Does menopause affect mental health?

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MENTAL HEALTH & MENOPAUSE

Following an invitation to talk on the Podcast ‘Mentally Yours’ with hosts Yvette Caster and Ellen Scott. We’ve looked at the link between fluctuating hormones in perimenopause, menopause and mental health. 

Many women still have no clear understanding of the different stages of menopause, therefore they’re even less likely to make the connection with the impact that menopause can have on their mental health.

Research has shown that 61% of women suffer anxiety during the perimenopause (the time when menstrual periods become lighter and less frequent) and this phase can last anywhere from a few months, to up to 12 years.  Gynaecologist, Dr Karen Morton, says “It’s one of the most underestimated symptoms of menopause.”

In 2018, 44% of respondents in a survey carried out for BBC Radio 4 Woman’s Hour, reported that menopause significantly affected their mood and mental health. We take a look at why this may be the case.

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What causes mental health problems in menopause?

Ovaries are the source of oestrogen and progesterone, two key hormones that control our reproductive systems. Oestrogen influences the production and breakdown of serotonin, the so-called ‘happy’ hormone that regulates mood, as oestrogen levels drop during perimenopause, so do serotonin levels affecting moods, impacting on mental health or exacerbating pre-existing mental illness.

The average age for menopause is 51, an age at which women can be vulnerable to mental health issues, as the complexities of life collide with hormonal imbalance.

A 2013 report by The Office for National Statistics found more women reported suffering from anxiety or depression, with the highest level of self -reporting from women in the 50-54 age group.

What are the signs of mental health problems in menopause?

Psychological symptoms include:

  • Low mood,

  • Irrational mood swings

  • Anxiety

  • Inability to concentrate

  • Brain fog

  • Forgetfulness

  • Low self-esteem and confidence

  • Feelings of fatigue

  • Jumbled thoughts

  • Irritability and difficulty coping

Women can experience several of these at once, leaving them feeling exhausted from being on a hormonal ‘rollercoaster’!

When to get help?

The NHS recommendation is: ‘See your GP if you experience symptoms of depression for most of the day, every day, for more than 2 weeks’.

What causes mental health issues in menopause?

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Social factors

Natural menopause and approaching middle age often bring increased stress, anxiety and dread. Symptoms of menopause add more pressure and this stage of life is often loaded with additional emotional stressors such as:

  • Ending or starting relationships

  • Grown children leaving or returning home

  • Financial or career worries

  • Ageing parents

  • Getting older

  • Health worries for ourselves, or partner.

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Surgery

1 in 100 women will experience an early menopause, before the age of 40, often due to chemotherapy, or surgery/hysterectomy when the ovaries are removed, plunging women into instant menopause as their hormone supply is cut.

Many women are unprepared for instant, intense menopause, or the psychological implications associated with it. (Read guest blogger Sophie on how she’s dealt with early surgical menopause).

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Relapse

Menopause can be linked with a recurrence of depression, potential relapses or changes to pre-existing symptoms of mental illness.

Clinical trials are yet to find a link between depression and menopause. But many women do experience mood swings during perimenopause.

Research suggests women who’ve had severe PMS, or postpartum depression, may have more severe mood swings during perimenopause.

Bipolar Disorder

At menopause women living with bipolar disorder report more depressive episodes than those without.

Some of the symptoms of menopause can be similar to those of bipolar disorder: irritability, fatigue, memory issues and more, meaning that menopause as a cause can be missed. By recognising the link with hormonal imbalance and its’ impact, women can talk with their health practitioners about how to manage their mental health appropriately.

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Postpartum Psychosis & Menopause

In a review of post-menopausal women with a history of postpartum psychosis, it was found that 30% reported an episode of illness including depression during perimenopause. Most women who relapsed during the perimenopause had been well during the years in between childbirth and the menopause.

Women, their partners and families should look out for signs of relapse during the perimenopause and seek help from their GP or mental health team should symptoms develop.

What can help women manage mental health in menopause?

NICE guidelines recommend:

  • HRT should be offered for treatment of mood changes which are hormonally related.

  • Cognitive Behavioural Therapy (CBT).

  • NICE also backs the use of the herb, St John’s Wort, to treat mild depression.

  • Exercise leads to the production of endorphins, or ‘feel good’ hormones, that lift your mood. Being outside when you exercise enhances this effect.

  • Avoiding alcohol, which can trigger low mood.

Be Aware

Awareness is key to tackling mental health in menopause early enough to manage the symptoms and to be able to discuss this with medical professionals.

Yet knowledge is power, the more informed women are at an early age of the power of their hormones, the more proactive they can be to seek support and navigate the challenges of menopause.

Check our SYMPTOMS section on ‘Menopause Depression’ and Anxiety to find more information. We are not providing any medical support, it’s essential to seek medical help if you have any concerns about your physical, emotional or mental health.

June 2019

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