Menopause and mental health: anxiety, low mood, and confidence

Loss of confidence can be part of menopause, particularly when anxiety, poor sleep, brain fog, or physical symptoms begin to affect work, relationships, or activities you usually enjoy. You might second-guess decisions, withdraw socially, or notice more overthinking during perimenopause.

That doesn’t mean you’ve lost who you are. Tracking your symptoms, talking about how you feel, and addressing the symptoms contributing to your confidence can all help. You can also read more about menopause and loss of confidence and self-esteem.

 Can menopause affect your mental health?

Yes. Psychological symptoms during perimenopause and menopause can include anxiety, low mood, irritability, poor concentration, brain fog, and a loss of confidence.

These symptoms can overlap with depression and anxiety disorders, so it’s important not to assume that hormones are the only explanation. A healthcare professional can consider when your symptoms began, whether you have other menopause symptoms, and how they’re affecting your daily life.

NICE recommends considering HRT for depressive symptoms that begin around the same time as other menopause symptoms but don’t meet the criteria for clinical depression. If depression is suspected or diagnosed, you should also be offered appropriate mental health assessment and treatment.

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. During perimenopause, oestrogen levels can fluctuate unpredictably. They generally decline and remain lower after menopause. These hormonal changes may affect brain systems involved in mood, sleep, and cognition, while poor sleep, physical symptoms, stress, and other health or life factors can also influence how you feel.

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.

 Menopause, confidence, and self-esteem

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.

Loss of confidence can be part of menopause, particularly when anxiety, poor sleep, brain fog, or physical symptoms begin to affect work, relationships, or activities you usually enjoy. You might second-guess decisions, withdraw socially, or notice more overthinking during perimenopause.

That doesn’t mean you’ve lost who you are. Tracking your symptoms, talking about how you feel, and addressing the symptoms contributing to your confidence can all help.

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, 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.

Some women have even left their jobs and partners as a direct result of menopause-related symptoms.

 What can help with menopause and mental health?

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 therapies and menopause-specific 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

HRT can help many menopause symptoms and may be considered for depressive symptoms that began around the same time as other menopause symptoms but don’t meet the criteria for clinical depression. It isn’t a substitute for assessing or treating depression.

The right approach will depend on your symptoms, medical history, preferences, and whether other factors may be affecting your mental health. A healthcare professional can talk you through HRT, menopause-specific CBT, mental health treatment, and other suitable options.

If you need urgent support

If menopause feels as though it’s taking over your life, please don’t wait until your symptoms become unmanageable. Speak to your GP or another healthcare professional.

If you or someone else is in immediate danger, call 999 or go to A&E. For urgent mental health support, contact NHS 111 online or call 111 and select the mental health option. You can also call Samaritans free on 116 123.

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.”