2022 World Menopause Awareness Day – and the focus this year is shining a light on the psychological symptoms of menopause.  We couldn’t welcome this more.  

Symptoms like hot flashes and missed periods are well known but many women find themselves unprepared for the intensity and impact of the more psychological symptoms. The truth is perimenopause and menopause can bring a whole range of symptoms that affect you physically, mentally, and emotionally. 

Changes in hormones can affect both your mental and physical health.  It’s important to understand that the mental symptoms of menopause are as real as the physical ones and their affect can be just as debilitating.  Understanding how hormones impact our mental and emotional wellbeing, and how they can affect our quality of life during menopause, can help us to be better prepared to cope with them and seek the help we need.

HORMONES & OUR MOOD

It will probably come as no surprise to you to learn that hormones can impact our mood. Think back to the emotional rollercoaster of your teenage years, pregnancy or PMS just before your period.  All caused by fluctuating hormones and the same happens as we go through perimenopause and menopause. Our hormones are in constant flux then decline in perimenopause and menopause and this can have a significant impact on our mental health and emotional wellbeing.

Oestrogen.  Oestrogen levels are linked to mood as they regulate several of the “happy hormones”.  Serotonin, norepinephrine and dopamine all have mood-boosting properties and are all impacted by declining levels of oestrogen.  Low levels of oestrogen are linked to low mood, anxiety and feelings of depression.

Progesterone.  This hormone plays an important role in your menstrual cycle and levels drop away as we go through perimenopause and menopause.  Progesterone is known to have a calming effect on your mood and helps promote relaxation and good sleep.  When progesterone levels decline in perimenopause and menopause, it can cause a rise in irritability, mood swings, and brain fog.

Testosterone.  Often seen as the 'male' hormone, it plays a key role in the female body too. It declines slowing in menopause and can impact mood, cognitive function and libido. 

Oxytocin.  Often referred to as the 'love' hormone. Oxytocin sends chemical messages to the brain controlling key aspects of human behaviour. As oestrogen production declines we see a noticeable decline in oxytocin levels too. This can impact our cognitive abilities, mood and can cause a drop in libido. 

What are the psychological symptoms of menopause?

Fluctuating hormone levels can be responsible for many psychological changes during perimenopause and menopause. This can impact your mental health, emotional well-being, and quality of life.  It can sometimes be hard, particularly in perimenopause when you may still be having regular periods, to realise that your hormones are causing you to feel this way.  Life can be pressured during this time and it can often take a while for women to realise that perimenopause is causing their mental symptoms. 

Mood swings. Perimenopause can be an emotional rollercoaster and many women experience mood swings.  Similar to the changes you experience during your period but in menopause they can be much more extreme. 

Anxiety or panic attacks.  As well as mood swings many menopausal women suffer from anxiety as a result of fluctuating oestrogen and progesterone. Some women going through menopause start to experience panic attacks – a feeling of sudden and intense anxiety with physical symptoms – a racing heartbeat, feeling dizzy, sweating and nausea.

Irritability. It is very common to feel more irritable in perimenopause.  Hormonal changes, lack of sleep and other menopausal symptoms can all contribute to this.

Feeling unhappy or depressed. According to Mental Health UK, during menopause, it’s common to experience mood changes such as irritability, sadness, lack of motivation, aggressiveness, problems focusing, stress, difficulty concentrating, and depression. Much like constant premenstrual syndrome (PMS), these effects can cause emotional strain.  Some women can also suffer feelings of low self-esteem, loss of confidence and loss of interest in things they previously enjoyed. The impact of these hormonal changes can have a debilitating impact on women’s mental health.  Women aged 50-54 have the highest suicide rate in the UK according to the Office for National Statistics. Understanding the way menopause can affect your mental health is the first step in getting the help you need.  It’s important to realise that help is available, and you can feel better. 

Feeling overwhelmed.  Women report feeling overwhelmed and unable to cope with things they previously found easy or manageable.  This can have a debilitating impact at home and at work with many women leaving the workforce as they find they are unable to deal with the impact of menopausal symptoms whilst working. There is progress being made in this area in the UK with large organisations pledging to support women at work.  

HOW DOES MENOPAUSE AFFECT OUR MEMORY?

"Brain Fog” or “Menopause Brain” isn’t all in your imagination – it's real.  You aren’t going crazy.  The physical and emotional symptoms related to the changes in your hormone levels are very real and can be debilitating.  In perimenopause and the early stages of menopause, women describe changes in their ability to think clearly, make decisions and function well mentally.  Forgetfulness, inability to concentrate or focus, as well as problems with memory are very common during this time.  This can have a huge impact on your self-confidence and can make life difficult at work and at home.    

