The Impact of Menopause on Mental Health and Anxiety.

Menopause is a normal biological process, and it affects people in different ways. The hormonal changes that come with it can have a negative impact on their mental health. Women are twice as likely as men to develop clinical depression and anxiety, and this is often related to hormonal changes. There are three key hormones that fluctuate and reduce in the perimenopause and menopause. They play an important role in the brain:

Estrogen:

Estrogen helps control hormones which may have mood-boosting effects
such as serotonin, norepinephrine and dopamine. Additionally, estrogen
supports your ability to think clearly. When levels are low, it can cause
forgetfulness or brain fog, which can impair your mood. While some
research indicates that mood declines due to a drop in oestrogen levels,
other research suggests that it is the fluctuation of the hormones that may
be the cause.

Progesterone:

This hormone is important for your monthly cycle before the menopause.
It works in partnership with oestrogen to prepare the lining of the womb
and then shed it.

Progesterone also has a calming effect on your mood, promoting
relaxation and sleep. During perimenopause and menopause, the
deficiency of progesterone can increase irritability, mood swings and
cognitive fog. For individuals who are sensitive to progesterone, have
elevated levels might cause symptoms such as depression and decreased
motivation.

Testosterone:

Testosterone is not only a male hormone, it is produced by your ovaries. It
has a significant impact on your mental stamina, sleep quality, focus and
clarity of mind and concentration. When those functions are compromised,
it can therefore affect your overall health and stress levels. Additionally,
testosterone increases libido.

Psychological symptoms of perimenopause and menopause.

The cause of mood and emotion swings have been discussed, let’s take a
closer look at the variety of perimenopause and menopause-related
psychological symptoms and how they may affect your general health.

Depression

Hormonal changes can cause poor mood, however, this is not the same as traditional clinical depression. Research has indicated that over 50% of women in the perimenopausal stage report a rise in depressive symptoms, but also shows there are differences in the types of depression experienced by individuals at this stage of life.

The level of sadness may not be as low as in the case of non-hormonal depression, however, there may be increased irritability and anger, unwanted thoughts of worthlessness and concern for other’s opinions, feelings of guilt and intrusive thoughts that may even involve suicide. Menopause can cause an increased risk of depression.

Sadly, women between the ages of 45 and 54 have the greatest rate of female suicide. It would be overly simplified to attribute this entirely to hormonal changes, however it is a contributing factor behind this tragic statistic.

High-stress levels due to dissatisfaction with body image, changes in one’s sense of self that may be related to ageing and fertility, and difficulty raising teenagers or caring for ageing parents.

In women, the largest divorce rate occurs between the ages of 45 and 49. It’s possible that a mix of all these elements can make this stage of life very difficult for women and be another element that contributes to low mood, signs of depression, or clinical depression.

Anxiety

Regular anxiety is a very common condition that is characterised by a fluctuating sense of unease and worry, often depending on what is going on in your life at the time. When emotions linger, the anxiety gets bigger and more overwhelming and it starts to impact your daily life, it becomes more of an issue.

Felling of anxiety can range from butterflies in the stomach to restlessness, difficulty sleeping, focusing and a racing heartbeat. It is possible for you to experience a lack of control and disconnection between your body and thoughts. Some women may experience panic attacks, nightmares or painful thoughts.

If you are suffering from anxiety, you may ask for comfort from people more frequently than usual, you may experience more memory loss, feel exhausted or experience headaches. It could also cause you to avoid certain people, places or activities as these may trigger your anxiety.

Suicidal thoughts.

It’s common for intrusive thoughts and urges to strike out of nowhere, and while your hormone levels are dropping this can happen more frequently. These ideas may upset you or make you feel anxious or afraid. However, it is your reaction to these thoughts that determines if it become distressing or not.

Suicidal thoughts are also possible, but they normally come with no intention of acting upon them – rather, they are just an attempt to try and take control of your suffering. If suicidal thoughts start to become frequent and obsessional, get help right away.

Reduced motivation and feeling flat.

A decrease in motivation, desire and mental energy is a common occurrence during perimenopause and menopause.

It can be challenging to get started on a task that needs to be done, and activities you used to like may no longer seem appealing. Your mood may occasionally stay flat and uninterested even though your hormones may be fluctuating from high to low.

Loss of confidence.

Menopause and perimenopause physical changes can have a big impact on how you feel about yourself, how attractive you think you are to your partner, and how society perceives you. These physical changes include weight gain, changes to body shape, hair loss, dullness of the skin, wrinkles and acne and a variety of other changes. Your level of desire and libido has decreased, affecting your identity and self-worth, leading to low self-esteem.

