We’re all familiar with the physical symptoms of the menopause — hot flushes, night sweats and vaginal dryness — but the mental and emotional side can often be overlooked, or even belittled.
It’s true, though: the menopause can play with our mood and affect our mental health significantly. As with all other menopause symptoms, it’s down to those hormones. Oestrogen fluctuations, in particular, have the potential to leave us feeling a bit down in the dumps, stressed out and more prone to anxiety.
Let’s take a look at how the menopause process is, in fact, intimately tied to our mental and emotional wellbeing. What are the key hormones involved and what can women do to enjoy a healthy, happy menopause?
What happens to your hormones during menopause?
During the menopause process, the ovaries naturally begin to produce less oestrogen, a female sex hormone. Levels in the body fluctuate, declining in an unpredictable, irregular fashion. The ovaries also begin to produce less progesterone, another female hormone, as well as less testosterone, a ‘male’ androgen hormone that exists in low levels in women.
These changes take place as we age. Most women experience the menopause process between the ages of 45 and 55; around this time, oestrogen levels naturally drop.
What are the main hormones involved in menopause?
The menopause is a natural biological process that involves a change in the balance of three key sex hormones — oestrogen, progesterone and testosterone.
Oestrogen’s role in the menopause
Oestrogen is absolutely central to the menopause process. All of the major symptoms we associate with the menopause are the result of falling levels of oestrogen in the body, caused by the ovaries naturally producing less of this primary female sex hormone as we age.
Oestrogen plays a role in the function of our reproductive system, our brain, our bones, our behaviour and even our immune system. Indeed, it is the most important hormone related to menopause and its symptoms. When less oestrogen is produced, the body behaves differently.
How oestrogen levels can fluctuate and gradually decline
You don’t stop producing oestrogen overnight, of course. As we get older, levels of oestrogen begin a slow natural decline. Known as the perimenopause, these hormonal changes usually begin in your mid-to-late 40s.
During these years, there is a diminishing release of oestrogen from the ovary — levels of the hormone fluctuate erratically and unpredictably, but decline over time. As they do so, menopause symptoms can arise gradually, with periods becoming less frequent.
After several years, a woman stops having periods. In the UK, the women reach this point at 51 years of age, on average.
Estradiol is the main form of oestrogen. Before the menopause, it exists in the body at 30-400 picograms per millilitre (pg/mL). After the menopause, it falls below 30 pg/mL. Levels in the body will remain at a consistent, lower level compared to before the menopause.
Progesterone’s role in the menopause
During a woman’s reproductive years, levels of progesterone in the body fluctuate in line with different stages of the menstrual cycle. During the menopause process, average levels of progesterone follow a similar pattern to our oestrogen: a gradual, natural decline before plateauing at a lower level.
Progesterone is important for reproduction; it prepares the uterus for an egg and helps to sustain early-stage pregnancy. If you’re pregnant, your progesterone levels will be substantially higher. It also plays a role in blood pressure regulation, sleep and our mood.
As part of hormone replacement therapy, progesterone is often combined with oestrogen to treat menopause symptoms.
Testosterone’s role in the menopause
Although it’s a ‘male’ androgen hormone, women do naturally produce low levels of testosterone. Levels peak in your mid-20s, before beginning a gradual decline. By the time of menopause, testosterone levels are at around half of the peak. Important for sexual health, the hormone plays a key role in oestrogen production, libido and bone health.
Research into low testosterone levels in women is still ongoing, but it is believed to lead to symptoms including sluggishness, fatigue, lower sex drive, sleeping troubles and weight gain — which can, quite understandably, have a knock-on effect for our mental health!
Even after the ovaries stop producing oestrogen, they continue to create testosterone. The adrenal glands, in partnership with the pituitary, also continue to produce testosterone after menopause. This can sometimes mean that levels of testosterone, although reduced, are relatively high compared to other hormones, known to be a possible cause for menopause hormonal acne.
A word on follicle-stimulating hormone (FSH) in the menopause
Follicle-stimulating hormone (FSH) is a protein made by the pituitary gland that stimulates ovulation. If you’re beyond the menopause, your ovaries will no longer respond to FSH — the pituitary reacts by sending out even more. As a result, high levels of FSH, coupled with no longer having periods, can be used as an indicator that you are menopausal.
Can menopause hormonal changes cause stress, anxiety and depression?
Vulnerability to depression, anxiety and stress is increased during the menopause transition, as well as the early years into the postmenopause. The impact of oestrogen deficiency on regions of the brain that regulate mood, cognition and stress response are implicated in this, but there is often an interplay between hormonal, social and health factors.
So, the answer: yes, menopause hormonal fluctuations can cause stress, anxiety and increase vulnerability to depression, but the reason a menopausal woman may experience mental health problems is often multifactorial and can be complex.
Hormonal changes during the menopause can affect our mood
Hormonal factors are understood to be major contributors to mood changes during the menopause transition. Our brain’s neurotransmitter systems — including serotonin, dopamine, epinephrine and norepinephrine — are directly regulated by oestrogen, a hormone which fluctuates during the menopause.
Scientists are increasingly confident that ‘hormonal changes associated with the menopausal transition are primarily responsible for the increased risk of depressive disorders’. Oestrogen plays a ‘facilitative role’ in managing our mood.
