Menopause and Mental Health

Every woman experiences the menopause differently. 

Often it doesn’t just cause physical symptoms, it can impact your mental health as well.

What is the menopause?

Every woman will experience menopause, but your experience is unique to you.

In the simplest terms, menopause is the time when you stop having periods and can no longer get pregnant naturally. This occurs because your ovaries stop producing eggs and, as a result, the levels of the hormones they produce (oestrogen, progesterone and testosterone) fall.

Although many of us use the word ‘menopause’ to describe the period of time when we notice our periods begin to change and we experience typical menopausal symptoms, the menopause is in fact a single day: when you haven’t had a period for 12 consecutive months. That said, perimenopause can start well before menopause and the symptoms can last for several years.

The average age of menopause for women in the UK is 51, but it could happen sooner or later than this.

What treatment is available?

The main medicine treatment for menopause and perimenopause symptoms is hormone replacement therapy (HRT), which replaces the hormones that are at low levels.

There are other treatments if you cannot, or choose not to, have HRT.

HRT

HRT is a safe and effective treatment for most going through menopause and perimenopause. Your GP will discuss any risks with you.

HRT involves using oestrogen to replace your body's own levels around the time of the menopause.

There are different types and doses of HRT. Using the right dose and type usually means your symptoms improve.

Oestrogen comes as:

  • skin patches
  • a gel or spray to put on the skin
  • implants
  • tablets

If you have a womb (uterus) you also need to take progesterone to protect your womb lining from the effects of oestrogen. Taking oestrogen and progesterone is called combined HRT.

Progesterone comes as:

  • patches, as part of a combined patch with oestrogen
  • IUS (intrauterine system, or coil)
  • tablets

If you have low sex drive because of menopause and HRT does not improve it, you may be offered testosterone.

What are the benefits of HRT?

The main benefit of HRT is that it can help relieve most menopause and perimenopause symptoms, including hot flushes, brain fog, joint pains, mood swings and vaginal dryness.

Hot flushes or night sweats often improve within a few weeks. Other symptoms like mood changes and vaginal dryness can take a few months to improve.

Taking HRT can also reduce your risk of hormone-related health problems including osteoporosis and heart disease.

Complementary and alternative therapies

Complementary and alternative treatments, such as herbal remedies and compounded bioidentical ("natural") hormones, are not recommended for symptoms of the menopause or perimenopause.

This is because it's not clear how safe and effective they are.

Red clover and black cohosh are herbal remedies but there is no strong evidence that they work.

Some complementary and alternative therapies can also interact with other medicines and cause side effects.

Ask your GP or pharmacist for advice if you're thinking about using a complementary therapy.

Non hormone treatments

There are non-hormone treatments if your symptoms are having a big impact on your life and you cannot, or choose not to, have HRT.

Hot flushes and night sweats

There are some medicines that can help with hot flushes and night sweats.

These include:

  • a blood pressure medicine called Clonidine
  • an epilepsy medicine called Gabapentin

Talk with a GP about these medicines and their side effects, and if they might be suitable for you.

Mood symptoms

Antidepressants can help with mood symptoms if you've been diagnosed with depression or anxiety.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy which can help with:

  • low mood and anxiety caused by menopause and perimenopause
  • some physical symptoms like hot flushes and joint pain

You can get NHS talking therapy without going to a GP first.

How can it affect your mental health?

For lots of women, the menopause can have a significant impact on their mental wellbeing.

You might experience:

  • feeling low
  • anxiety
  • mood swings
  • problems with memory and concentration
  • low energy and motivation
  • panic attacks
  • new fears and phobias
  • low self-esteem

You might be feeling this way because of the hormonal changes that are happening in your body. Or you might find that living with other symptoms of the menopause is affecting your mental health.

What other things may affect my mental health?

Dealing with symptoms like weight gain, joint pain and hot flushes can be difficult to cope with and may affect your mood.

You might also have difficulty sleeping, night sweats and bladder problems that stop you from getting enough rest. These can also contribute to feeling low and stressed. Some women may also become depressed.

You might also feel low, anxious or sad for other reasons. Around the time of the menopause, many people find themselves going through changes in their work life, family life and dealing with bereavement. You might also feel sad about no longer being able to have children or feel worried about getting older.

What can I do to look after my mental health?

Eat well

Eating healthy, balanced meals and snacks regularly will help keep your blood sugar stable. 

Make sure you aren’t drinking too much alcohol and avoid caffeine if you find it makes you anxious, affects your sleep or triggers your hot flushes.

    Sleep well

    You should aim for 7-8 hours of sleep each night. If you suffer from hot flushes in the night or night sweats, then you should sleep naked or wear cotton nightclothes. Consider investing in a cold gel pack or cooling pillow.

    Avoid hot drinks before bed and take sips of cold water instead.

    Ensure your bedroom is comfortably cool. Keep the window slightly open and/or a fan near your bed. Switch off electronic devices/screens at least one hour before bed and/or consider wearing blue-light blocking glasses in the evening. Avoid alcohol before bed; not only does it reduce good-quality sleep, it is an endocrine (hormone) disrupter and can affect the efficacy of medication, including HRT.

    Exercise

    Get some exercise if you can, as it will lift your mood. 

    Try activities like yoga, Pilates or walking to help you to de-stress.

    Relaxation techniques

    Try to do things that you find relaxing, like reading, going for a walk or practising mindfulness.