Menopausal symptoms, whether physical or emotional can cause you to stop doing things you like, negatively impacting your feeling of identity and self-worth, especially if these activities were an important part of who you are and you valued them highly.

How can I help my mental health and emotional well-being?

There are lots of treatment options available you can consider to help the psychological and emotional changes, these include:

Hormone Replacement Therapy (HRT)

The most effective medical treatment for these changes and symptoms is replacing the depleted hormones. The treatment involves replacing the hormones oestrogen, progesterone and occasionally testosterone. HRT
will regulate blood hormone levels and restore the body’s natural production of these hormones.

While physical symptoms for most women will improve quickly, psychological symptoms occasionally take longer to resolve, usually taking 3-6 months for most individuals to feel like their “old self”.

It is important to find the right type and dose of HRT, this can take several months of trial and error. For further information, please click on the link (Link to the HRT page on the menoclinic website)

Talking Therapies

There are several different therapies available to support you during this phase, these include:

• Cognitive Behavioural Therapy (CBT):
  There is strong evidence that CBT can help you feel more balanced in your thoughts and emotions, even though it does not treat the underlying cause of hormonal imbalance.
  CBT is a well-known talking therapy that seeks to make you more conscious of the connection between your feelings, ideas and actions. You can learn coping mechanisms from the therapy to deal with undesired thoughts, feelings and related physical reactions. NICE has endorsed CBT in their guidelines for menopause management due to the strong supporting evidence.
  
• Counselling
  In a private setting, counselling enables people to discuss their issues and any challenging emotions they may be experiencing. By setting time aside to delve deeper into your thoughts and emotions in a secure and encouraging environment could be beneficial. The counsellor usually encourages you to discuss your problems in order to find any underlying issues and pinpoint unique thought patterns, they generally do not give advice.
  
• Psychotherapy
  For individuals experiencing emotional and psychological turmoil around the time of menopause, psychotherapy is an additional form of talking therapy that may be beneficial. It usually involves more sessions over a longer period of time and it relies on building a rapport with your therapist. Discussions may go deeper into your past, looking at how they shape your thoughts and feelings. This can improve your self-awareness and interpersonal communication skills, assisting you in healing and coping with any future issues.

Herbal Remedies and alternative therapies

Herbal remedies for stress, anxiety and depression are widely available. The following herbal remedies have been shown in clinical trials of nonmenopausal women to be beneficial: ashwagandha, St. John’s Wort, Ltheanine and Rhodiola. Despite being natural, herbal treatments may not always come without risk. The efficiency and potency of these products vary greatly and some have side effects or interact with medication you may be taking. However, they do not address the root cause of your symptoms, which is low hormone levels and they do not provide any longterm health safeguards.

When considering herbal remedies, ensure you use products with the Traditional Herbal Registration (THR) certification mark.

Diet and Lifestyle:

Sleep well

Sleeping soundly at night is really important for both your body and mind. Aim for 7-8 hours of sleep each night by maintaining a regular schedule that includes going to bed and waking up at the same time every day. Keep all unnecessary distractions out of your bedroom and keep it cool and dark. If you find it difficult to fall asleep try the Calm app or alternatives. Reduce caffeine and alcohol or any drugs as they give you artificial sleep which does not have the same benefits as ‘natural’ sleep. They also block your dream sleep or REM sleep which is essential for emotional and mental health.

Staying Physically active:

Exercise is beneficial for your mental and physical health, as well as your bodily well-being. Ideally, try and do a variety of exercises at least three times a week, such as brisk walking, swimming or running anything that increases your heart rate and releases endorphins, (which help to reduce stress and pain) or low-impact restorative exercise such as yoga and Pilates. Combining these activities with meditation or breathing exercises will promote relaxation and improve your concentration levels and memory.

Eat Well

The link between nutrition and mood, as well as how your diet affects your brain function is a growing area of interest for experts. During the perimenopause and menopause foods that are important are:

• Diary products rich in calcium and vitamin D for the bones
• Pre and postbiotics for the gut
• Low carbohydrate to help manage weight gain
• Food rich in Omega 3 oils to support brain function
• Plant-based food such as kidney beans, Chai seeds, edamame

It is important to limit processed food, food high salt content and sugary products. As well as cutting out unhealthy habits such as smoking and alcohol as they do more harm than good.

Make time for yourself.

It’s important that you schedule time for yourself and do things you enjoy, whether that is a walk with a friend or on your own, spending time with loved ones or anything that lifts your mood.

For further information, please click on the link NHS Eat Well Move More