The Science of Mental Health During Menopause

May is Mental Health Awareness Month, and at Kindra, we’re using this time to explore the intricate relationship between menopause and mental well-being. To start things off, let’s dive into the science behind menopause — and how it can have a huge impact on what’s going on in your brain.

In many ways, our society has come a long way in the past decade when it comes to the importance of mental health. People openly talk about their therapy sessions and swap notes on their self-care routines. But things are far from perfect. People still face discrimination for disclosing their mental health condition at work or school, access to treatment remains expensive and inequitable, and there is still a lot of silence about mental health issues for specific populations — especially when it comes to menopausal women.

An estimated 20 percent — one in five! — of women have depression at some point during menopause. Depression tends to get worse during the menopause transition, with 18 percent of women reporting some symptoms of depression at the beginning of perimenopause, and 38 percent reporting them at the end of perimenopause. Some women also find that they have increased anxiety symptoms, like panic attacks or feelings of dread.

Clearly many women struggle with their mental health during during menopause. Yet reporting from NPR found that women say their doctors don’t take their concerns seriously, or even brief them that mental health challenges are a potential part of this life change.

What’s going on during this time that can have such a big impact on your mental health? Let’s break it down together.

The Science of the Menopause Transition

For a huge part of your life, your body has a set rhythm every month designed to prepare you for a potential pregnancy in the form of your menstrual cycle. You have your period every 21 to 35 days thanks to sex hormones like estrogen and progesterone, which trigger key parts of your menstrual cycle. High levels of estrogen mid-cycle, for example, tell the brain to release something called luteinizing hormone, which in turn tells the ovary it’s time to ovulate.

Barring pregnancy or illness, that process happens every 21 to 35 days for decades of your life. Your ovaries start to produce less and less estrogen and progesterone as you get older and eventually, you eventually stop having periods. Once you’ve gone 12 months after that last period, you’ve officially hit menopause.

The years leading up to that last period are known as perimenopause, or the menopause transition. This is when your sex hormone levels start to plummet. Those hormonal changes can cause a wide variety of symptoms including irregular periods, increased PMS symptoms or heavier bleeding, hot flashes, migraines, heart palpitations, and so much more.

Can Menopause Trigger Depression and Anxiety?

But wait, you ask, I thought hormones were just a period thing? Not so. Your so-called reproductive hormones play important roles throughout your body. Estrogen is a powerhouse hormone that helps regulate your mood, keeps your bones strong, protects brain health, and stabilizes your blood pressure. Progesterone, meanwhile, can affect bowel function and cause constipation in excess. Changes to these hormone levels can trigger big changes that can affect many different parts of your body — and your mental health.

Estrogen in particular plays a surprisingly significant role in your mental health. Among many other complex functions, it’s involved in the production of serotonin, a neurotransmitter that helps regulate your mood, and helps ensure that there’s enough of it for your body to use. Researchers believe that changes in estrogen levels might affect the body’s production of serotonin, which could make some women vulnerable to depression. This could explain why menopause is linked with depression for some women, although more research is needed to be sure. (It’s unclear if this could also trigger anxiety — we currently know very little about the relationship between that mental health condition and menopause.)

Other physical changes during menopause can wreck havoc on your mood. For example, many women find it incredibly difficult to get a good night’s sleep thanks to hot flashes and other sleep issues, which can contribute to depression and anxiety. Hot flashes themselves can trigger feelings of anxiety and panic attacks (and in fact, people with anxiety tend to have more hot flashes). You may also have less physical energy or struggle with brain fog, which can make a bad mood worse. Things that may have been enjoyable for you before, like sex, might just be painful or uncomfortable now, which could add more stress or unhappiness into the equation.

With so much going on at once, it’s no wonder that many women struggle with their mental health during the menopause transition. Indeed, 33 percent of women who take the Kindra Menopause Symptoms Quiz report feeling sad during menopause, and 42 percent say they’re moody. Many women say they feel unusually irritable, can’t sleep, or even experience their first panic attacks or anxious feelings. Others feel extremely sad or blue, or struggle with mood swings. Some, but not all people, develop clinical depression or anxiety disorders during perimenopause. You might just feel unhappy without a clear “reason” why.

