What is Menopause?
Menopause is a normal part of ageing. It is caused by changes in the balance of sex hormones where the ovaries produce less oestrogen, and no eggs are available to be released.
This process typically starts when women are between 45 and 55 years of age, although early menopause (premature menopause) can occur before 40.
The first most noticeable symptoms are periods becoming less and less frequent. They may also be less or more intense and more irregular.
Symptoms of Menopause
When a woman is in menopause, she can experience an array of physical and psychological symptoms, which can be very similar to premenstrual syndrome (PMS) and can significantly impact day-to-day life.
First symptoms usually occur a few months to a few years before the onset of menopause and can last about four years or more after the last period. This period is called perimenopause and can start as early as ten years before menopause.
Some of the most commonly described physical symptoms of menopause include:
- irregular periods
- hot flushes
- night sweats
- vaginal dryness and discomfort during sex
- difficulty sleeping
- weight gain and slowed metabolism
- thinning hair and dry skin
- loss of breast fullness
- reduced sex drive (libido)
Although the physical symptoms are the primary way menopause is diagnosed, mental health symptoms are widespread with women undergoing menopause.
Some of the most commonly described mental health symptoms of menopause are:
- problems with memory and concentration
- mood changes
- low self-esteem
- thoughts of ending one’s life
- brain fog
Mental Health Symptoms of Menopause
Although not talked about as much as the physical symptoms, menopause can have a profound impact on your emotional wellbeing.
As your body changes physically and there are more hormonal deficits happening, these changes can make you feel anxious, depressed, irritable or stressed. For some, low motivation, decreased self-esteem or memory and concentration problems, often called a ‘brain fog’, can also occur.
Naturally, feeling this way can be pretty unsettling, especially as these symptoms typically occur a few months or even years before the onset of menopause and are not commonly recognised as such until later in the process, when physical symptoms kick in.
However, how one experiences the psychological symptoms of menopause closely depends on one’s life circumstances, as many stressful life transitions can be happening at the same time. Some life transitions include children leaving home, divorce, retirement, parents’ illness or death, and physical ageing.
Menopause and Depression
Research suggests that the incidents of depression double during menopause, suggesting a strong link between the two. Just as hormonal changes may impact your mood during puberty and the period cycle, they can also have an effect during menopause.
If you struggled to regulate your mood before menopause, an increase in depressive symptoms could be more likely during menopause. Physical symptoms, such as hot flushes or night sweats, can often cause disturbed sleep, making you more tired, irritable, less motivated, and less able to focus or remember things.
Menopause and Anxiety
Although there is no clear link between menopause and increased anxiety, many women report heightened worry or panic attacks during this period. Some scientists believe these may be misinterpreted symptoms of hot flushes, which can be similar to a panic attack, increased heart rate, sweating and feeling hot. These experiences can often be preceded by thoughts of something terrible about to happen.
Menopause and Brain Fog
Brain fog is often characterised by difficulties in remembering things, focusing, or attending to things, creativity, or problem-solving issues. Women can start questioning their ability to perform as mothers, partners, experienced professionals and begin doubting themselves. They can become frightened and worried that there is something really wrong with them. These symptoms can be similar to those of dementia, so it’s common to worry that dementia is the cause.
Menopause and Stress
Many women find the time around menopause stressful. Physical symptoms brought about by menopause and the changes associated with them can be stress-inducing in themselves. On top of that, demands of everyday life and additional stressful life events are often co-occurring. Prolonged and continuous stress can profoundly affect our physical (e.g., heart or gastric problems) and mental health (e.g., depression or anxiety).
Treatments for Menopause Symptoms
There are many ways to treat the symptoms of menopause, including physical and psychological interventions.
Physical Treatments for Menopause Symptoms
Most common is hormone replacement therapy (HRT), which relies on tablets, skin patches, gels, and implants to relieve menopausal symptoms by replacing oestrogen. Vaginal oestrogen creams, lubricants or moisturisers are also often prescribed for vaginal dryness.
There used to be a widespread belief that HRT would increase the chances of developing some cancers. Still, the chances of developing those cancers through HRT is usually much smaller than common lifestyle choices (e.g. drinking alcohol regularly, overeating).
Even though HRT may resolve the mental health difficulties of some women, for those who don’t want to use HRT or are not eligible, mental health treatments can offer relief. Psychological therapies for menopause may also help those who don’t improve on HRT.
Psychological Treatments for Menopause
Cognitive behavioural therapy (CBT) is one of the recommended treatments for symptoms of anxiety and depression. It looks at how feelings, thoughts and behaviour influence each other and how unhelpful thinking patterns can be changed.
Additionally, and to reduce stress, mindfulness and breathing techniques can also be taught and practised. These strategies can help one live in the moment, refocus their attention and help someone feel calmer and more present.
Furthermore, when going through menopause, lifestyle must remain optimal to reduce the chances of mental health difficulties being caused by lifestyle choices. Eating a healthy and balanced diet and exercising regularly could ease some emotional symptoms. Getting enough rest and making sure that you plan times for self-care and relaxing are also helpful in easing the mental health symptoms and allowing you to feel more in control.
Finally, it’s important to have the chance to talk about how you feel to other people. That trusted person could be a family member, a friend, a therapist, or a group of women going through menopause themselves.