When we think about the effects of menopause, we often focus on the physical. The hot sweats, dryness, sleep problems and irregular periods. But hormonal changes can also have a significant impact on mental health, too. In a 2021 survey conducted on topic of menopause, 44% of participants (all between ages 50 – 60) said it had significantly affected their general mental and emotional wellbeing.

“Menopause can have a huge impact on mental health,” psychologist Dr Becky Spelman tells Stylist. “Women will often experience horrific physical symptoms which can feed into anxiety and depression, and there can be a lack of support from those around them, who don’t have the same level of understanding about the menopause.”

This rings true for those experiencing every stage of menopause, from perimenopause to post-menopause.

“During perimenopause, the main steroid hormones, oestrogen, and progesterone are changing in concentration in the body. Progesterone declines, and this can affect GABA, a calming neurotransmitter in the brain and can produce feelings of anxiety,” adds Hannah Hope, a clinically trained nutritionist specialising in hormones.

“Fluctuating oestrogen can also cause low mood and anxiety, high levels leading to irritability and low levels causing depressive feelings. More than 80% of women experience some degree of psychological symptoms around menopause.”

Annabelle*, says perimenopause started to have a real impact on her mental health when she started getting panic attacks.

“I’d never had them before and had no idea at first what was causing them,” she shares. “I’d wake up at three or four in the morning with a racing heart and fearful thoughts. The strange thing is, although I feel fearful about something, I can’t pinpoint what it actually is. There’s nothing in my life at the moment to actually cause me this level of anxiety, but while I know there’s no logic to it, I still feel worried.”

It was only after talking to friends and doing a bit of her own research that Annabelle recognised what was causing it.

“Just knowing that it’s a symptom of perimenopause has made a massive difference, partly because I know that other women are experiencing the same thing, and partly because I can remind myself that this IS the cause, and that there’s nothing to fear,” she explains.

Thelma, a 42-year-old women’s health coach, agrees that being perimenopausal has also impacted her from a cognitive point of view. “I am less sharp, forgetful and can often get down,” she shares.

“Black women’s menopause journey tends to start early and the symptoms are more profound. Our mental health in menopause is always magnified because of accumulative stress that occurs as a Black woman because of the additional layer of systemic racism that we have to deal with.”

Imogen, also 42, went through the menopause after a hysterectomy at 37 due to having very large fibroids. “It has hugely impacted my mental health,” she says. “I used to feel sharp – I’m bright and capable, and have always felt like I was good at my job, but now I struggle to retain info, I feel upset a lot of the time, my brain is foggy, and unable to cope.”

Imogen says she feels like she “exploded her life,” leaving three jobs in the past two years. “Honestly, I don’t know who I am anymore,” she admits.

Low self-esteem and a loss identity appear to be common themes among many women throughout all stages of menopause. 

Lucy, a confidence coach, found that her bad moods caused a cycle of guilt and anger while she was perimenopausal. “My periods were getting closer together and I felt trapped in a cycle of anxiousness and heightened emotions due to what I now know was a natural drop in hormones,” she tells Stylist. “But I felt overwhelmed with work and like a terrible, shouty parent when I couldn’t break out of the ‘slump’.

For her, a supportive, understanding GP combined with HRT helped ease a lot of the mental burden. I started oestrogen patches and progesterone tablets in June, and each month has been brighter and brighter,” she says.

“But despite the great work done around the menopause, it is still an embarrassing topic. The word itself conjours up an image of a middle-aged frumpy woman, and is the very reason I didn’t think I was entering into the menopause. But I was wrong. Menopause has been a huge knock to my confidence, but luckily I didn’t let that feeling fester for too long. I knew I had to do something about it and I feel fortunate that my GP was brilliant.” 

Unfortunately, the mental toll of menopause doesn’t simply stop once the hormonal transition does. For some women, it can continue years after the cycle is completed.

“Some women obviously are affected more than others and in this instance, it’s always helpful to seek the advice of a GP,” Dr Spelman advises.

“Women never need to suffer alone and thankfully, we as a society are finally beginning to understand the suffering that menopause can cause. The key message is that in order to maintain positive mental health whilst experiencing these changes such as insomnia, weight gain, irritability, brain fog and hot flushes, both professional and personal support is needed. It’s just as important to seek out women who are sharing the same experience and challenges as it is to ask for medical help.”

For more information about the support available, please visit the NHS menopause hub.

Images: Getty