Written by Cassie Hart
Hormones affect women in different ways throughout much of their lives. In fact, you can count on over 40 years of hormonal ups and downs, from puberty through menopause.
These miniscule but mighty chemical messengers influence a number of processes in the body, including cognitive functions, body temperature maintenance, and mood stability. Hormones fluctuate quite a bit during periods, pregnancy, and childbirth, but the most dramatic shift begins with perimenopause (the months or years leading up to menopause) and continues through menopause (the end of menses and fertility).1
Many women begin experiencing menopausal symptoms in their mid-40s, but some are affected as early as their 30s.2 Mood swings and other emotional shifts are common during this transitional time, so if you’re experiencing a mess of feelings, know that it isn’t unusual—and you definitely aren’t alone.
What Causes Depression, Anxiety, and Irritability During Menopause?
Hormonal volatility contributes to cognitive disturbances during menopause, including mood swings, fatigue, loss of memory, and concentration issues. A combination of these symptoms can lead to mental distress: you may feel worried, irritable, or anxious. You may even have intense physical reactions to thoughts or situations that never bothered you before.3 And when symptoms overlap and are compounded, increased anxiety and even depression may occur.
“Perimenopause is a window of vulnerability,” says Dr. Stephanie Faubion, Director at the Mayo Clinic Center for Women’s Health and Medical Director for The North American Menopause Society (NAMS). "This is true in women even if they have never had a prior episode of depression. We don’t know exactly why this is, but variable estrogen levels at this time may contribute.” Women who have had major depression in the past have the greatest risk for a recurrence during perimenopause or menopause, but even those without a history of depression may experience depressive symptoms.
Stress During Menopause Can Worsen Symptoms
Feeling uncomfortably warm? Hot flashes (a sudden feeling of warmth in the head, neck, and chest) are a classic menopause symptom caused by decreased estrogen.4 “Vasomotor [causing or relating to the constriction or dilatation of blood vessels] symptoms may cause difficulty with sleep in the menopause transition,” Dr. Faubion explains. Hot flashes can occur anytime, but nighttime episodes, also referred to as night sweats, can cause higher daytime stress levels due to sleep loss. Because really, who can get a good night’s rest when you wake with sweat-soaked sheets several times a week?
Non-hormonal circumstances can raise stress levels, too. “Menopause [is] a uniquely challenging time,” Dr. Faubion says. “Many women experience stressors such as caring for aging parents, death of parents, medical illness in themselves or family members, children leaving home, and changes in marital status (divorce).”
When you factor in children who still need assistance, parents requiring care, and women navigating their own careers—well, that’s a lot to deal with. It’s no wonder women approaching menopause frequently feel and experience irritability, mood swings, anxiety, and/or depression.
Who’s at Risk for Menopause Depression and Anxiety?
Not all women are affected negatively by menopause symptoms. But enough are—more than 85%4—that it’s worth taking a look at who is most likely to suffer from mental distress.
While women with a history of anxiety and depression have the highest risk of these issues recurring later in life, other stress factors should be considered as well. According to Dr. Faubion, menopause-related depression and anxiety are more likely to affect women who:
- Are low income
- Lack social support systems
- Are experiencing adverse life events
- Have a history of postpartum or premenstrual depressive symptoms
If you're female, over age 30, and match any of these categories, be sure to pay close attention to how you’re feeling and seek help if things don't seem quite right.
How to Treat the Symptoms
The good news is that help is available for women seeking support for their mental health during menopause. Consider consulting your general practitioner, gynecologist, or mental health specialist if you have any of the following symptoms:
- Persistent feelings of sadness, discontent, or hopelessness
- Trouble sleeping or sleeping more or less than usual
- Difficulty concentrating and making decisions
- Weight loss or gain
- Low energy or lack of enjoyment in usual activities
- Thinking of death or having thoughts of suicide
A variety of treatments and support services are available, such as talking with a therapist, prescribed antidepressants, estrogen-based therapies, and management for sleep disorders. But the only way to find the right treatment is to have an honest talk with your healthcare provider. They can then help you find the best course of action to manage your symptoms.