Stories Link Copied 10.23.24

How to Deal With the Mental Health Toll of Menopause—From People Who Know 

If you know, you know. ByHeather Morgan Shott

Shutterstock / Wondermind

Ah menopause, the point in time when people with a uterus stop getting their period and start getting a lot of unexpected health symptoms. Ask anyone who’s been through it or currently going through it and you’ll hear that the experience is a whole lot more than just the end of your fertility.

In addition to loads of stressful physical issues (like hot flashes, insomnia, wonky menstrual cycles, and heart palpitations), more recent research suggests that mental health symptoms can come with the territory too. And it usually starts in your mid-to-late 40s, thanks to perimenopause (the time leading up to menopause when the levels of estrogen produced by your ovaries fluctuate and your cycle begins to change, per the American College of Obstetricians and Gynecologists).

The link between menopause and mental health

A 2023 systematic review published in the journal Australasian Psychiatry concluded that “there is a ‘window of vulnerability’ for depression and anxiety during menopause.” Some of the risk factors they found included a history of depression and anxiety, physical symptoms (like hot flashes and trouble sleeping), stressful life events, and a lack of social support. Similarly, a recent systematic review and meta-analysis found that perimenopausal people had a higher risk of depression than premenopausal people. 

So, what might be causing this link—aside from the horrible physical symptoms? Experts say hormones are likely to play a role. Unlike the weekly hormonal shifts that happen to premenopausal people, the levels of estrogen and progesterone vary over the course of years during perimenopause and menopause, explains psychiatrist and researcher Judith Joseph, MD, a board member of the non-profit Let’s Talk Menopause. Those long-term hormonal fluctuations may disrupt the neurotransmitters serotonin and gamma-aminobutyric acid (GABA), which impact your mood, anxiety, and sleep, says Dr. Joseph. 

Unfortunately, all of this can strike amid typical midlife stress: raising teenagers, caring for aging parents, career changes, and facing age discrimination at work, says Melissa Greenberg, PsyD, a clinical psychologist and founder of Princeton Psychotherapy. Add in endless doctor appointments, sleepless nights, and other seemingly random physical symptoms, and you’ve got a serious mental struggle on your hands. 

If you can relate, Dr. Joseph says metacognitive therapy (MCT) and cognitive behavioral therapy (CBT) can be helpful, though pretty much any kind of work with a mental health professional is a great choice for navigating the unexpected challenges of perimenopause or menopause. Even if you never thought to seek out therapy before, having a designated time, place, and person to share your challenges and emotions can make you feel less overwhelmed and alone. 

In the spirit of sharing what’s worked for others in your shoes, we asked people to share how they coped with the mental and physical toll of menopause, learned to advocate for themselves, and—ultimately—thrived. Here are their stories. 

I built a support system.

“At the age of 39, I went through a very difficult divorce and my anxiety went through the roof. I felt rage. I would fly off the handle at something very small, and then after, I would sob in my room because I had gotten so mad at my children over something so small. I would get so upset with anyone who was unkind or rude to me. My heart would start pounding, and I could feel my face getting hot. I didn't trust myself to go to social gatherings because I was afraid I would show my rage and lose friends. I became reclusive and would go days without talking to anyone, especially when my kids were at their father’s house. I had never acted this way before. I later learned that these symptoms were a direct result of perimenopause.

I remarried and, luckily, I have an amazing husband and kids and friends, who help me feel supported and less alone. This stage in life can feel like a roller coaster. But my support system also includes a psychiatrist I see sometimes weekly during really stressful times. I will sit in his office and just cry without saying a word and he will wait. We then talk through events and how I responded to them over the past week. I have walked in during a panic attack and he has talked me through it to relieve the pressure in my chest and settle my mind. 

I am now on medication to help with anxiety, and I have no regrets taking it. I also found a midwife who truly gets me (just as they help people in the labor and delivery process, midwives can help people spot the signs of menopause and manage the physical impact), and we’re working together to find a treatment plan that will relieve my symptoms. She says things like, ‘I understand how you feel. This is normal. I have felt this, and we will get through this,’ which helps calm my anxiety about my physical symptoms.” —Elizabeth C., 48

I changed my routine.

“I was put on antidepressants in my mid-forties. I was really anxious, and I had a low- grade depression. I was tired a lot, and I didn’t have the desire to work out even though I was gaining weight. I had brain fog. I was having really heavy periods. Then, one night I was on air anchoring a newscast and my heart was racing out of control. I was hot all over. I thought I was going to pass out or throw up. During a commercial break, the sports anchor helped me get up. I went to the bathroom and laid on the floor for 15 minutes and eventually felt better.

