For many women, the transition into menopause can feel like more than a change in periods or the occasional hot flush. You might notice that you're more anxious than usual. Your mood may feel less predictable. You may find yourself becoming unusually irritable, emotional or overwhelmed. Perhaps you're struggling to sleep, finding it harder to concentrate, or feeling like you're not quite yourself. These changes can be confusing - and sometimes frightening. But you're not imagining it.
The menopause transition can have a significant impact on mental health, and understanding the connection can be an important first step towards getting the right support.
What is perimenopause?
Perimenopause is the stage leading up to menopause. During this time, hormone levels - particularly oestrogen and progesterone - fluctuate and gradually change.
Perimenopause can last several years and is different for everyone. Periods may become irregular, and physical symptoms such as hot flushes, night sweats and sleep difficulties can occur. But the emotional and cognitive changes can sometimes be less recognised. Menopause is reached when you have gone 12 months without a period. In Australia, menopause most commonly occurs between the ages of 45 and 55.
How can menopause affect mental health?
Hormonal changes during the menopause transition can affect mood, emotions and cognitive functioning. Some women experience:
For some women, symptoms of depression or anxiety may occur for the first time during perimenopause. For others, a previous mental health condition may return or become more difficult to manage.
It is important to remember that not every emotional change during menopause is caused by hormones alone. Midlife can also be a particularly demanding stage of life. Women may be balancing work, parenting, caring responsibilities, relationship changes, ageing parents, financial pressures or significant changes in identity and direction. Often, it is a combination of biological, psychological and social factors that affects how someone feels.
When “brain fog” doesn't feel like you
One of the most commonly described experiences during perimenopause is difficulty concentrating or remembering things.
You might walk into a room and forget why you went there. Struggle to find the right word. Lose your train of thought during a conversation. Find multitasking much harder than it used to be.
For some women, this can lead to worry: “Is something seriously wrong with me?”
Cognitive changes can occur during perimenopause and menopause, and sleep disruption, stress and hormonal changes can all contribute.
That doesn't mean you should simply put significant or persistent changes down to menopause. If symptoms are affecting your daily life, it's worth talking with your GP or healthcare professional so that other possible causes can also be considered.
The sleep–mood connection
Sleep can be one of the biggest pieces of the puzzle. Night sweats, hot flushes, anxiety and hormonal changes can disrupt sleep. Over time, poor sleep can contribute to irritability, low mood, difficulty concentrating and feeling less able to cope. This can create a cycle:
Hormonal changes → disrupted sleep → fatigue → reduced resilience → increased anxiety or irritability → even more difficulty sleeping.
Addressing sleep can therefore be an important part of supporting mental wellbeing during this stage of life.
Does menopause cause depression?
The relationship between menopause and depression is complex. Women going through the menopausal transition have an increased risk of experiencing mood changes and symptoms of depression and anxiety - even if they have never experienced a major depressive episode before. Women with a previous history of depression or anxiety may also be more vulnerable to symptoms returning. It's important not to assume that persistent low mood, anxiety or other significant symptoms are simply something a woman needs to “push through.” Menopause is a life stage - not a reason to ignore your mental health.
When should you seek help?
Consider speaking with your GP or healthcare professional if you notice that your symptoms:
Your doctor can consider your physical symptoms, menstrual history, mental health history, sleep and other health factors to help understand what may be contributing to how you're feeling.
What can help?
There isn't one solution that works for everyone. Depending on your symptoms and circumstances, support may include lifestyle changes, psychological therapy, medication, menopausal hormone therapy (MHT), or a combination of approaches.
Psychological therapies can help women understand changes in mood, develop coping strategies and manage anxiety, stress and other emotional difficulties. MHT may also be appropriate for some women, particularly where psychological symptoms occur alongside other menopausal symptoms, although it is not suitable for everyone and should be discussed with a healthcare professional.
Regular physical activity, healthy eating, good sleep habits, relaxation strategies and maintaining supportive relationships can also contribute to wellbeing during this transition.
Most importantly, you don't have to simply put up with it.
Menopause is a natural stage of life, but that doesn't mean you have to accept feeling unlike yourself or struggling in silence. If you're experiencing changes in your mood, anxiety, sleep, concentration or emotional wellbeing, talk to someone about it. Your symptoms are worth discussing. Your mental health matters at every stage of life. Understanding that what you're experiencing has a name- and support is available.
If you are concerned about your mental health, speak with a qualified healthcare professional. If you are experiencing thoughts of suicide or immediate distress, seek urgent support.
