Menopause and mental health

Menopause is a natural transition that marks a significant change both physically and mentally for many women. The drop in female hormones causes a wide range of symptoms including brain fog and depression. So, it’s important that we acknowledge the impact this can have on mental health.

There are about 13 million women in the UK currently experiencing menopause and perimenopause¹. Many women are familiar with the physical symptoms of menopause. But the mental health impact of menopause is not as well understood.

In this guide we take a look at how menopause can affect your mental health and how to alleviate the symptoms. Thankfully, mental health support during menopause is available. And with private health insurance you can get access to a range of practical information and therapies.

A change in your mental health can also have a knock-on effect in your daily life. Two thirds of women in a workplace survey by the CIPD feel that their menopausal symptoms had a negative effect on them at work. And over half took time off due to these symptoms². And it’s not only work that suffers. Personal relationships, social interactions and self-perceptions can also be affected.

However, recognising these mental health changes as part of the wider menopause experience can be a relief for many. It validates their feelings and means they can access the right support. When considering menopause and mental health, psychological symptoms are very common. We explain some of them here.

Problems with memory or concentration (brain fog)

When we talk about brain fog we mean problems with memory, concentration and thought processes. This can manifest itself in many ways. Such as:

• struggling to find the right words
• forgetting names or appointments
• losing track of what you were saying
• ·not being as clear thinking as usual
• struggling with motivation and making decisions.

It happens when our oestrogen levels decline. Oestrogen plays a crucial role in memory and mood regulation. When it reduces, it doesn’t support these functions so well, leading to brain fog. The consequences can be significant. You may find you’re no longer on top of things at home and work. And this in turn can be upsetting and frustrating, leading to low self-worth and doubt about your abilities. The good news is that brain fog doesn’t tend to last and gets better when you’re past menopause.

Anxiety

When we’re anxious, we’re worried or fearful about things that are due to happen in the future. It’s natural to be anxious sometimes, before an exam for example. But when it starts to affect your everyday life then it’s important to speak to someone about your feelings.

Anxiety has both physical and psychological symptoms. You may find yourself worrying a lot about things you took in your stride before. You may feel scared about doing things you usually manage easily, such as driving. Or you feel overwhelmed and don't know how to cope. Sometimes it can spill over into a panic attack, which can feel like you’re having a heart attack.

These feelings often start during perimenopause because we notice changes in ourselves that we feel we can’t control. Such as weight gain or sleepless nights. But it’s actually fluctuating oestrogen that impacts our ability to regulate our mood and anxiety levels. Thankfully, there are many ways to alleviate anxiety and get help with your condition.

Mood swings

We sometimes joke about menopausal mood swings. But they can be upsetting and challenging to manage. They may come out of the blue and you’ll find yourself riding a rollercoaster of emotions. You can experience anger, irritability, anxiety and low mood without any clear reason why. All of which can have a negative impact on relationships and your own self-perception. However, it’s important to recognise that your change of mood is not a character flaw. There are physiological reasons for it happening.

There is some evidence that oestrogen is linked to serotonin and cortisol³ When oestrogen levels drop, so does serotonin (the happy hormone). Whereas cortisol (the stress hormone) levels rise. This means there’s a double impact on mood.

Low self esteem

Your self-esteem can be impacted by the changes that happen to you physically and mentally during menopause. In particular changes to your body, such as weight gain, joint pain and reduced sex drive can affect body image and self-confidence.

Feelings of worthlessness and self-hatred can cloud your judgement. You may mourn your younger self and worry you’ll always feel this way. However, there are ways to challenge this thinking and change your feelings about yourself.

Try to stay connected to friends and family and find things that bring you joy. Focus on positive relationships that accept you as you are. Challenge your negative thoughts and don't compare yourself to others. Especially those on social media who project an unrealistic image. 

