Menopause

Changes in your period. Sleep difficulties and night sweats. Hot flashes and palpitations. A glass or two of wine seems to exact revenge the next morning in a way it never did before. Your body feels different; maybe you have a bit less energy, flexibility, or stamina.

At the same time, you may have challenging teens at home or ageing parents needing assistance. You may have risen through the ranks at work and though you’re loving the sense of accomplishment, some days and weeks feel really challenging. There’s a lot going on in your life, and sometimes it all seems a bit overwhelming.

If all this feels familiar, and you’re in your forties (maybe a bit earlier, maybe a bit later), you’re probably aware that you may be experiencing perimenopause and on your way to menopause. “Menopause is enjoying the moment,” according to the Guardian, but while there is certainly more awareness about physical menopausal symptoms and their impact, there is much less focus on how perimenopause and menopause can impact mental health, and how this life transition brings both challenges and opportunities.

In this video, I explain the impact of menopause on mental health, and how working with a counsellor can help turn this often challenging experience into a positive one.

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What is menopause? 

Menopause officially begins one year after you’ve had your last period, at around an average age of 51. Perimenopause is the period prior to that (typically around four or five years) when hormone levels are both fluctuating and decreasing. Although menopause is natural and part of the normal ageing process, these years can be more emotionally and physically challenging than we expect. Just like the onset of menstruation, the changes you go through can feel awkward, isolating, bewildering, and contradictory.

At times, it feels like everything is up for grabs - your moods, how your body is behaving, what you think you want, and who you want to be. And the issue with perimenopause and menopause is that so many factors are entangled - hormones, physical changes, sleep issues and life stresses can all impact us during this time and it can feel difficult to untangle the true roots of our difficulties.

Your life during the menopause transition is like a delicate ecosystem. Even small changes in one area can impact other areas, requiring you to tend carefully to yourself to nourish the parts that have stopped flourishing. 

Although menopause is the end of your childbearing years, it is also the beginning of another fruitful life phase... With patience, knowledge, and solid support, this transition can be deep and nourishing, creating solid foundations for your next phase of growth and evolution. 

What is actually going on in the body?

Levels of female sex hormones oestrogen and progesterone both drop because of a decline in ovarian function, leading, in approximately 75% of Western people, to symptoms, such as hot flashes, night sweats, changes in the menstrual cycle, vaginal dryness, and decreased libido. From a mental health standpoint, you may experience symptoms such as persistent low moods, brain fog, low motivation, anger, and even a return of previous psychological conditions. 

Scientists are still unravelling the exact interplay between hormones and our mental health, but there is nonetheless solid research that helps us understand what is going on in the body during perimenopause. For example, we know that oestrogen impacts serotonin levels. Serotonin is one of the body’s “happy hormones”, stabilising mood, feelings of well-being, and happiness, and helping with sleep and digestion.

When levels of oestrogen go down, so do serotonin levels, which may lead to you being easily upset, or feeling persistently low. The fact that our oestrogen levels are unpredictable during this period makes it worse. While post-menopause, our bodies can acclimate to lower levels, the fluctuations experienced during the menopause transition can make you feel as though you’re on a rollercoaster. Similarly, reduced levels of progesterone can also create mood changes, sleep disturbances, anxiety, and depression.

Finally, though not spoken about as much, testosterone levels also decrease. This can contribute to tiredness, depression, headaches, cognitive problems, and an obvious reduction in sexual desire, arousal and orgasm. 

Obviously, we are not just our hormones. How your menopause transition feels depends on many other factors, such as:

• Your overall health and stress levels.
• Attitudes toward menopause and openness to discussing it - do you feel supported by your employer and your loved ones? What are your own attitudes towards it? 
• Your current life satisfaction - are you where you want to be? How are your relationships? Have you had the children you wanted to have? 
• Your comfort with your body and its journey of change.
• Your mental health - do you have a history of anxiety, depression, or other mental health issues? Do you engage in self-reflection and self-care? 

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Menopause and mental health

According to experts, 45-70% of people experience mental health impacts during perimenopause and menopause. Let’s talk about some of the common symptoms.

Depression and anxiety

Studies show that symptoms of depression occur in perimenopausal individuals at a 40% greater rate than in the general population and that your chance of developing depression increases by two to 14 times during this time. Women between the ages of 45-54 have the highest rates of suicide of any age cohort. Perimenopausal depression may manifest with more irritability, changeability, and dullness in mood than traditional depression and is therefore sometimes overlooked. 

Symptoms of anxiety also rise during perimenopause. For some people, this may manifest as nervousness, while for others, it can lead to panic attacks and a constant feeling of vigilance. And other perimenopausal symptoms such as the feeling of a hot flash, changes in the menstrual cycle, and palpitations can themselves trigger anxiety. The menopause transition can also be a time when previous trauma or childhood issues can come into focus, potentially feeding anxious and depressive symptoms. 

It is important if you are experiencing these symptoms to speak to your doctor who can suggest effective treatment paths. 

Sexuality, relationships, and body image

Libido may reduce or disappear, leaving you without a desire for something that may previously have brought you pleasure and connection. Some of this loss is directly due to changing hormone levels impacting levels of desire, but often losing your sex drive is due to other issues brought about by menopause.

People can experience pain during intercourse and vaginal dryness as a physical side effect, and may simply be more tired than usual due to night sweats and sleep disturbances. Often, psychological elements, such as beliefs about ageing and desirability can come in as well. Although you may feel you’ve closed up shop as a sexual being, losing libido is a symptom and not a rest-of-life sentence - it will typically return after menopause when hormones are stabilised. 

