Mental health & emotions


Hormone changes at menopause can contribute to depressed mood and anxious feelings, and you may find your emotions swing from joy to frustration and annoyance in the blink of an eye. Whether menopause causes depression continues to be debated, but there are many things you can do to help with both depression and anxiety if you experience these at the same time as menopause.

Emotions

The hormonal changes during perimenopause and in the first few years after the menopause can cause emotions to change quite quickly. Emotions can swing from joy one moment to anger and irritability the next. Sometimes you might think you are feeling one thing when really it is a mask for another feeling. For example, you might think you are angry when really you are sad about something. Often it is easier, or more acceptable, to display one emotion rather than the emotion you are really feeling.

It is important to pay attention to your emotions and consider how you are really feeling.

Rollercoaster

Depression, anxiety & menopause

Hormonal changes may be a small part of the causes of the depressed mood and anxious feelings women often experience around perimenopause.

Identifying what is a menopausal symptom and what are 'true' mood changes, depression or anxiety can be confusing. Often anxiety symptoms get worse with perimenopause. What might start as a hot flush might lead to an anxiety attack. 

In turn, the symptoms of menopause, such as hot flushes and night sweats, can affect mood and make some women feel depressed. Many women kept awake at night because of night sweats find they are exhausted, can't think clearly and feel more negative because they have had poor quality sleep. 

Depression and depressed mood around the time of expected menopause (51-52 years in Australia) is more likely to occur because of factors other than menopause, including:

  • prior episodes of depression
  • significant stress in your life
  • a negative attitude to things happening in your life
  • dissatisfaction with your relationships
  • low self-esteem
  • poor body image
  • poor lifestyle such as little exercise or a high intake of alcohol.

Emotional health around the menopause is also more likely to be influenced by previous experiences of prior traumatic events; for example, past abuse. Women often seek counselling at menopause and might want to work through traumas they have previously experienced. This time of life seems to allow things to come to the surface.

Research suggests women who have a surgical menopause and/or an early menopause are more likely to experience a clinical depression than women who have menopause at the expected age. This seems to be influenced by the more sudden drop in hormones that comes with a surgical menopause, and it might also be related to the illness that caused the surgery in the first place, such as a cancer diagnosis.

Reactions to menopause

Midlife woman looking pensiveSome women perceive menopause and midlife as stressful experiences. You might have a sense the person you once knew yourself to be before menopause has changed. You might not be as sure of what to expect from your body or your emotions. What seemed like a body you could rely on and trust is now breaking out in a sweat at times you can't control, and you don't know when to expect more changes.

How you react to menopause will depend on many things, including:

  • the type of menopause you have – whether it is expected and on time, early, as a result of surgery, or chemotherapy, or premature (before 40 years of age)
  • your age
  • your stage of life and whether you have done the things you wanted to, such as have children or all the children you wanted to have
  • your mental health – whether you have been depressed or anxious in the past
  • whether you have achieved the things you wanted to achieve – do you have an identity and purpose you are happy with?
  • how you view your body and feel about the changes that are happening to you
  • whether you are as healthy as you can be and are taking care of yourself.

Sometimes it is hard to know if the hormonal changes of menopause affect your life, or if your life influences how you experience menopause.

The following are some thoughts from women about how they have reacted to menopause:

"My menopause was premature through surgery. I really struggled with it at first. I was 31 years old and I thought that I was going to be a lesser woman to society and to my partner. I saw both a sex counsellor and a marriage counsellor. In the end, it was my own acceptance of what had happened that pulled me through. I realised that this was not the end of my life. It is how I think about myself that matters."

"Men stopped noticing me. But I found it very liberating: I could do something and be who I wanted and not be noticed for it. I am more focused on me now. My menopause was related to the chemotherapy I had for breast cancer. The cancer may be a part of the change, but I feel this is my process I'm going through, this is about MY life."

"Since I turned 50, there have been a few changes in my house. I had become invisible to my husband. I thought 'menopause makes me invisible in society, at least I should be visible in my marriage'. So, I moved out of the matrimonial bed. I am more like a mistress now. We have great sex when I am romanced. I don't look after him anymore. I cook for him if I am cooking for myself. I don't assume the same things about me or him."

Menopause & culture

Although the biological changes are the same in all women, the socio-cultural experience of menopause will differ between women. For some women, menopause will be a freedom from the risk of pregnancy; for others it will be a sadness if they have not had children.

In some cultures, reaching the menopause is an elevation in society, and brings age and wisdom. In Western cultures, it may have negative connotations of losing youth, with the consequences of ageing. Also, discussion about the menopause and its changes might be taboo, and not talked about, even among friends.

