You say 'I'm not myself': you're more irritable, you snap over small things, you cry without quite knowing why and you find it harder to concentrate than before. Maybe you've put it down to stress… but you're in your forties or fifties and you're noticing changes in your body too. Many of these emotional changes have an explanation that's still talked about far too little: the link between menopause and mental health.
Menopause isn't just hot flushes and periods coming to an end. For many women, the hardest part of this stage is in the head and the emotions, often during the years leading up to it (perimenopause). In this article I'll explain how menopause affects mental health, why it happens, which emotional changes are the most common and what you can do to feel better.
Menopause and mental health: much more than hot flushes
When we think of menopause, we picture hot flushes, sweats and the end of periods. But its emotional impact is just as important and far less acknowledged. Irritability, anxiety, sadness, brain fog… Many of these symptoms appear even before periods change for good, and they catch many women by surprise because no one had warned them that menopause and mental health were so closely linked.
What menopause and perimenopause are
Technically, menopause is the point when a woman has gone twelve months without a period; on average, around the age of fifty. But what tends to have the biggest emotional impact is perimenopause: the transition years beforehand (they can be four to eight, or more) when hormones are on a rollercoaster. The American Psychological Association notes that this transition is a gradual process, not a switch that turns off all at once. And it's precisely in this phase of hormonal swings that many psychological symptoms are most intense.
Why menopause affects mood
It isn't 'all in your head' or a lack of willpower. The drop and the swings in oestrogen directly influence neurotransmitters like serotonin, closely linked to mood. On top of that, hot flushes and night sweats break your sleep, and sleeping badly makes everything worse. The World Health Organization notes that menopause can come with symptoms that affect psychological well-being. In other words: there's a real biological basis behind these changes.
The emotional symptoms of menopause
Menopause and mental health meet in the form of very concrete symptoms, which vary a lot from one woman to another.
The most common emotional changes
- Irritability and sudden mood swings.
- Anxiety, restlessness or a new unease you didn't have before.
- Sadness, tearfulness and low spirits.
- Loss of confidence and self-assurance.
- A feeling of being overwhelmed and not getting to everything.
- Less interest in things you used to enjoy.
Brain fog: memory and concentration
One of the symptoms that causes the most distress and gets talked about the least is brain fog: forgetting words mid-sentence, walking into a room and not remembering why, or struggling to concentrate or follow the thread. Many women get frightened, thinking their mind is failing seriously, but in most cases it's a temporary effect of the hormonal changes and poor sleep, not a sign of decline. Simply knowing this already eases much of the worry.
Menopause, sleep and fatigue
Menopause and sleep are closely tied. Hot flushes and night sweats interrupt rest over and over, and insomnia sets in. And we all know it: when you don't sleep, everything feels worse -more irritability, less patience, more sadness. That's why looking after sleep is one of the most powerful levers for mental health at this stage; if you're struggling, the guide to sleep disorders may help.
Menopause and the risk of depression and anxiety
Perimenopause is a window of greater vulnerability: several studies show that the risk of depression and anxiety rises in these years, especially in women who have had them before. But note: feeling more sensitive or having ups and downs isn't the same as clinical depression. It's worth getting help when the sadness is deep and constant, when it lasts weeks, or when it stops you living your life. In those cases, asking for help is the wisest thing.
It isn't only hormonal: the life stage
Menopause usually coincides with a particularly demanding stage of life: teenage children or children leaving home (the empty nest syndrome), ageing parents who need care, work changes and a relationship with your own body and image that gets stirred up. All of this forms a 'perfect storm' in which hormones are one more piece, but not the only one. Understanding this helps you not to reduce everything to 'it's the hormones' or to pile guilt on yourself.
Menopause, PMS and hormones across life
There's a thread connecting different stages. Women who are especially sensitive to hormonal changes tend to notice it throughout their lives: in premenstrual syndrome, postpartum and also at menopause. In fact, the symptoms of ADHD in women can also intensify at this stage. It's no coincidence: we're talking about the same system responding to the swings of hormones. Knowing your own sensitivity lets you anticipate and look after yourself better.
How to look after your mental health in menopause
The good news is there's a lot you can do to live this stage better. It isn't about 'putting up with it' until it passes, but about actively looking after yourself.
Habits that help
- Prioritise sleep: regular hours, a cool bedroom and putting screens away before bed.
- Move your body: regular exercise improves mood, sleep and brain fog.
- Moderate caffeine and alcohol, which worsen hot flushes and restlessness.
- Look after your self-esteem and your relationship with your body at this new stage.
- Talk about it: sharing it with other women and with those around you breaks the silence and the loneliness.
- Treat yourself kindly; don't demand your usual pace of yourself on bad days.
When to see your doctor or gynaecologist
The physical and hormonal side is medical territory. It's worth seeing your GP or gynaecologist if the symptoms are intense: they can consider treatments (from lifestyle measures to, in some cases, hormone therapy) and rule out other causes, such as thyroid problems, which sometimes mimic menopause symptoms. The UK's National Health Service (NHS) notes that there are effective options and that you don't have to resign yourself to a bad time. Bring along a note of how you feel; it will help them get their bearings.
How therapy helps
In therapy we don't 'give you your hormones back', but we do support you to get through this stage with more tools and less suffering. We work on emotional regulation so you're not at the mercy of irritability or sadness, we address the anxiety and low mood, and we make space for something often forgotten: the identity side, the 'who am I now' at this new stage of life. I do this through emotional management therapy and, as an online psychologist for women, I accompany many women through this process, in online therapy, in English, Spanish or Catalan.
If you feel that menopause is getting the better of you, get in touch for a first assessment with no obligation. This stage isn't the end of anything: with support, it can also be an opportunity to get to know yourself again, to put yourself first and to start looking after yourself as perhaps you hadn't done in a long time.