If the sexual connection changes, our partners may feel insecure or rejected. One study showed 65% of women believed their menopausal symptoms impacted their relationships. Feelings of irritation, anger, anxiety and lack of motivation can wreak havoc in relationships, and your partner may struggle to understand what is happening, and how to best support you.

Cognitive changes

Oestrogen also impacts our thinking processes. During perimenopause, it’s common for people to experience:

• difficulty concentrating
• brain fog
• feelings of overwhelm in situations that previously would have felt fine
• fatigue
• lack of motivation for things that were once engaging
• amplified emotions, particularly anger and frustration

These symptoms may be particularly obvious in the workplace. The pressures many women have felt throughout their careers to fit into a male-dominated environment may cause you to minimise your symptoms, making coping even more difficult. 

Questions of identity and purpose

The menopause transition can seem like a time of loss - of youth, desirability, looks, and opportunities. This can prompt a deep look at where you are in your life. Women are socialised to believe that as we age, we lose our beauty, our attractiveness, and our power. It’s interesting to note that in societies where older women are respected for their wisdom and experience, the menopause transition appears to be much less problematic. 

There can be other questions surrounding the subject of identity and purpose. Maybe you wanted children but couldn’t, and there’s grief around that door closing for you. Maybe you’re assessing your future and realise that you’re not where you wanted to be, financially, professionally, or in your relationships, and are feeling shame around that. You might have a sense that the person you thought you were has disappeared, or the things you once thought were important are no longer. This can feel very vulnerable and challenging to explore. 

5 tips for improving your mental health during menopause

Educate yourself - read articles, watch tv programmes such as Channel 4’s Sex, Myths and the Menopause, and check out books - many have been published in the last year or two and contain really up-to-date information. Dr Jen Gunter’s The Menopause Manifesto, Dr Lisa Mosconi’s The XX Brain, and Kate Muir’s Everything You Need to Know About the Menopause (and were too afraid to ask) are all good resources. 

Talk to your friends about what you’ve learned and are going through, and compare notes. Sharing (and laughing about, where possible) your experience is terrific medicine.

Adapt and/or improve your self-care. For some, this may mean taking up meditation, changing your diet, or trying out a new type of exercise. For others, this may mean compassionately scaling back and learning more about your energy cycles and capacity, and what feels renewing and nourishing. 

Find space and time for yourself - to reflect, to feel, to slow down, and to sense into your new and changing experience. Introduce or return to parts of your life that nurture your values and interests and create connections, such as creative pursuits, developing skills, or exploring spiritual or religious beliefs.

Develop a good sleep routine. Simple steps such as limiting screen time an hour or two before bed, keeping the bedroom cool, having layers of bedding that can be added and shed, and getting up when anxiety is keeping you awake can really change the quality of your sleep over time. 

Listen to Lucy Donoughue speak with Nicki Williams, founder of Happy Hormones for Life and Jo Moseley, host of The Joy of Sup podcast, about movement and menopause.

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Types of support available

If your physical and mental health symptoms are interfering with your daily life, the best first stop is your GP. Talk to them about your symptoms, and explore what treatment options are available for your particular circumstances. This discussion is important to have as factors such as genetics, individual health and habits, age, and medical history will guide your GP’s recommendations. Research shows that mental health concerns during the menopause transition are not simply down to hormonal shifts, but rather are multi-faceted issues, which can benefit from a holistic response.

Alternative and complementary therapies such as massage, nutritional therapy, acupuncture, reflexology, and naturopathy can be useful to explore, and seeking counselling by a qualified therapist can be one of the most effective forms of support during this time.

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How menopause counselling can help

With the right help and support, the menopause transition can be a transformational phase of life. Counsellors who specialise in menopause will understand the physical and mental effects of hormonal changes as well as the common life challenges of midlife. They will be happy to work alongside your doctor to identify and support solutions to get you through this often challenging time. 

Some common areas that can be explored in menopause counselling are:

• Identifying sources of anxiety, low mood, and negative thinking and learning techniques to mitigate their impact.
• Rebuilding self-confidence, particularly around the ageing body and societal norms.
• Building healthy habits around sleep, exercise and nutrition.
• Exploring grief about the end of childbearing and other changes in identity.
• Supporting the exploration of childhood trauma or other issues that you have not reflected on in the past.
• Exploring sources of pleasure and learning new paths of sexual expression.
• Seeking out new opportunities and goals for this next phase of life and receiving support in working towards them.
• Re-programming how you speak to yourself about your body and learning ways to support and accept, rather than fight, yourself.
• Understanding your mother’s experience and how that may impact your own.

What clients can expect from a menopause counsellor or therapist

You should expect your counsellor to provide a safe and confidential space where you can feel heard and understood. Your counsellor’s purpose will be to support you in reducing your symptoms and building long-term health. They will support you to identify, understand and develop strategies to manage the symptoms you are experiencing. You may explore the origins of your issues and how the menopause transition is impacting your loved ones.

You can expect your counsellor to provide reframing of your issues and at times present different options for you to experiment with. You will feel deeply listened to and supported as you consider your future priorities and challenges. As you move through your counselling journey, which may be a few sessions to a few years, you should begin to feel better about yourself, gain an understanding of your symptoms and experiences, and build hope and optimism for the future. 

There’s a mystery to all transitions of the female body. We don’t know when they’ll happen or how they’ll be. For some people, the menopause transition brings about a sense of relief and freedom - the end of periods and accompanying PMS, of worrying about birth control, the lessening of societal expectations regarding parenthood and relationships, and anticipation for a time of vitality and renewal. For many others, it is a time of major disruption - physical, emotional, and spiritual, with feelings of shame, grief and loss. 

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This page was written in Feb 2022 by women's and LGBTQIA+ therapist, K Murphy (MBACP, CSB).