The influence of hormones on a woman’s emotional well-being is well-known. It should come as no surprise then that women are particularly vulnerable to mood changes in menopause.
The symptoms that may come with the menopause transition are varied and interconnected. While hot flashes and vaginal dryness may be expected, hormonal fluctuations can also impact sleep, energy, body composition, and libido. When these symptoms are accompanied by mood changes, it can be more difficult to cope with the impact menopause often has on emotional wellness, body image, self-confidence, and relationships.
There is a tendency to downplay the significance of mood-related menopause symptoms because menopause is a normal and expected stage of life for women. But health experts warn against ignoring emotional issues during this period of vulnerability. Fortunately, forward-thinking health care providers are increasingly in tune with the needs of women and able to offer better treatment options.
The Connection Between Hormones and Mood
The influence of hormones on mood is often first evident in adolescence, when ovarian hormones are believed to interact with neurotransmitters that impact mood, behavior, and cognitive function. This leads to unique vulnerabilities throughout your reproductive years, both in terms of transient mood symptoms and mood and anxiety disorders:
- From puberty onward, depression becomes twice as prevalent in females as in males.
- Premenstrual syndrome affects over 90% of women at some point in their lifetime and may cause transient but severe symptoms of anxiety, depression, and irritability.
- Premenstrual dysmorphic disorder affects approximately 3-8% of women, causing severe symptoms that interfere with everyday functionality.
- Perinatal mood and anxiety disorders are the #1 complication of pregnancy and childbirth, affecting an estimated 20-25% of women.
However, many women experience the most significant hormonal impact on mood as the reproductive years begin to dwindle. The North American Menopause Society (NAMS) has described perimenopause, including the early and late menopause transition stages and the early postmenopause period, as “a window of vulnerability for the development of both depressive symptoms and major depressive episodes.”
- New diagnoses of depressive and anxiety disorders are common during this time.
- Women with a history of depression are up to 5 times more likely to experience a major depressive disorder during this time.
- Perimenopause and early postmenopause are associated with more severe mood symptoms in women with bipolar disorder.
Of course, not all mood changes in menopause and perimenopause are symptoms of a mental health disorder. Likewise, not all are the direct result of hormones; loss of fertility, aging, and physical menopause symptoms can all have a profound effect on your psychological well-being. But all symptoms should be taken seriously.
Addressing Mood Changes in Menopause
Mood changes in menopause can be deeply distressing. Even relatively mild disturbances can impact your sense of self, your work, and your most intimate relationships. Getting the right support to buoy you through this time is essential for preserving your quality of life. What that support looks like will vary from person to person, but options include:
Psychotherapy
Psychotherapy can be an invaluable part of a comprehensive treatment plan for mood changes in menopause. A therapist with experience supporting women in midlife will create a safe space for you to explore your emotions, gain greater insight into your experiences, and develop meaningful coping strategies. While many modalities are available, individual or group cognitive behavioral therapy (CBT) is often recommended for women struggling with mood changes or anxiety during the menopause transition.
Mindfulness Practices
Mindfulness practices, including relaxation techniques, breathing exercises, and meditation, can be very helpful for women struggling with menopause. A 2021 study found that short-term mindfulness exercises improved psychosocial symptoms, leading to an immediate improvement in quality of life that persisted at least three months post-intervention. An earlier study found that mindfulness exercises “mitigate stress by avoiding emotional reactivity and ruminative thinking.” Greater mindfulness and lower stress correlated with a reduction in menopausal symptoms, particularly psychological symptoms.
Psychotropic Medication
There are many psychotropic medications available to treat depression and anxiety, including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications can be powerful tools for women who are experiencing mood disturbances. However, they may have little impact on other menopause symptoms. Additionally, side effects like sexual dysfunction and weight gain are not uncommon, which can make them less desirable to women in midlife. You and your doctor should always weigh the risks and benefits of specific treatment options while maintaining open communication to determine if a particular medication is right for you.
Hormone Replacement Therapy
Hormone replacement therapy (HRT) has been used for decades to address an array of menopause symptoms and reduce the risk of health conditions like osteoporosis. If your mood changes are caused by hormonal fluctuation or decline, HRT can be an important addition to your treatment approach. According to NAMS:
Although estrogen therapy is not approved to treat perimenopausal depression, there is evidence that it has antidepressant effects in perimenopausal women, particularly those with concomitant vasomotor symptoms.
Since menopause-related depression may be more severe and treatment-resistant, some experts believe that women diagnosed with depression are best served by combining antidepressants with hormone therapy (HT). As one study notes, “The combination of the antidepressant with HT seems to offer the best therapeutic potential in terms of efficacy, rapidity of improvement, and consistency of remission.”
While these approaches are considered the best ways to address mood changes in menopause, some women also incorporate exercise, acupuncture, herbal medicine, and peer support in their treatment plans.
Achieving Balance
The menopause transition is a time of unique psychological vulnerability. Those who experience mood disturbances or anxiety for the first time may be unsure of where to turn for help as they navigate unfamiliar emotions. Women who have had existing mental health diagnoses may require additional support and new treatment strategies.
Increasing awareness of the complex connections between hormones and mood changes in menopause has led to better screening, more effective treatment, and more personalized care. However, since each woman‘s menopausal journey is unique, finding a knowledgeable and compassionate doctor is essential. The right doctor will address both your physical and emotional concerns, develop a personalized treatment plan, and can collaborate with your existing supports to help you thrive.
