Perimenopause, Menopause, and Mental Health: Understanding the Hidden Struggles

In my mid 30’s I went through the loss of my mother, a divorce, my master’s program and becoming a licensed therapist, getting remarried, moving and becoming a step-parent. Whew. It’s easy to brush off the physical and emotional changes and challenges that occur during such an important decade of our lives as normal or expected. I never even thought that I might also be struggling with the impact of something biological and not my “fault”, perimenopause!

The transition into perimenopause and menopause can bring significant changes to a woman’s physical health. Much of this process, including the impact on women’s mental health, continues to go overlooked. As hormonal shifts occur, women may experience a wide range of emotional and psychological effects, including anxiety, depression, and mood swings. Understanding these mental health impacts is crucial, as they can severely affect daily life and well-being.

What is Perimenopause and Menopause?

Perimenopause is the transition period leading up to menopause. Believe it or not, this can begin as early as 35 and typically begins in our 40’s. During this phase, the body starts producing less estrogen and progesterone, causing irregular menstrual cycles and a variety of physical and emotional symptoms. Menopause is reached when a woman has gone 12 months without a menstrual period, usually occurring in her late 40s or early 50s.

While most women expect physical symptoms like hot flashes, night sweats, and sleep disturbances during menopause, fewer are prepared for the emotional toll that can accompany these changes. Many spend years in their mid to late 30’s feeling like they are doing something wrong or experiencing changes that are somehow their fault. Perimenopause and menopause can exacerbate underlying mental health conditions and increase the risk of severe emotional distress.

Hormonal Changes and Mental Health: What You Should Know

The hormonal fluctuations during perimenopause and menopause directly impact neurotransmitters in the brain, particularly serotonin and dopamine, which regulate mood. This can lead to symptoms such as:

• Increased anxiety
• Depressive episodes
• Irritability or mood swings
• Difficulty concentrating (often referred to as “brain fog”)
• Insomnia and fatigue

For women already dealing with mental health conditions, such as anxiety or depression, this stage of life can exacerbate these issues, making it harder to cope with day-to-day stressors.

Perimenopause, Menopause, and Severe Mental Illness

Recent research has shed light on the more serious mental health risks associated with perimenopause and menopause. According to an article published in November 2023 by Cambridge University Press titled “Severe Mental Illness and the Perimenopause,” there is growing evidence that hormonal changes during this phase can trigger or worsen severe mental illnesses, such as bipolar disorder or major depressive disorder. The article highlights that women experiencing these conditions are at an increased risk of hospitalization and psychiatric intervention during the perimenopausal transition.

This research underscores the need for us to monitor our mental health closely during perimenopause and menopause, particularly for women with a history of mental illness. By recognizing these risks early, both patients and clinicians can take proactive steps to manage symptoms and prevent severe outcomes.

The Risk of Suicide: A Startling Reality

One of the most alarming statistics regarding mental health during perimenopause and menopause is the increased risk of suicide. Studies have shown that middle-aged women, particularly those aged 45-54, have the highest rate of suicide among women in the United States. In fact, during perimenopause, a woman’s risk of attempting suicide may increase by up to threefold compared to premenopausal women.

It’s important to remember that the same phase of life where women are going through such a huge biological change can also be the same time that they are dealing with major life stressors like life career changes, caregiving responsibilities, or relationship challenges. This can create the perfect storm for emotional distress. Without proper support, some women may feel overwhelmed and unable to cope, making it critical to address the mental health implications of this life stage.

How to Support Your Mental Health During Perimenopause and Menopause

If you or someone you know is experiencing mental health challenges related to perimenopause or menopause, it’s essential to seek help and utilize strategies to manage these symptoms. Here are some tools and resources you can use:

1. Talk to a Healthcare Provider

Open communication with a healthcare provider about your mental health during this time is vital. This includes your primary care doctor, gynecologist, or a mental health professional. Discussing your symptoms can help identify potential treatment options, including hormone replacement therapy (HRT), which has been shown to relieve both physical and emotional symptoms in some women. Many women have been scared away from trying HRT due to a misinterpreted and misleading study done in 2002 which presented risks such as increased risk of cancer, heart attacks and strokes. There are providers and agencies now that specialize in working with women during this phase of our lives that can more fully discuss the latest research with you. 

2. Therapy and Counseling

Therapy is a valuable tool for navigating the emotional ups and downs of perimenopause and menopause. Cognitive Behavioral Therapy (CBT) has been particularly effective in helping women manage mood swings, anxiety, and depression during this stage. Developing self compassion and mindful awareness can be particularly helpful during perimenopause and menopause. 

3. Prioritize Self-Care

This is a time to focus on self-care practices that promote mental and physical well-being. Regular exercise, mindfulness meditation, and maintaining a healthy diet can have a positive impact on mood and stress levels. Consider incorporating relaxation techniques like deep breathing or yoga to help reduce anxiety and improve sleep quality.

4. Build a Support System

Navigating menopause can feel isolating, but you’re not alone. Lean on friends, family, or support groups to share your experiences and receive encouragement. Talking with others who are going through the same thing can be immensely helpful in normalizing what you’re feeling.

5. Monitor for Signs of Severe Depression

If you notice signs of severe depression, such as feelings of hopelessness, withdrawal from loved ones, or thoughts of self-harm, it’s critical to seek immediate help. Don’t wait to get support—reach out to a therapist, call a helpline, or go to an emergency room if needed.

You’re Not Alone—We Can Help

If you’re experiencing emotional distress during perimenopause or menopause, know that you don’t have to go through this alone. As someone who has been going through perimenopause myself, I could not be more dedicated to supporting women as they navigate the mental health challenges that come with this stage of life.

Whether you’re dealing with mood swings, depression, or anxiety, I’m here for you. Reach out today to schedule a session, and take the first step toward reclaiming your mental well-being.