute to.

Are there any other risk factors for mental health issues during menopause?

Midlife is a time when many of us go through life-changing experiences and events. Life stressors and adversity can contribute to mental health difficulties, which is why psychotherapy or cognitive behavioural therapy (CBT) can help. In addition, people who have experienced depression previously are at higher risk during perimenopause.

What should you do if you’re struggling with your mental health during menopause?

There are many things you can do to improve your chances of a positive menopause transition. Dr Rosén advises the following:

  1. Read up about perimenopause so that you’re able to identify symptoms and know what to expect.
  2. Try to accept and manage the psychological difficulties – let yourself feel your emotions while also trying to find peace.
  3. Identify situations that trigger negative emotions and try to avoid them.
  4. Allow yourself to take things more slowly throughout this period of your life, as perimenopausal problems tend to be more difficult to manage if you’re stressed.
  5. Exercise regularly. Research shows that physical activity has a positive effect on both physical and mental health during perimenopause. It also releases endorphins and other feel-good hormones.
  6. Eat a well-balanced diet.
  7. Use techniques like meditation or yoga to help lower stress levels.
  8. Maintain a good sleep routine, keep the bedroom cool and keep extra bed sheets close by to improve your chances of a good night’s sleep.
  9. Tell family and friends how you’re feeling – they can be a huge support during tough times.

What if I feel like I need professional help?

If these habits don’t relieve your symptoms, reach out for professional help. Depressive symptoms are very common during perimenopause, and a doctor will be able to guide you through your options, including talk therapy, antidepressants, HRT or a combination.

For many people, a mixed approach is best. While in many countries, HRT is currently only prescribed for night sweats and hot flushes, some recent studies suggest it might also help prevent depression in perimenopause. Options like family therapy can also be helpful.

‘The physical consequences of reduced hormone levels can’t be reversed, even if HRT may postpone the reduction by a few years, while local oestrogen tends to help with vaginal dryness,’ says Dr Rosén.

‘But psychological problems tend to ease off and eventually go away when the body has adapted to the new levels of oestrogen.’

This article has been medically reviewed by Dr Elisabeth Rosén, a Livi doctor who specialises in gynaecology and obstetrics.

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