It is believed that the fluctuations are to blame. The risk of depression is 2–5 times higher during the early stages of the menopause process (when hormone levels are in flux) than it is after the menopause, when these hormone levels are low but stable.
These changing hormone levels can make us more likely to be psychologically affected by other adverse social, environmental, health and lifestyle events; hormonal changes can ‘reduce the threshold for depression in the presence of adverse life events’.
This confirms that whilst hormones play a key role in making menopausal women more susceptible to mood disorders, there’s a dynamic interplay between factors.
Social factors, attitudes and genes can play a role in menopause mental health, too
The years of the menopause can be a stressful time of life. Big life events, interpersonal problems (like divorce), financial issues, empty nest syndrome and a lack of social support can all place women at higher risk of depression in mid-life, compounded by hormonal fluctuations.
Your own personality traits — such as whether you’re a pessimist — is also a risk factor, with your genes playing a potential role in your predisposition to mental health issues during menopause. Even your level of education may determine your likelihood to suffer from menopause mental health problems.
Attitudes towards aging can also play a role. Particularly in Western cultures, there is a notion that aging (and the menopause) is a bad, non-womanly thing. In cultures that revere aging and experience, such as many in East Asia, fewer stress-related menopause symptoms are reported.
What does all this tell us? The risk of developing mental health problems during the menopause can be complex and multifactorial. Hormones and social factors all come into play, having the potential to compound one another.
Lifestyle factors and menopause mental health are also closely linked
Certain lifestyle behaviours — smoking, drinking, being overweight, sleep disturbance and a lack of physical activity — are associated with an increased risk of depression and anxiety in menopausal women.
Health conditions also play a role. Chronic pain, medical conditions, physical disabilities, hot flushes (resulting from fluctuating oestrogen levels) and a history of mental health issues are all risk factors for depression during the menopause.
Treatments and coping methods for menopause stress, anxiety and depression
Take up some exercise
It’s pretty much impossible to escape health advice about doing more exercise, but for good reason — science shows that it really does help menopausal women who may be suffering with their mental health.
Exercise causes an increase in blood circulation to the brain, modulating three important neurotransmitters: dopamine, serotonin and noradrenaline, leading to improvement in self-esteem and cognitive function.
There is a clear link between physical activity and decreased depressive symptoms in middle-aged women, independent of any pre-existing health problems.
- Menopausal women who perform moderate-intensity physical exercise report improvement in depressive symptoms, insomnia and sleep quality.
- Resistance training and aerobic exercise have a clear positive impact on psychological health and depression amongst menopausal women.
Exercise is perhaps the most clinically proven, simple and effective treatment for menopause depression.
This also ties up with other lifestyle changes. Depression during the menopause is associated with being overweight, smoking and excessive drinking, so taking steps to cut out some of the bad stuff may well be of benefit.
Talk through your troubles
A problem shared is a problem halved. The research is unequivocal: discussing your problems, worries and concerns works. Whether this is just over a cup of coffee with a couple of friends or as part of a structured mental health treatment program, talking is proven to ease menopause mental health problems.
- A good support network with an adequate number and quality of social relationships has been clinically proven to shield menopausal women from depression and depressive symptoms.
- Talking therapies, like group cognitive behavioural therapy (CBT), are ‘effective for reducing depression among menopausal women’ according to results from randomised trials.
Review your attitude towards the menopause
Could we start seeing the menopause as being ‘empowering’, rather than something to be ashamed, anxious or embarrassed about? Research suggests that those who do are less likely to report symptoms of stress — in cultures where age is more socially celebrated, menopause symptoms are less reported.
Whilst we’re not entrusting you with the sole responsibility of transforming society’s views towards the menopause, remember that normalising and discussing its challenges is something associated with improved mental health.
Try to get that eight hours’ sleep
Research shows that sleep disruption contributes towards vulnerability to depression in menopausal women. In one particular study, mid-life women who have sleeping problems are eight times more likely to report a pattern of depression!
Whilst night sweats can make getting quality sleep slightly easier said than done, you might benefit from a regular bedtime or reduced caffeine intake during the day to try and maximise the time spent capturing those forty winks.
Medications, therapies and other treatments
For moderate and severe cases of depression, get in touch with your doctor; they may recommend a course of medication, like antidepressants.
If you have other major menopause symptoms also causing you issues, your doctor may want to discuss hormone replacement therapy (HRT). As well as being proven to reduce hot flushes and improve sleep quality, randomised trials have shown that HRT can alleviate symptoms in women with perimenopausal depression.
Although not licensed for treatment, some women have also found that alternative and complementary therapies can help with menopause mental worries. St John’s wort in particular, derived from the dried leaves and flowers of the wild Hypericum perforatum plant, was shown to help improve psychological symptoms in menopausal women when one 900mg tablet was taken three times per day.
An all-in-one supplement specially formulated for menopausal women, like Cleanmarine MenoMin, can also work alongside other treatments and coping methods to help manage and minimise troublesome symptoms.
Enjoy a happy, healthy menopause
The menopause represents a challenging time of life; hormonal fluctuations often arrive alongside other life events and leave us more vulnerable to stress, anxiety and depression.
Many women find exercise and talking therapies to be a huge help for managing symptoms of a low mood. Other women may find that hormone replacement therapy and its benefits for hot flushes and improved sleep quality helps them to feel more like themselves.
For more insight-packed articles on the menopause, hormones, nutrition, fitness and much more, head over to The Menopause Blog.