I blamed how I was feeling mentally on my divorce, but after that incident at work, I saw my gynecologist of 20+ years. After my appointment, I got an email that said, ‘You’re in menopause. Let me know if you have any questions.’ No advice, just that dismissive message. I saw five different doctors in search of answers. I started hormone replacement therapy (HRT), and I don’t have mood swings or anxiety like I did before. I sleep better and I feel more focused. My mind is clearer.

I’ve changed my lifestyle as well. I swear by cognitive behavioral therapy (CBT) because it has helped me understand and change negative patterns of thoughts, behaviors, and feelings into positive ones. Working out stimulates me on so many levels—it’s how I start my day. It has also given me confidence, since I’ve become stronger, have better balance, and am healthier overall. I used to think of self-care as a luxury, but it’s actually a necessity.” —Tamsen Fadal, 53, TV journalist and author of How to Menopause: Take Charge of Your Health, Reclaim Your Life, and Feel Even Better than Before, and producer of the documentary The M Factor 

I learned to take a pause.

“I had to have my ovaries and tubes surgically removed, which immediately put me into menopause. Educating myself about what was to come by reading (The Menopause Manifesto,  The Vagina Bible, and What Fresh Hell Is This?) and talking to my therapist about what to expect after surgery helped me feel more empowered because I wasn’t going into menopause blindly.

After my surgery, it was like a punch in the face. I was mad about things that weren’t a big deal—like, I wanted bread but we didn’t have any because someone in my family ate the last piece and didn’t replace the loaf. I felt like I wanted to murder everyone. On top of all that, I was coping with all these layers of grief from my sister’s and mother’s recent deaths, as well as figuring out college for one child, high school for another, and caring for my husband’s aging parents. 

My therapist taught me how to cope with it all. If I got upset about something, I used mindfulness skills that I learned in therapy to observe how I felt, take a deep breath, and realize that whatever was upsetting me wasn’t that big of a deal. My therapist also told me to walk to help clear my mind, so I was really proactive about going outside in the morning with a friend and getting vitamin D. Taking this break from my responsibilities helped lower my stress levels. It’s been over a year now, and I’m in a really good place.” —Kim B., 48

I exercised to stay calm.

“It was like going through a second puberty. I had a ton of anxiety and I felt gaslit every time I asked my doctor questions about new physical symptoms. For example, I have a hereditary heart arrhythmia and my palpitations got much worse as I entered the later stages of perimenopause, which led to a surgery I now think was unnecessary. Much later, I learned that the loss of estrogen during peri/menopause may be correlated with cardiovascular disease. Disrupted sleep also contributed to my anxiety, due to recurring hot flashes at night, and I took melatonin for about a year to cope.

Exercise definitely helped my heart issues and my mental health—especially yoga. Focusing on my breathing and staying trained on whatever flow I was doing that day helped keep me in the present, which in turn calmed my mind. I rode my recumbent cycle or hit the treadmill, and both boosted my sense of well-being. I also went on long walks with my dog in a park with lots of trees and birds and focused on the sounds of nature around me. Mindfulness exercises, like being in nature, really do soothe the soul. As my body rebalanced itself, my mood improved.” —Lauren D., 56

I worked with my doctor to ease my mental health symptoms.

“My first perimenopausal mood swing scared me. I had a very extreme reaction to something that was such a non-incident. I don’t even remember what it was. I've never even gotten crabby during my periods. When I was pregnant, it was like someone gave me a happy pill. As time has gone on I’ve had trouble with emotional regulation—like crying during a commercial I would have barely noticed before. I'll stress about things way more than I otherwise would and get overwhelmed easily, even by something as simple as cooking dinner—and I really enjoy cooking.

After speaking to my doctor about functional medicine for menopause I started taking supplements my doctor approves of, and they’ve helped me feel more calm.” —Anonymous, 47

I used cognitive behavioral therapy.

“By the time I was 40 or so, I was experiencing vaginal dryness, painful sex, and my period went from totally manageable to incredibly heavy. I started to experience brain fog, which felt like sifting through layers of thick mist in an effort to access memories, especially things that just happened a few days ago, which was incredibly frustrating.

I have taken medication for anxiety for a long time, but I began experiencing more defined mood swings while adjusting to hormone replacement therapy. I am a therapist, so I use the basic principle of cognitive behavioral therapy to cope: I observe what I’m feeling but recognize what I’m going through will pass. Speaking with other women who are experiencing perimenopause symptoms helps me cope as well. I also take long vigorous walks to get my heart pumping and produce mood-regulating endorphins.” —Francesca B., 44

I started sleep meds.

“For me, menopause happened all at once about 10 years ago. I became a completely different person. I got extremely anxious about my children’s test grades in high school, and that anxiety persisted until they both graduated from college. On top of that, there were many nights when I only got three hours of sleep. My doctor prescribed sleeping medicine, which helped me rest better. With more energy, I was able to keep up with Pilates, which soothed my nerves and boosted my confidence.” —Maddie A., 59