Stress

Your menopausal symptoms can add to your everyday stresses. But lower oestrogen levels also make it more difficult to regulate cortisol. This makes it feel more difficult to manage your stress. Stress can also trigger or worsen hot flushes and night sweats, so compounding your stress and disrupting your sleep.

Taking time out to decompress can be really beneficial. So too can regular exercise and a healthy diet. If that isn't making a significant difference, then you may want to speak to your GP or a therapist.

Are there treatments for mental health during menopause?

There are many effective treatments for menopause symptoms that can also help your mental health. Speak to your GP or Vitality menopause practitioner to discuss your options.

Hormone Replacement Therapy (HRT)

HRT replaces the hormones that decline during menopause. The three main hormones are oestrogen, progesterone and testosterone. Together these hormones regulate your mood and can alleviate some physical symptoms too.

You’ll need to speak to a doctor about what type of HRT is best for you as there’s a range of options. And it can sometimes take a while to find the right combination. But if you’re happy with your HRT treatment, you can stay on it for many years, even when you’re post-menopausal.

Talking Therapies (CBT, Counselling)

Talking therapies like Cognitive Behavioural Therapy (CBT), can help manage anxiety and depression by teaching you mechanisms to cope with your feelings.  They can help you to stop the cycle of negative thoughts that cloud your judgement.  And provide practical solutions to managing these thoughts.

You can refer yourself for NHS talking therapies. However, waiting times can vary. While you might get an initial assessment relatively quickly, starting treatment can take time depending on your local service and demand.

With Vitality’s health insurance, you can access Talking Therapies quickly and conveniently, often within days, without needing a GP referral first. As part of our Core Cover, you’ll get access to up to eight sessions of Talking Therapies including Cognitive Behavioural Therapy (CBT) or counselling per plan year through our Talking Therapies network. For more comprehensive support, we also offer optional Mental Health Cover which provides additional mental health cover including unlimited access to Talking Therapies.

Medications

If HRT isn’t suitable for you, there are other medications you can take to alleviate symptoms. However, NICE guidelines don’t recommend antidepressants for treating menopause symptoms. Unless you already have depression. Speak to your doctor about your options.

Regular physical activity

There’s plenty of evidence that points to a positive link between mental wellbeing and physical activity⁴. Getting out for a walk or taking part in a yoga class can boost our mood and improve sleep. Exercise releases endorphins which are nature’s mood boosters. Build regular exercise into your weekly routine. You may find it helps relieve both physical and mental symptoms of menopause.

Nutritional support

It’s tempting to use alcohol and comfort food to boost your mood. But these treats are short term solutions and can make you feel worse in the long term. Instead, look carefully at what you’re eating and drinking. Try to eat foods that are high in omega-3s, B vitamins and magnesium, all which are important for brain health.

Prioritising sleep hygiene

Lack of sleep can have a serious impact on our mental health. Try to develop a bedtime routine that helps you wind down. And if you’re suffering from night sweats, keep the bedroom cool and a fan nearby. Try not to stress about your lack of sleep as this will keep you awake for longer. HRT can alleviate some of the physical symptoms of menopause that can keep you awake.

Mindfulness and stress reduction techniques

Do things that calm your mind and bring you joy. It can be as simple as walking the dog or taking a long bath. When you relax, your mind is better able to cope with anxious thoughts. Daily mindful meditation can help manage your cortisol levels which can rise during menopause. Just five minutes of steady breathing can make a difference.

Building a strong support network

Talk about your feelings with friends, family and workplace if you feel able to. Explain how they can support you when you’re feeling overwhelmed. There are also many forums online where you can talk about menopause and get feedback from others about what works for them.

Read more: How to support someone going through menopause

Sources:

[1] Royal College of Nursing. Menopause at work

[2] CIPD. Menopause in the workplace

[3] My Menopause Centre. Menopause and mood swings

[4] Sport England. Understanding the impact of movement on mental health and wellbeing. November 2023

[5] Vitality Health Claims Insights Report 2024 

[6] Vitality Life Claims and Benefits Report 2024