Changes to your mental health are very common during perimenopause and beyond. During the years leading up to menopause, as your body prepares to stop having periods, your naturally fluctuating hormone levels begin to decline. This can have an impact on both your body and your mind.1 But, while you may have expected symptoms like hot flushes and night sweats, these psychological changes are typically less often talked about and may have taken you by surprise.
Like other symptoms of the menopause, mental health changes are caused by declining and unstable levels of the hormone oestrogen in your body during the transition period known as perimenopause. Among other things, oestrogen plays a role in the production of ‘feel-good’ hormones like serotonin, which is important for managing your mood.2 Just as you may have experienced mood disturbances during puberty, pregnancy or during the postnatal period, the hormonal changes occurring at perimenopause can also send your emotions off kilter.
It’s also worth bearing in mind that perimenopause often coincides with other challenging midlife events, which can have an aggravating effect on these hormonal mood changes. You may be dealing with ‘empty nest syndrome’, with adult children leaving home or going off to university. This not only means a big shift in your family role as a mother, but may also bring a new dynamic to your relationship with your partner.
Similarly, you may find yourself taking on more senior roles at work, or caring responsibilities for ageing parents, as well as grappling with the physical changes taking place in your body. Don’t underestimate the effect all these situations can have, particularly if your mental health already feels more fragile than usual.
Like many hormonal issues, people will experience perimenopausal mood changes differently3
Psychological symptoms can include:
- Low mood or depression
- Loss of confidence, identity or self-esteem
- Low energy
- Sleep disturbances
- Problems with memory and concentration – sometimes referred to as ‘brain fog’
Psychological symptoms can include:
Many of these will interact with the other things going on in your life. For example, weight gain or other physical changes to your body may well have an impact on your confidence and self-esteem. The challenges of taking on more responsibility in your personal and professional life can add to feelings like anxiety and irritability, while trying to juggle too much could affect cognitive symptoms like ‘brain fog’.
However, just because you’ve got a lot of other things on your plate, that doesn’t mean the hormonal roots of these symptoms shouldn’t be taken seriously. If you’re struggling with your mental health during perimenopause, there are both medical treatments and lifestyle changes you can try to help manage your mood.
If you suspect that your mental health symptoms are related to the menopause, your first port of call should always be your GP. Treatment guidelines by the National Institute for Health and Care Excellence (NICE) recommend considering hormone replacement therapy (HRT) and/or cognitive behavioural therapy (CBT – a type of talking therapy) to treat psychological symptoms of menopause.4 Antidepressants shouldn’t be offered as a first-line treatment for perimenopausal mood changes.
HRT works by topping up your hormone levels and, for most people, evidence shows the benefits of using it outweighs any risks.5 CBT is a non-pharmaceutical option, which you could try alongside or instead of HRT. It works by providing a safe space for you to talk about your difficulties and develop coping strategies to help you manage better in everyday life.
There are also self-help techniques you can try, including mindfulness and breathing exercises, or relaxing activities like yoga and tai chi.6,7 These can provide you with calming techniques for when it all feels a bit much, as well as carving out a vital bit of ‘me time’ and helping to improve your sleep and relaxation.
Likewise, repeating positive affirmations to yourself, like ‘I am strong and capable’ or ‘I can do this’, could help if you’re struggling with low confidence and self-esteem, or finding it difficult to adapt to changing roles and identities in your personal and professional life. While it might make you feel self-conscious at first, research suggests self-affirmation can have a positive impact, reducing stress and increasing feelings of self-worth.8
Finally, whatever you choose to try, remember that you’re not alone and don’t need to suffer in silence with perimenopausal mental health issues. While these symptoms are very common, they’re not something you simply have to put up with, and there’s no shame in seeking out whatever help and support you need.
The advice in this article is for information only and should not replace medical care. Please check with your GP or healthcare professional before trying any supplements, treatments or remedies. Food supplements must not be used as a substitute for a varied and balanced diet and a healthy lifestyle.
Last updated: 29 September 2022