Difficulty Concentrating.  Caused by declining oestrogen many women struggle with concentration during menopause.  This can cause problems for many women at work with some women leaving their jobs because they feel they can no longer cope.

Memory problems. Brain fog is another troubling symptom for many women where they find it hard to focus, struggle to remember words, forget things and struggle to put their thoughts into words.

Brain fog and memory problems can often be one of the earlier symptoms of the menopause because it typically occurs during the perimenopausal phase.  It can often strike before the physical symptoms like missed periods or hot flashes.  Not realising that these problems are caused by the menopause, a lot of women worry this is the onset of dementia or that there is something seriously wrong with them.

WHAT CAN HELP ME DURING MENOPAUSE? 

The menopause can be tough to go through and affect our physical and mental health in many ways but there are things we can do to reduce the impact of symptoms and improve our quality of life.  Support and treatment are available - topping up your hormones, getting enough sleep, diet, exercise and managing stress can make a big difference to how you feel.  A broad approach to wellness and selfcare can help you manage your symptoms.

HRT.  If you are finding your symptoms debilitating, HRT (hormone replacement therapy) can successfully alleviate menopausal symptoms for many women. Whilst much has been said about the need to improve national GP training for the menopause, there are many doctors and specialists that are focused on driving this change. We recommend  you visit www.mymenopausedoctor for information on managing the perimenopause and menopause.  Dr Louise Newson is a GP and menopause specialist, and her website is a brilliant source of information for women going through menopause.  There is a very useful section on how to approach your GP to discuss HRT.

Cognitive Behavioural Therapy (CBT).  An effective treatment to consider for your psychological and emotional changes during perimenopause and menopause. It is a talking therapy that can help you manage challenges by altering the way you think and behave.

Eat A Balanced Healthy Diet.  Eat better, feel better. A healthy balanced diet can help boost your mood.  Base your diet around fresh fruits and vegetables, whole grains, lean meats, fish and olive oil.  Make sure you are drinking enough water – aim for 2 litres a day.

Get Enough Rest. Poor sleep can make symptoms worse.  We know that menopausal symptoms can make getting enough sleep a tall order but there are things you can do to try and get proper rest

• Avoid spicy food, caffeine and alcohol near bedtime
• Make your room cool
• Switch off your phone at least a couple of hours before bedtime
• Yoga, meditation and massage can all help promote a better night’s sleep

Make Time to Move. Regular movement is proven to boost mood and makes us healthier and happier.  A mix of cardiovascular, strength training and flexibility is perfect for menopausal women.  Walking, cycling, running, swimming, yoga and weight training are all excellent for boosting mood and staying fit and healthy.

Reduce Stress.  Easier said than done we know but trying to reduce stress in your life is key to managing menopausal symptoms.  Try to find time each day to focus on yourself and put your self first. Reading, walking, watching TV, taking a bath, catching up with a friend – whatever it takes to put yourself first and unwind.  Try to make yourself a priority.

Stay Connected.  Seeing friends and family can be the last thing you feel like doing when you aren’t feeling your best but it’s so important to stay connected.  The support we give and receive to friends and family is so important in helping us manage the menopause and the way we feel. Sharing how you are feeling and being open to the support that others can give can make a huge difference to how we live from day to day.

TAKING CARE OF YOU DURING MENOPAUSE

Understanding the way menopause can affect your mental health is the first step in getting the help you need.  It’s important to realise that help is available, and you can feel better.  At Living M the impact of psychological changes are as much a focus as our physical changes and we are pledging our support to raise awareness for this aspect of menopause in society. 

If you are feeling impacted by any of the symptoms raised in this article please seek medical advice. Other sources of support are listed below.

Samaritans operates a 24-hour service available every day of the year, by calling 116 123. If you prefer to write down how you’re feeling you can email Samaritans at jo@samaritans.org

Mental Health UK  With their local service delivery and national expertise in supporting people whose lives are affected by mental health problems, they have been able to mark a significant footprint in the areas that deeply challenge our mental health and stability.

Rethink Mental Illness offer practical advice and information for anyone affected by mental health problems on a wide range of topics including treatment, support and care. Phone 0300 5000 927 (Mon-Fri 9.30am-4pm) or visit rethink.org

Mind offers mental health support between 9am and 6pm, Monday to Friday. You can call them on 0300 123 3393 or text them on 86463.  There is a lot of useful information on their website www.mind.org.uk

Campaign Against Living Miserably has a (CALM) helpline and webchat that are open from 5pm until midnight, 365 days a year. Call CALM on 0800 58 58 58 or chat to their trained helpline staff online. It's free, anonymous and confidential.