It is OK to seek help from your local doctor or women's health clinic if you have any concerns or would like more information about menopause.

Managing psychological symptoms

What to do

If you are troubled by strong emotions ask yourself:

  • What is the real cause of my feelings?
  • What is the real feeling?
  • Am I masking a feeling that I feel uncomfortable expressing?

When it comes to stress, try to identify and challenge the thoughts or inner voice that makes you feel stressed. It can be helpful to:

  • identify what makes you feel stressed
  • rate stressful situations out of 10
  • remember it is OK to accept you are feeling a particular way, and you are not bad, silly or crazy for feeling that way.

Sometimes if you don't waste energy fighting a feeling, you can feel better faster and calm down faster.

If you have been worrying about your mood, stress, emotions or body image, there are also many other practical things you can do to help:

Discuss your symptoms This might be with a doctor, psychologist or a trusted friend or family member
Seek to understand the symptoms you are experiencing  Keep a diary  this can help you identify what is a menopausal symptom and what is more likely to be a symptom of anxiety and/or depression 
Take time out for yourself and nurture yourself Do this so you have the emotional energy to do other things you need to do
Get quality rest if you can Fatigue can make you more prone to anxiety and lowered mood
Get moving Activity can help with mood as much as it can help with physical health
Recognise the things in your life that recharge you, and ensure you do them regularly A deep relaxing breath or a walk with a friend, making time for a chat with a friend, sitting in the park or in the garden, a movie, a relaxing bubble bath, facial or manicure, or making time to do whatever you want to do

Learn and practise relaxation

This can help reduce the impact of stress in your life
Think about your inner voice

What messages is it sending?

  • If your inner voice is overly critical, or demands perfection, or is depressed or anxious, you can feel bad about yourself
  • Challenging the negative inner voice is important
  • You might find positive affirmations can be helpful – such as "I can do this"
  • Come up with an affirmation that means something to you
Do a regular emotional audit

Is there an issue that has been on your mind?

Do you have a plan to do something about it?

What can you do, and how might others help you?

Take time out to think about what's going on in your life and how you can best manage it.

Are you suffering from low mood or anxiety Check out the symptoms at anxiety.jeanhailes.org.au and www.beyondblue.org.au and seek help if you have been experiencing the symptoms for more than 2 weeks

Think about your own role/s. Is there a good balance?

Women who have a role, or a number of roles, that they feel good about, have fewer menopausal symptoms and are more satisfied with their lives

Self management techniques

There are techniques that can be successful in helping to deal with depression, anxiety, stress and poor body image.

Cognitive behavioural therapy (CBT)

CBT involves recognising the unhelpful thoughts that influence depression and anxiety, replacing them with more helpful thoughts and using relaxation and breathing techniques to reduce the impact of the physical symptoms of anxiety. Recent research suggests that CBT can be used effectively to help manage hot flushes. For more information on CBT, go to anxiety.jeanhailes.org.

Mindfulness

Mindfulness training teaches you to focus on the present moment and not get so caught up in your thinking. It is also important to reduce stressors, as these can set off anxiety and depression. Mindfulness is a clinically proven technique that can be learned and incorporated into your daily life to help manage anxiety and improve your wellbeing.

Relaxation

Relaxation is a skill that needs to be learned. There are different techniques that can help you to relax, and knowing the one that suits you is best. For more information on relaxation go to anxiety.jeanhailes.org.au.

Other therapies

First, see your doctor or health professional to discuss what therapy or therapies might be most suitable for you. Severe depression and anxiety can respond to treatment with medication such as antidepressants in combination with 'talk' therapy (counselling or psycho-therapy) from a registered psychologist or psychiatrist.

In some women with mood disturbance, anxiety or depression, menopause hormone therapy (MHT) may be of value in reducing their symptoms, but may also be combined with antidepressants or therapies, such as CBT.

To find a qualified psychologist, either ask your doctor to refer you or go to the website of the Australian Psychological Society: www.psychology.org.au

References

  1. Santoro N, Epperson CN, Mathews SB. Menopausal symptoms and their management. Endocrinol Metab Clin North Am. 2015 Sep;44(3):497–515. doi: 10.1016/j.ecl.2015.05.001. Review.

  2. Toffol E, Heikinheimo O, Partonen T. Hormone therapy and mood in perimenopausal and postmenopausal women: a narrative review. Menopause. 2015 May;22(5):564–78. doi: 10.1097/GME.0000000000000323. Review.

  3. Soares CN. Mood disorders in midlife women: understanding the critical window and its clinical implications. Menopause. 2014 Feb;21(2):198–206. doi: 10.1097/GME.0000000000000193. Review.

Last updated 17 August 2018 — Last reviewed 17 December 2017

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at December 2017.

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