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This article will explore the stages of menopause, what happens and why, the common symptoms to look for, and the range of strategies - from lifestyle adjustments to medical support - that can help you regain control and feel like yourself again.
Menopause is a significant life transition that affects every woman, but its impact isn't just physical. It marks the natural stage of life when your ovaries cease working, leading to the end of your reproductive years. This transition triggers a significant hormonal shift, chiefly a drop in oestrogen, progesterone and testosterone. These hormones support a vast array of functions, so their decline can create a profound connection between menopause and mental health, leading to new or worsening anxiety, low mood and brain fog, alongside other physical symptoms.
You may find yourself asking: Is this normal? Why do I feel this way?
There are over 40 documented symptoms linked to menopause, which can have a significant impact on your quality of life and even your ability to function at work with your usual confidence. These symptoms can be broadly grouped into physical and psychological.
Common physical challenges include:
But the psychological symptoms can be just as, if not more, debilitating:
This cognitive fog in particular can be deeply unsettling, shaking your confidence at home and at work.
Oestrogen plays a vital, protective role in maintaining your health. It supports your bone density, your cardiovascular system and your brain function.
Therefore, the post-menopausal drop in oestrogen is linked to an increased risk for certain long-term health conditions. These include osteoporosis (brittle bones), heart disease and cognitive decline. In fact, developing Alzheimer's disease is roughly twice as common in women as it is in men, a statistic many researchers link to the loss of oestrogen.
If you feel your mood has plummeted or anxiety has suddenly spiked, you are not alone. This is one of the most challenging, and most common, aspects of menopause and mental health.
A survey by the British Menopause Society found that over half of women aged 45 to 65 going through menopause report mood changes that affect their mental health, such as depression and anxiety. Furthermore, between 45% and 68% of women in perimenopause (the transition before menopause) also present with symptoms of depression.
Your risk of experiencing these mental health effects is higher if you have a personal history of depression or anxiety, have had postnatal depression or typically experience low mood linked to your monthly cycle.
It's also important to recognise that this hormonal shift often collides with other significant life stresses: financial worries, marital issues or the "sandwich generation" pressure of juggling children and ageing parents. These pressures don't cause the hormonal change, but they can certainly amplify its challenging effects.
Menopause affects your brain chemistry in two key ways: directly and indirectly.
1. The Direct Chemical Shift: Your brain is rich in oestrogen receptors: proteins on your cells that oestrogen binds to. When stimulated, these receptors help regulate your mood. As oestrogen levels fall during menopause, these receptors get less stimulation, which can directly lead to a decline in your mental health.
At the same time, when your oestrogen levels go down, your cortisol (stress hormone) levels often go up. Higher cortisol levels can hard-wire a persistent feeling of anxiety or being "on edge."
2. The Indirect 'Domino Effect': The physical symptoms of menopause can create a challenging domino effect, highlighting the strong and complex link between menopause and mental health.
For example, persistent night sweats disrupt your sleep. This leads to chronic fatigue, making it harder to concentrate. This exhaustion can erode your confidence and self-esteem, which in turn can spiral into low mood, anxiety or depression.
Similarly, hot flushes can cause acute stress and social anxiety, especially if you're worried about having one during an important work presentation. During perimenopause, the unpredictability of heavier or irregular periods can also make you feel like you've lost control of your own body, adding to a background level of stress.
When you're struggling with these menopause symptoms, the first step is to focus on what you can control. This is about building a strong foundation of self-care to support your body and mind through this transition.
Start by asking yourself these critical questions:
This isn't a journey you have to take alone. Creating a multi-layered support system is key to navigating the challenges of menopause and mental health.
1. Lifestyle and Connection: Alongside the lifestyle changes above, connection is vital. Talk to other women who are going through the same thing; sharing experiences can be incredibly validating. It is also important to speak to your employer, colleagues or HR department. Many workplaces now have menopause policies or support systems to ensure you get the understanding and adjustments you need.
2. When to Seek Professional Expertise: If you've tried these lifestyle adjustments and you're still struggling, it's time to consult your GP. This is not a failure; it is the next logical step to get the expert help you deserve.
3. Exploring Your Treatment Options: Your GP can discuss a wide range of options to create a personalised plan. These may include:
This is one of the most common and frustrating questions, and the honest answer is that there is no set timeline. It’s different for everyone.
Many women find their anxiety is at its peak during perimenopause. This is the transitional stage before menopause, when your hormones are fluctuating erratically, which can worsen feelings of anxiety and being on edge. This stage can last for several years.
