The emotional roller coaster of the menopause

Most people are familiar with the physical symptoms associated with menopause but may be unaware of how it also affects their emotional well-being.


Studies have shown that the highest rate of female suicide is between the ages of 45-54 years and the highest rate of divorce in women is between the ages of 45-49 years. We also know that the average age of menopause in the UK is 51 years. 

Now, it would be too simplistic to conclude that hormonal changes are solely responsible for these statistics, but it is also too much of a coincidence to ignore a connection. 

Some facts about menopause

  • Menopause occurs when the ovaries stop producing eggs, resulting in a fall in levels of sex hormones.
  • These hormones play several roles throughout the body, so when levels start to fluctuate, this imbalance can result in a range of physical and emotional symptoms.
  • The physical symptoms include hot flushes, night sweats, insomnia, aches and pains, fatigue, vaginal and urinatory symptoms and headaches.
  • Some women may only experience symptoms for a few months, whereas others can continue to suffer for years, even decades. 
  • A woman is said to have reached menopause when she hasn’t had a period for 12 consecutive months.
  • Perimenopause is the time before you reach menopause when you experience menopausal symptoms but are still having periods.
  • Symptoms of perimenopause often start at around 45 years of age, but it can be much younger.

The emotional symptoms of menopause

For many women, the emotional symptoms can be more debilitating than the physical changes. However, women often don’t make the connection to their hormones. For example, you may be in your forties and start to experience emotional changes, but because you are still having periods and think that menopause affects older women, you may not realise you are perimenopausal.

So, let’s look at some of the most common emotional symptoms.

Mood swings

Many women find themselves on an emotional roller coaster, where their moods seem unpredictable, extreme, and often irrational. You could be fine one minute, then suddenly you’re in a rage because of a dirty cup left on the table, and the next minute you're sobbing uncontrollably in the bathroom. It can make you feel as if you have completely lost control of your emotions because it appears to come out of nowhere. 


Feelings of anxiety can vary during this time. Some women feel overwhelmed, have a sense of nervousness, tension, or feel ill at ease. They may worry about things they never worried about before or seek out reassurance more than usual.  

For some women, it can lead to panic attacks for the first time. These can hit unexpectedly and at any time, for instance, while you’re in a shopping centre or watching TV. Some women may also develop sudden unexplained fears or phobias, such as driving on the motorway.

Low mood 

Women often report feeling flat, joyless, sad, disinterested or have feelings of impending doom. They may find it hard to get excited about things and no longer find pleasure in the things they used to.

Reduced motivation

Feeling low can also affect your motivation, drive, and mental energy. It can be difficult to start something you know needs to be done and so you procrastinate. 

Newfound social anxiety

You may also have less interest in socialising with friends and family and start questioning the value of these relationships and feel less inclined to please others. You would rather just curl up on the sofa than go out. This can add to feelings of loneliness and isolation and lower your mood further.


Some women may feel more irritated, short-tempered, less patient, or more frustrated than usual. You may find yourself snapping at the kids for no reason or being overly critical of your partner. However, some women experience intense rage, having major outbursts over the slightest thing. For example, screaming at the cashier in the supermarket or shouting at other drivers. It can seem as if a “switch has flipped” and you are going to explode. It may also result in being physically aggressive, such as throwing things.

This can make those around you more cautious about being on the receiving end of an angry outburst. It can damage your relationships and sadly will make people move further away from you, at a time when you need their support the most.

Brain fog

Problems with memory or concentration are common. You may find yourself standing in a room wondering why on earth you are there or find your car keys in the fridge. You may struggle to recall someone’s name or forget an important meeting. Or you may start a sentence and forget what it was you needed to say: simple words can escape you. Some women may struggle to stay focussed or forget what was said ten minutes ago. These symptoms can be so severe, that women may worry they have early-onset dementia.

Body image issues

Physical changes in menopause can lead women to feel dissatisfied with their appearance. Some women find they gain weight, particularly around the midriff, as well as noticing changes in their body shape. It can also become harder to lose weight, despite exercising and eating well, which can feel demoralising. Beliefs about ageing and desirability can also affect libido, putting a strain on relationships.

Loss of self-esteem and confidence

Many of the changes mentioned above can affect how you feel about yourself. 

Being unable to cope with things that were never a problem before, can leave you feeling helpless or worthless. If you have stopped doing the things you enjoyed, it can affect your sense of self and identity, especially if they were a significant part of who you were. Also, if you feel more anger or rage, you may feel guilty or ashamed of your behaviour and consequently tell yourself what a terrible person you are.

Brain fog can have a huge impact on your confidence at work. You may start to lack belief in your ability to be in control, make decisions or multitask. For some women, this can result in them giving up on careers, they have taken a lifetime to build. 

In a culture that celebrates youth and thinness, it can be hard to accept the physical changes that occur in midlife, leaving women feeling less attractive and less valued in society. In addition, the loss of fertility may signal the end of youth and femininity, and that, somehow, you have nothing more to contribute.

You don’t have to struggle alone.

All of these things can leave you feeling like you don’t matter anymore and could make you withdraw from life and feel more isolated.

Suicidal thoughts

If your self-worth deteriorates to the point of consistently believing that the world would be better off without you, please seek help urgently. You can contact the Samaritans by calling 116 123.

What causes this emotional roller coaster?

There are three key hormones that fluctuate and then reduce in perimenopause and menopause: estrogen, progesterone, and testosterone.

Estrogen controls how much serotonin is being produced in your brain. Serotonin is known as the “feel-good” hormone and helps regulate your moods. So, if you’re producing less estrogen, you’re also producing less serotonin. This can result in mood swings, reduced motivation, feelings of nervousness, irritability, and low mood.

Progesterone has a calming effect on your mood, as well as aiding relaxation and sleep. So, when it starts to deplete, it can cause a rise in brain fog, irritability and feeling more panicky.

Declining testosterone can also affect your mental focus and concentration, your libido, and your energy levels.

All these emotional symptoms will be exasperated by poor sleep and fatigue.

It’s important to note that if you have had postnatal depression or a history of premenstrual syndrome (PMS), it is more likely you will experience these types of symptoms during your menopause, because your body is more sensitive to changing levels of hormones.

What else is going on in your life?

Your experience of menopause will be affected by many different things, not just what’s happening in your body. You may be caring for elderly parents, struggling with teenagers, coming to terms with adult children leaving home or have work or financial pressures. Midlife can also be a time of reflection, which may bring up unresolved issues from the past.

There is an expectation for women to care for, fix and help those around them, and so you may be juggling all these responsibilities, as well as having to cope with menopausal symptoms. This can be a very difficult time for some women.

If you’re struggling with any of the physical or emotional symptoms of menopause, it’s important to see your GP. Therapy can also help you gain a deeper understanding of your emotional turmoil as well as find ways to manage your difficulties. You don’t have to struggle alone.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Solihull B93 & Birmingham B28
Written by Nabeelah Khan-Cheema, BA (Hons), MBACP
Solihull B93 & Birmingham B28

I offer online counselling to women with a range of issues such as low self-esteem, anxiety, and relationship difficulties. I have a special interest in supporting women going through the menopause. Please get in touch for a free 15-minute telephone consultation.

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