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Menopause and mental health

AMS Menopause and mental healthMAIN POINTS

  • Women going through the menopausal transition are at a higher risk of mood changes and symptoms of depression and anxiety
  • Common physical, emotional and cognitive issues related to menopause can complicate and overlap with mental health symptoms
  • Stress related to life circumstances can also complicate understanding whether changes in mood and mental health are related to menopause 
  • Having an open discussion about your symptoms, life circumstances and mental health history can assist your doctor in offering suitable treatment options and lifestyle changes
  • Therapies proven for the broader population are also suitable for mental health symptoms related to menopause – medication, psychological therapy and lifestyle changes

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While not a problem for everyone transitioning through menopause, the risk of mood changes and symptoms of depression and anxiety are higher during perimenopause, even in women without a history of major depression.

While the risk is higher for women in the age-related and natural menopausal transition, women might also have a higher risk of mood changes after menopause caused by surgery such as hysterectomy or if the ovaries have been removed. Depression also occurs at a higher rate in women with a lack of oestrogen caused by primary ovarian insufficiency.

Mental health symptoms related to menopause

Mental health symptoms related to menopause can include feeling:

  • irritable
  • sad
  • anxious 
  • hopeless 
  • less able to concentrate or focus 
  • tired 
  • unmotivated.

Some women might experience these symptoms in a mild form. Others might have more severe symptoms of depression (including thoughts of suicide) lasting for at least two weeks. This is known as a major depressive episode and is more likely in women who have a history of major depression during their pre-menopausal years.

While many women do not have mental health issues during the menopausal transition, unstable oestrogen levels can have an impact on the brain, predisposing some women to feelings of depression and anxiety.

Some of the common physical, memory and thinking symptoms related to menopause (hot flushes, night sweats, sleep and sexual disturbances, weight changes and “brain fog”) can complicate and overlap with mental health symptoms.

Another complicating factor is stress related to life circumstances. Feeling stress is common during middle age as personal and environmental changes take place. This can have a strong effect on mood in some women. Life circumstances that can impact mental health include:

  • caring for children
  • caring for elderly parents
  • career changes
  • relationship changes
  • ageing
  • body changes
  • illness.

The menopause transition is an ideal time to take stock of all aspects of your health and consider lifestyle and other changes so that you can live the healthiest possible lifestyle.

Given the complex and overlapping nature of the physical and mental health changes during the menopause transition, speaking with your doctor is the best place to start.

Untangling physical and mental health symptoms related to menopause

For some women, mental health issues and other changes can begin to affect how they live their lives. Your doctor can take a holistic approach to your health to help you untangle the web of symptoms around physical and mental health changes. Understanding mental health during perimenopausal and postmenopausal changes can include:

  • identifying your stage of perimenopause / menopause and any physical and cognitive symptoms
  • discussing your history of mental health symptoms
  • discussing your current mental health symptoms
  • understanding any lifestyle factors that could affect your mood – for example, lack of sleep and exercise
  • understanding other stressful life circumstances contributing to your symptoms – for example, caring for children and parents, career and relationship changes, body changes and illness.

Speaking with your doctor about your menopausal symptoms, life circumstances and clinical history can help them to recommend the best treatment options and lifestyle and behavioural changes for your situation.

Treatment options for mental health symptoms 

Lifestyle changes to assist with managing mental health are similar to those recommended for menopause-related physical changes. Changes that can help with mental health symptoms include:

  • ensuring healthy levels of physical activity
  • improving sleep
  • considering changes to decrease stress associated with life circumstances
  • limit alcohol intake

Psychological therapies and social supports can be beneficial to women with mental health symptoms.

Women should have an individualised assessment with their doctor in order to discuss the most appropriate treatment pathway. Options may include lifestyle changes, psychological therapies and medications such as menopausal hormone therapy (MHT) or antidepressants.

While some international guidelines do not recommend MHT as firstline therapy, many doctors have seen a positive effect on mood with the use of MHT in the first instance. There is evidence that oestrogen has antidepressant effects, particularly in perimenopausal women. We emphasise an individualised approach with treatment tailored to the individual patient.

Oestrogen is not recommended for women with a history of breast cancer.

At this stage, there is no evidence to recommend alternative or complementary therapies for treatment of perimenopausal depression.

Where can you find more information?

If your mental health or other symptoms are bothering you, your doctor can help. Your doctor can help you understand physical and mental health changes and offer options for managing your symptoms.

Fact sheets:

Infographics:

Where can you get help for depression and mood changes?

If you have severe mental health symptoms or symptoms of depression and have thoughts of suicide, help is available.

  • Lifeline – Phone 13 11 14
  • beyondblue – Phone 1300 22 4636
  • Australian Psychological Society – Find a psychologist service – Phone 1800 333 497
  • Your doctor
  • Australasian Menopause Society – Find an AMS Doctor

 

If you have any mental health concerns or questions, visit your doctor or go to the Find an AMS Doctor service on the AMS website.

AMS Empowering menopausal women

NOTE: Medical and scientific information provided and endorsed by the Australasian Menopause Society might not be relevant to a particular person's circumstances and should always be discussed with that person's own healthcare provider. This Information Sheet contains copyright or otherwise protected material. Reproduction of this Information Sheet by Australasian Menopause Society Members and other health professionals for clinical practice is permissible. No other reproduction or transmission is permitted in any form or by any information storage and retrieval systems except as permitted under the Copyright Act 1968 or with prior written permission from the copyright owner. I

Content updated February 2023