The good news is that for many women, this anxiety does lessen or stabilise once they are post-menopausal and hormone levels are consistently low. However, this isn't a guarantee. The best approach is to actively manage the anxiety now with lifestyle changes, stress-reduction techniques and by speaking to your GP about options like CBT or HRT, rather than just waiting for it to disappear.
This refers to a "360-degree" or holistic approach to managing your health through the menopausal transition. Instead of focusing on just one solution, it combines five key areas:
Nutrition: Focusing on a balanced diet rich in calcium and vitamin D, managing blood sugar and avoiding triggers that can worsen symptoms (like excess caffeine, sugar and alcohol).
Fitness: Incorporating regular movement, especially weight-bearing exercise to protect bone health, and activities like yoga or Pilates to support mental wellbeing.
Mental Wellbeing: Actively managing stress through practices like mindfulness, breathing exercises and cognitive behavioural therapy (CBT) to help reframe anxious thoughts.
Natural Remedies: This can include supplements and herbal options (like St. John's Wort or isoflavones) that some women find helpful for managing symptoms.
HRT (Hormone Replacement Therapy): This is the medical pillar, involving a discussion with your GP about replacing the hormones your body is no longer producing to alleviate symptoms.
The most effective plan often involves creating a personalised strategy that draws from all five pillars.
Yes, it does. This is the good news. Since PMDD (Premenstrual Dysphoric Disorder) is triggered by the sharp rise and fall of hormones during your menstrual cycle, it does resolve completely once you reach menopause (defined as 12 months without a period).
The challenging part is that symptoms of PMDD can get significantly worse during perimenopause. As your cycles become more erratic, the hormone fluctuations can become more extreme, amplifying the severe mood symptoms of PMDD. It can be a very difficult time, and it's essential to seek support from your GP to manage these intensified symptoms during the transition.
You are not losing your mind. You are in menopause (or perimenopause).
The feeling of "losing it" (the brain fog, the forgetfulness, the inability to concentrate, the sudden anxiety or the uncharacteristic irritability) is one of the most frightening aspects of this transition. These are not imagined. They are real, physiological symptoms caused by a major hormonal shift.
The oestrogen receptors in your brain are getting less stimulation, which directly affects your cognitive function and mood. When you add the indirect effects, like chronic lack of sleep from night sweats, it's no wonder you feel this way. It's a common experience, and it's a sign that your body is navigating a significant change.
Yes. This feeling is incredibly common and a direct result of the chemical and physical changes happening in your body.
Feeling "crazy" often comes from the sheer unpredictability and intensity of the symptoms. You may not recognise yourself. You might have been a confident, calm person, and now you're dealing with sudden anxiety, heart palpitations, bursts of rage or irritability and a brain that feels like it's full of fog.
When you feel out of control of your own emotions and mind, it's easy to feel like you're going crazy. It's crucial to understand that this is a hormonal response, not a personal failing.
There is no single "better" way; there is only the way that is best and safest for you.
This is a personal and medical decision that should be made only after a thorough conversation with your GP, who understands your personal and family medical history. For many women, HRT is a highly effective, safe treatment that dramatically improves their quality of life by managing debilitating symptoms. For other women, it may not be suitable due to other health risks.
A healthy lifestyle (focusing on nutrition, exercise and mental wellbeing) is the essential foundation for everyone going through menopause. HRT is a powerful and effective treatment option that you can discuss with your doctor to see if it's the right choice to add to that foundation.
Dr. Wendy Molefi (BM MRCGP DFSRH DRCOG MSt in MBCT (Oxford)) is a GP, Wellbeing Coach, Mindfulness Teacher and a British Menopause Society accredited Menopause Specialist. She is also an award-winning businesswoman with a passion for women's health. Dr. Molefi uses an integrated and preventative approach, combining her expertise in wellness coaching and mindfulness with her clinical practice. She has a special interest in the psychological impact of menopause, and her dissertation on the role of mindfulness in menopause was published in the British Menopause Society Journal. Dr. Molefi is also an international keynote speaker on women's health and provides menopause in the workplace training to help women thrive.
Navigating the complex connection between menopause and mental health can feel overwhelming, but it's crucial to remember that you are not on this journey alone. These symptoms are real, they are physiological, and you do not have to simply "put up with it." Understanding why you feel this way is the first step; the next is seeking expert, compassionate support. If you are ready to feel like yourself again, we invite you to book your complimentary consultation with one of our specialists in one of our multi-award winning Aesthetics & Wellness clinics. We are here to listen and help you build a personalised plan to restore your balance, your wellbeing and your confidence.
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