Other important symptoms of depression and anxiety that might crop up during perimenopause and beyond:

• Reduced appetite
• Feelings of sadness or hopelessness
• Feelings of worthlessness, guilt
• Trouble concentrating or making decisions
• Increased heart rate, hyperventilation, sweating, or trembling
• Feeling a constant sense of panic or doom
• Thoughts of suicide
• Unexplained physical pains

Anyone can develop depression or anxiety during perimenopause or beyond. But research has shown that there are certain factors that can increase your risk of menopausal depression,  including a previous history of depression or mental health issues, being unemployed or having financial problems, and having chronic health problems or little social support.

How To Get Support for Your Mental Health During Menopause

Not many people know how menopause can affect your mood and mental well-being, which can make getting help challenging. You might accidentally assume that your low energy and exhaustion are just part of menopause, rather than a specific sign of depression. And not all doctors are well-versed on the many different ways that menopause can affect people. (It doesn’t help that research is so limited on the subject, either…)

If you’re finding that you have lots of symptoms of depression or anxiety, or that they’re interfering with your ability to get through your day or live your life, it’s time to seek out help. Talk to your doctor or healthcare provider about how you’re feeling to get information on next steps, referrals to specialists, and treatment options.

Your doctor might recommend one or some of the following treatments to help you grapple with your depression or anxiety:

• Talk therapy: You work with a therapist, either one-on-one or in a group setting, to help you learn about yourself and find strategies to help you better manage your mental well-being. There are many different types of therapy, such as cognitive behavioral therapy (CBT), which helps people change unhealthy patterns and reframe their thinking.  
• Medication: Antidepressants and anti-anxiety medications can be life-changing, especially if you have a serious mental health condition. You shouldn’t be ashamed to take them if you need them. (Do we shame people with diabetes for needing insulin? I didn’t think so.)
• Lifestyle changes: These alone don’t “cure” mental health issues, but things like regular exercise, meditation, stress management, and regular socialization can really help support your mental health and improve depression and anxiety symptoms along with other treatment.

We also recommend trying one of these amazing resources for more guidance, support, and information:

• National Alliance on Mental Illness (NAMI): This national organization works to provide mental healthcare and education to those in need around the country. If you need more information about depression and anxiety, or help finding a doctor or navigating insurance, they have helpful guides to get you started.
• SAMHSA Behavioral Health Treatment Services Locator: The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has a free service to help you find treatment in your area, including mental health clinics and other programs.
• CVS Mental Health Counseling: In an effort to make mental healthcare more accessible, select CVS Pharmacy locations now offer in-person or virtual mental health counseling with licensed therapists.
• Therapy for Black Girls: This organization connects Black women and girls with Black therapists in their area to provide affirming, culturally-conscious care.
• Asian Mental Health Collective: This group is dedicated to combatting the stigma of mental illness in the Asian American community, and has a tool to help you find an Asian mental health professional in your area.
• Latinx Therapy: Another great organization to help connect the Latinx community in the U.S. with bilingual, Latinx therapists. You can also learn more about mental health and other topics through the group’s website and podcast.
• The Native Wellness Institute: Promotes culturally-conscious and appropriate mental health and wellness education and treatment for Native American community members.
• Gay and Lesbian Medical Association (GLMA): This organization lets you search for LGBTQ-affirming medical providers, including therapists.

Don’t be afraid to lean on loved ones for support, either. Talk to your partner, a close friend, or even a trusted, non-judgemental family member about how you’re feeling and what you need so that they can provide you with help and encouragement. (If you’re not sure what to say, try writing it out first.)

Menopause can be a difficult transition in many ways, especially if it’s affecting your mental well-being. But know that there are millions of women around the world who are going through the same thing as you. Fight the silence around this condition by speaking out and getting yourself the help you need.