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Too often, society treats the symptoms of menopause as fodder for jokes. But the link between menopause and mental health is no laughing matter. During menopause, people may deal with real and severe mental health issues.

What’s unclear is whether menopause can cause mental health issues, such as depression. Or if getting older leads to these mental health changes.

That may surprise you, but clinical research on women’s health issues, including menopause, is still fairly new. Here’s what you should know about how menopause affects women’s mental health.

What Is Menopause?

Menopause is a biological process signifying the end of a person’s menstrual cycles, confirmed after 12 consecutive months without a period. Perimenopause, also referred to as the menopausal transition, is the phase before menopause when the body starts to experience hormonal changes.

Perimenopause is characterized by several changes. Menstrual cycles can become irregular, with periods that may be longer, shorter, heavier, or lighter. Hormonal fluctuations are common, with levels of estrogen and progesterone varying widely. Many people experience symptoms such as hot flashes, night sweats, sleep disturbances, mood swings, and vaginal dryness.

How Menopause Affects Mental Health

It’s normal to feel mood changes before, during, and after menopause. You aren’t alone if you feel this way. But that doesn’t mean menopause is causing these mood changes.

According to the North American Menopause Society (NAMS), there isn’t proof menopause causes clinical depression, severe anxiety, or erratic behavior. The vast majority of women go through menopause without getting a major mood disorder.

According to the American College of Obstetricians and Gynecologists, approximately four in 10 women experience mood symptoms during perimenopause.

Menopause and depression

Depression is a serious mood disorder that makes people feel very sad or down for at least two weeks. How menopause and depression are connected isn’t entirely clear.

A 2018 review found that depression is especially common during the transition to menopause. Women are two to five times more likely to be depressed during perimenopause than before. However, this risk goes down two to four years after their last period.

Menopause-related stress

Life stressors may add to the risk of depression and anxiety during mid-life. Dealing with menopause-related symptoms may cause or add to the stress. Chronic stress can lead to or worsen mental health issues.

And mental health issues can make it harder to manage menopause symptoms. Women with high levels of anxiety and depression are also more likely to have night sweats and hot flashes. And women who have anxiety or depressed mood also report having a harder time dealing with these symptoms.

Treatment For Mental Health Issues During Menopause

Treatment for mental health issues often includes a mix of psychotherapy and medication.

It’s also vital to get menopause symptoms under control. That can help you reduce related stress and improve your well-being.

There are three major treatment options to manage menopausal symptoms and mood changes. They include:

• Antidepressants.
• Psychotherapy.
• Lifestyle changes.

Antidepressants

Several antidepressants can improve both mental health and menopausal symptoms.

• Paroxetine (Brisdelle^®) is the only antidepressant and non-hormonal therapy that is FDA-approved for hot flashes.

Research shows that several antidepressants like citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, sertraline, and venlafaxine work well and are generally well tolerated at normal doses. If someone has had depression before and found relief with a specific antidepressant, that can help guide which one to choose if depression comes back during midlife.

Lifestyle changes to menopause

Lifestyle changes can also help you manage menopausal symptoms and improve your mood.

• Eat a balanced diet.
• Practice relaxation techniques.
• Stay cool and hydrated.
• Prioritize good sleep habits.
• Stay connected with loved ones.
• Seek support when needed from health care providers or support groups.

The current evidence does not support recommending any botanical or complementary/alternative approaches for treating depression associated with perimenopause.

Hormone replacement therapy (HRT) is not approved by the Food and Drug Administration for treatment of mood disorders. It can have other side effects that might affect mood, such as mood swings and low mood.

When to See Your Doctor

Many women try to handle menopause and mental health issues on their own. But you don’t have to struggle alone or in silence.

Talk to your doctor if you have mental health issues during menopause. Untreated depression can cause symptoms, including:

• Headaches.
• Fatigue.
• Insomnia.
• Higher risk of self-harm and suicide.

Your doctor can check that other health issues aren’t causing mood changes. They can also refer you to an expert to help manage your mental health.

Menopause-related depression is a complex problem needing mental health expertise. Your mental health worker will consider all your health needs and manage your care. They will know best how to work through menopause depression.