Women going through the menopausal transition are at a higher risk of mood changes and symptoms of depression and anxiety.

Common physical, emotional and cognitive issues related to menopause can complicate and overlap with mental health symptoms.

Stress related to life circumstances can also complicate understanding whether changes in mood and mental health are related to menopause.

Having an open discussion about your symptoms, life circumstances and mental health history can assist your doctor in offering suitable treatment options and lifestyle changes.

Therapies proven for the broader population are also suitable for mental health symptoms related to menopause – medication, psychological therapy and lifestyle changes.

While not a problem for everyone transitioning through menopause, the risk of mood changes and symptoms of depression and anxiety are higher during perimenopause, even in women without a history of major depression.

While the risk is higher for women in the age-related and natural menopausal transition, women might also have a higher risk of mood changes after menopause caused by surgery such as hysterectomy or if the ovaries have been removed. Depression also occurs at a higher rate in women with a lack of oestrogen caused by primary ovarian insufficiency.

Mental health symptoms related to menopause

Mental health symptoms related to menopause can include feeling:

irritable, sad, anxious, hopeless

stuggling to focus, concentrate, forgetful,

tired, unmotivated

Some women might experience these symptoms in a mild form which others unfortunately may suffer more severe symptoms of depression (including thoughts of suicide) lasting for at least two weeks. This is known as a major depressive episode and is more likely in women who have a history of major depression during their pre-menopausal years.

While many women do not have mental health issues during the menopausal transition, unstable oestrogen levels can have an impact on the brain, predisposing some women to feelings of depression and anxiety.

Some of the common physical, memory and thinking symptoms related to menopause (hot flushes, night sweats, sleep and sexual disturbances, weight changes and “brain fog”) can complicate and overlap with mental health symptoms.

Another complicating factor is stress related to life circumstances. Feeling stress is common during middle age as personal and environmental changes take place. This can have a strong effect on mood in some women. Life circumstances that can impact mental health include caring for children, teen issues, carers for elderly family members, career changes, body changes, illnesses, pre-existing ADHD, relatonships, pain levels, medication.

The menopause transition is an ideal time to look at your health and consider lifestyle and other changes so that you can live the healthiest possible lifestyle.

Untangling physical and mental health symptoms related to menopause

For some women, mental health issues and other changes can begin to affect how they live their lives. Your doctor can take a holistic approach to your health to help you untangle the web of symptoms around physical and mental health changes.

Understanding mental health during perimenopausal and postmenopausal changes can include:

identifying your stage of perimenopause / menopause and any physical and cognitive symptoms

discussing your history of mental health symptoms

discussing your current mental health symptoms

understanding any lifestyle factors that could affect your mood – for example, lack of sleep and exercise understanding other stressful life circumstances contributing to your symptoms – for example, caring for children and parents, career and relationship changes, body changes and illness.

When you see your GP/specialist it is important to explain the realm of menopausal symptoms you are experiencing as well as your life circumstances and clinical history so that they can help them to recommend the best treatment options and lifestyle and behavioural changes for your situation.

Treatment options for mental health symptoms

Lifestyle changes to assist with managing mental health are similar to those recommended for menopause-related physical changes. Changes that can help with mental health symptoms include:

ensuring healthy levels of physical activity

improving sleep

considering changes to decrease stress associated with life circumstances

limit alcohol intake

Psychological therapies and social supports can be beneficial to women with mental health symptoms.

Women should have an individualised assessment with their doctor in order to discuss the most appropriate treatment pathway. Options may include lifestyle changes, psychological therapies and medications such as menopausal hormone therapy (MHT) or antidepressants.

While some international guidelines do not recommend MHT as firstline therapy, many doctors have seen a positive effect on mood with the use of MHT in the first instance.

There is evidence that oestrogen has antidepressant effects, particularly in perimenopausal women. We emphasise an individualised approach with treatment tailored to the individual patient.

Oestrogen is not recommended for women with a history of breast cancer.

At this stage, there is no evidence to recommend alternative or complementary therapies for treatment of perimenopausal depression.

Where can you find more information?

If your mental health or other symptoms are bothering you, your doctor can help. Your doctor can help you understand physical and mental health changes and offer options for managing your sympt

Help for depression and mood changes?

If you have severe mental health symptoms or symptoms of depression and have thoughts of suicide, help is available.

Lifeline – Phone 13 11 14

beyondblue – Phone 1300 22 4636