What links are there between mental health problems and menopause?
Menopause has a variety of physical symptoms such as tiredness, night sweats, insomnia, hot flashes, memory loss and tension, which can all cause you to feel distressed.
During menopause, it’s common to experience mood changes such as irritability, sadness, lack of motivation, aggressiveness, problems focusing, stress, difficulty concentrating, and depression. Much like constant premenstrual syndrome (PMS), these effects can cause emotional strain.
If you have a pre-existing mental health problem, it’s possible that the effects of menopause could cause a relapse or change to your mental health.
Menopause and depression
Clinical trials are yet to find a link between depression and menopause. However, research suggests women who had severe PMS in their younger years or experience postpartum depression may have more severe mood swings during perimenopause.
Women with a history of clinical depression are often more likely to experience recurring clinical depression during menopause.
Menopause and bipolar disorder
Menopause has been shown to increase symptoms of bipolar disorder. Research suggests that women with bipolar disorder are more sensitive to hormonal shifts during menopause.
At menopause women living with bipolar disorder report more depressive episodes than those without. This is likely to be linked to the decrease in the hormone oestrogen, which naturally happens during menopause.
Menopause and schizophrenia
Research has shown that a reduction in oestrogen can trigger or aggravate mental health problems, including psychotic conditions.
Women with pre-existing chronic schizophrenia may experience a deterioration of their illness and require a higher demand for medication.
Perimenopause may also enhance the risk of first onset of schizophrenic psychosis. While schizophrenia typically begins in young adulthood, there is a second peak in women around menopause.
What other complications are there around this time of life?
As well as the known effect of oestrogen levels, there are many other factors which can impact women’s mental health during this time of her life. It’s common to feel burdened with emotional stressors such as:
- Ending or starting romantic relationships
- Grown children leaving or returning home
- Financial or career changes
- Concerns about ageing parents
- Getting older in a society that values youth
- Worries about the health of a partner
- Need to re-evaluate life expectations
“Mental health wasn’t something I’d thought about with menopause. I knew there could be mood changes – we all hear the jokes about the grumpy old woman in the family – but I never thought the impact could be so profound.
I didn’t even think I had a problem. It was my husband who was the problem, doing something or saying something that would trigger a huge rage inside me. I’ve never been an angry person, but I suddenly I could go from Bruce Banner into the Hulk in seconds and all I wanted to do was destroy. Destroy whoever had annoyed me, whether that was with words or actions. It sounds funny now, but I became a demon with the tea-towel, flicking it as hard as possible to inflict pain. It wasn’t only my poor husband; I’d wake up in the early hours of the morning, making lists of everyone who’d annoyed me, from politicians to TV stars to a woman in the shop. I even raged at the crisp-makers for not making my favourite flavour.
After the anger subsided, I’d be left feeling guilty and scared. This wasn’t me; it was as if an evil spirit had taken me over. I’d send guilt-ridden emails of apology to the people I’d vented my anger at hours – sometimes minutes – previously and I’d sit and wonder how anyone could like me when I was such a horrible person. “They all think I’m nice. If only they knew the truth…”
Mental Health Moments
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"My mind began building on this, going back over my actions, what I’d said, other people’s reactions, to see if they’d sussed how awful I was. Small things, such as a delay in a WhatsApp message reply, would send me into despair, convinced that my friend no longer liked me. I began to worry about my work; after all, if my boss, a good friend, no longer liked me and I started making mistakes, why should they keep me on? I work on a magazine in London and would spend all weekend worrying about my work until I saw the published article. Once, convinced I’d sent the wrong page to the printer, I shook so much my colleague had to open the magazine and show me that everything was okay. When mistakes happened, I would frantically double and treble-check to make sure I hadn’t worked on any of the pages concerned, even when I knew I hadn’t. I turned down the offer of promotion to a position I’d held before because I couldn’t trust myself.
Eventually, I found myself walking down to the Thames at lunchtimes and wonder what would happen if I jumped in. How much would it hurt? I didn’t want to kill myself; I just didn’t want to feel this way anymore. If I could just float away down the river and out into the sea…
I started taking lunch breaks in the middle of a project, so I knew I had a reason to return to work.
My husband tried to get me to go to a doctor. I’d suffered with depression in the past, although never this bad, I couldn’t make myself go. I didn’t want to waste my GP’s time when this was all brought on by me.
It was only when I started getting hot flushes and my husband googled ways to help that we realised everything I had been going through was menopause-related. I went to the GP the next morning, waiting in the queue for a same-day appointment, only to be told that I’d missed the last one. The thought of another day without help was too much and I burst into tears in the reception. “I’m fitting you in,” said the receptionist. “Take a seat. I don’t know when it’ll be, but you can’t go on like this.”
I wish I could say it had been plain sailing since then. Through HRT, I discovered I am progesterone sensitive, which has a huge impact on my mental health. Just this March, I broke down at work, unable to find a reason why I didn’t jump in front of a train. But because I now know what is causing it, I’m able to take action. I know to talk about how I’m feeling and we’re trying a more progesterone-friendly HRT once lockdown is over and I’m able to return to the GP for a Mirena coil fitting. Until then, I have what I’m calling the “second-best” option, which involves HRT patches with anti-depressants, which I discussed with my GP after explaining how scared I was of returning to the dark days."
"My hormones still fluctuate and I still have some blue days, so I use meditation and exercise to focus myself and am looking at my diet to feed my body the best nutrition I can. I also tell myself that this is hormones, not me, and try to speak nicer to myself.
I’ve started a menopause support group in my city to meet and help other women – seeing the relief on their faces when they realise they’re not alone in how they feel is humbling – and I started the Pausitivity menopause awareness campaign to make everyone aware that menopause is more than hot flushes.
The most important thing, however, is to talk. I’ve spoken to many women who have felt the same way; women who felt they were losing their mind or starting early dementia and others now strong enough to admit they felt suicidal. They are amazing, powerful women – raising families, holding down jobs, caring for elderly relatives, all while coping with menopause. I’ve also met many inspirational women who are post-menopausal and living their best lives ever, which gives me strength because I know this will pass.
By understanding my moods are menopause, I feel more in control and able to manage my symptoms. And my husband has no need to be concerned when I pick up a tea-towel.”
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