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Mental health in the menopause: what every woman needs to know

Hands up if you think the most common symptoms of the menopause are physical issues like hot flushes and night sweats? Got your hand up? You’re not alone. The reality, however, is that the menopause is so much more than just a bunch of physical symptoms - it can have a massive impact on our mental health too. It’s a bummer but it’s also a relief to know. If you haven’t been feeling yourself recently, chances are it’s because of the menopause - and not because you’re depressed.

Image of women of different ethnicities holding their raised hands together

If this is the first time you’ve heard this, we’re happy to have helped (cue the klaxons) but that in itself highlights what lies at the heart of the problem: because so little is said about this side of the menopause, the women experiencing it and the doctors treating them can be confused too. Women are given the wrong treatment and often end up spiralling further down.

It’s a worrying trend and something that our co-founder, registered menopause specialist and GP, Dr Clare Spencer sees time and time again in her menopause clinic. But it needn’t be this way. Here she gives her lowdown on the signs to look out for and solutions to help you through.

Busting the depression myth

Menopausal women are frequently misdiagnosed as suffering from depression and anxiety, when in fact the mood changes and other psychological symptoms they are experiencing are likely to be a result of the fluctuations in their oestrogen levels. The solution often offered is a prescription for antidepressants when HRT might be a more appropriate answer (more on this below). Many women don’t get on with this kind of medication, stop and find themselves back to square one, putting up with symptoms or, even worse, gradually declining.

The reality is that a range of psychological symptoms are very common in the perimenopause and menopause. They can range from forgetfulness to brain fog, from loss of confidence and self-esteem to low mood and depression.

But why? Like anything to do with the human mind and body, some women’s brains are more sensitive to hormonal changes than others and so their mental health challenges during the menopause can be more challenging.

It’s why some women have premenstrual syndrome. It’s why some women suffer post-natal depression. If this is you, you’re more likely to experience mood changes in the menopause transition.

Mental health issues vary from woman to woman during the menopause. For some, it’s feeling out of sorts. Other women I’ve seen have felt suicidal as a result of the combined menopause symptoms – the impact of the menopause on mental health should not be underestimated.

The good news is that there’s so much you can do to get on top of these symptoms and get back to living a more balanced, happier life.

Why are mental health symptoms misdiagnosed?

The answer to this question boils down to a lack of awareness and understanding of the menopause transition, and a lack of appreciation of the impact of hormones on the brain.

Here’s the science bit: oestrogen is one of the hormones made by the ovaries. When a woman goes through the perimenopause her oestrogen levels can be all over the place until the actual menopause when it completely drops and then stabilises. These hormonal swings and ultimate drop can affect the chemicals in the brain connected to mood – so there are real physical reasons why a woman’s mood can change.

In an ideal world, perimenopause symptoms would start with a flash and a bang bearing a label declaring themselves to be menopause related.

The reality is very different – symptoms can start gradually, with those relating to mental health sometimes starting before ‘giveaway’ symptoms like hot flushes. And that’s where the challenge lies – the women experiencing them and the doctors treating them often don’t appreciate that they are related to the menopause transition.

Another key factor is that the mental health symptoms are –  obviously – not specific to the menopause transition. Feeling tired or anxious, for example, could be due to relationship, family or work stresses that everyone can experience. So, the symptoms can become ‘explained away’ as being related to whatever is going on in life.

What makes things even more complicated is that a woman’s resilience can take a real knocking in the menopause, and situations that would have previously been challenging now seem to be unmanageable. Add sleep issues into the mix, caused from anything from night sweats to hormone-triggered anxiety, and even the smallest thing can become a challenge.

Women therefore often become labelled as not being able to cope, or stressed. They’re advised to drop activities or take time out. It could be that this is the right advice – but things could play out very differently if a woman’s symptoms are explained as being related to the menopause transition because this could open up a different conversation about the right treatment and advice, as well as other types of support that could make all the difference.

You are not alone

The menopause can be a challenging and isolating time so hearing other women’s mental health experiences, and knowing that many other women going through the menopause experience these symptoms too, can be an absolute lifeline.

In my clinic, I hear so many times that women ‘don’t feel themselves’. They feel low, flat and lacking in motivation. They feel their confidence has taken a battering and may start to avoid situations which they may find stressful – or didn’t used to find stressful but now do.

The changes of brain function mean that finding the right word when speaking can be more difficult, or a drop in memory, a common symptom of the menopause, might make presenting at work stressful. If that’s something you’ve always found easy, the effect on your confidence can be huge, fuelling anxiety and lower self-esteem.

Women tell me that they have lost their drive, lost their ‘mojo.’ They don’t recognise themselves anymore.

Anxiety is a common symptom and is often mislabelled as stress. Anxiety for some means lying awake at night negatively analysing the day and overthinking things said or not said. For other women I see, it’s not wanting to drive on the motorway anymore because they feel panic-stricken and overwhelmed – without knowing why. If your job depends on driving, this is incredibly debilitating.

Women feel ‘ratty’ and ‘frazzled.’ They tell me that they go from zero to sixty in a nanosecond and find themselves shouting at their children/partners/work colleagues/the neighbour. This in itself makes them feel unhappy with themselves – denting confidence and self-image. They often feel sad or upset about being a bad mother.

I have met women who have left their jobs and partners as a direct result of menopause-related symptoms.

You can turn things around

The good news is that there are many ways of turning round low mood, depression and anxiety. Taking control and understanding what’s going on is a great first step.

Exercise, diet and nutrition

Start with lifestyle changes that can have a massive impact. Exercise improves mood, sense of wellbeing, it’s relaxing and can build confidence so try to incorporate more into your daily life.

Take a look at your diet and nutrition– avoid alcohol which is a depressant and can affect sleep. I meet so many women who self-medicate with a few glasses of wine to feel better and get off to sleep, but it really doesn’t help mood and anxiety in the long term.

Talking and CBT

We all know how much better we feel after chatting through our problems with a friend. Talking through your symptoms and being listened to can help you understand what’s going on and have a therapeutic effect. Cognitive Behavioural Therapy (CBT) can help you take this to the next level – challenging and changing unhelpful behaviour that can feed into symptoms – like situation avoidance, or the feeling of anxiety because you can’t sleep that in itself keeps you awake in the middle of the night.

Meditation and yoga

Lots of women find that creating mental headspace helps them to rebalance so think about giving meditation or yoga a go.

HRT

If you’re really suffering from depression and anxiety, antidepressants may feel the way to go but HRT could be the better answer. Week in, week out I see the transformative effects of HRT. Like all things, HRT does not suit everyone who takes it, and the benefits and risks do need balancing, but it is a safe and effective option for most women.

As you can see, there isn’t a one-size-fits-all answer, so make some changes that feel right for you and see how you get on.

Remember, the greatest journey starts with a single step – keep believing in yourself and in life. To quote the wonderful Maya Angelou:

“I’ve learned that no matter what happens, or how bad it seems today, life does go on, and it will be better tomorrow.”

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