Emotional & Mental support
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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
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Telling your Partner you want a Separation or Divorce
Regardless of who has made the decision or how your relationship has been to date, telling your partner that you want a separation or divorce is likely to be one of the most difficult, painful and memorable conversations you are likely to ever have. It is often a conversation that both parties remember clearly for the rest of their lives, so take some small steps to get it right.
It is important to realise that the way in which you discuss this may set the tone for your future discussions and potentially increase OR decrease your chance of positively negotiating your future conversations regarding financials, family and the next phase of your lives.
TIPS
Planning the discussion
• Have you considered having counselling together or at least personally speaking with a counsellor, psychologist, separation coach to help you consider your emotions, options and plans. Family Counselling Support Network can assist. www.familycounsellingsupportnetwork.com. Speaking with your GP is often also highly recommended to ensure there are no medical reasons contributing to the way you are feeling.
• Make sure you are certain of your final decision before you break the news to your partner as it is very stressful and often emotionally difficult to come back from this type of disclosure if you change your mind.
• Consider what will be the best day, time and conditions to have this discussion so it is as amicable, respectful and calm as possible under the difficult circumstances. Ideally it should be done face to face (not via a text, a note, or via a third party) and when no one else is home, especially children. You may choose to go to a neutral place such as coffee in a park where you aren’t distracted or conscious of being the object of attention. Most importantly, make sure that your intention is not blurted out in the middle of heated discussions and avoid late at night or on a day which corresponds with important events such as celebrations or family holidays.
• Consider how will you remain safe throughout this discussion and afterwards? Do you need to consider having the discussion in conjunction with a counsellor? If you are leaving an abusive or violent partner, do you need a safe exit plan, a restraining order or emergency accommodation assistance? In an emergency call police 000.
• Have you considered your partner’s reaction, the likely questions that you will be asked and how you will respond to them? Are they likely to be surprised? Deeply emotional? Aggressive? Some people consider marriage a lifelong commitment and may be really surprised by your announcement. Often people are in denial and do not seem to absorb what is being said and perhaps the finality of your decision. Watch for the possible breadth of reactions, acknowledge their feelings and show empathy.
• Who is staying in the home and who is potentially leaving, and where the children and pets will immediately go, are likely to be the first issues raised. It is important to have thought through these issues so that solutions are more easily explored.
Planning the discussion
• When delivering your decision to separate or divorce, the key is to be kind, direct and not highly emotional. Examples of how you might raise it include, “I am unhappy and would like to live apart for six months. During that time, I am open to having more counselling to see if we can make it work.” Or “We have tried counselling but unfortunately I am still not happy and I would like to move towards a more permanent step to separate” or “I have been unhappy in our relationship for a long time and I would like to see if being apart improves things for us all.”
• Then deliver the terms, for example, “I would like you to live at your parents for a few weeks and I can remain here with the children until we work out the next steps”, or “I am going to visit my parents for the week to give you time and space to move out,” or perhaps if you are amicable and it is safe, you could suggest, “You are welcome to stay in the other bedroom until we sort out what we are going to do next.”
• Regardless of how the other person reacts, try not to get highly defensive, blaming and remember to acknowledge their emotions. Try to remain calm and supportive and continue to state your position - “I am sorry, I know this isn’t what you want to hear but we have tried our best, and I can’t do this anymore and I want to separate."
• Give your partner time and space to process what you have said. Don’t immediately proceed with details of what you are proposing in terms of parental and financial settlements, but it is a good time to suggest you want to work with them to ensure you sort things out as amicably as possible as you move forward.
• Try to calmly agree together on how and when to tell the children and other family members and friends, allowing a respectful period of time to digest the details.
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