Menopausal Transition and Mental Health: You're Not Crazy

Perimenopause: The Menopausal Transition and Mental Health

“I think I’m going crazy,” she tells me. “I’m serious. I screamed at my husband and kids over the weekend and then I collapsed in tears. Every little thing sets me off, I can’t seem to get a good night’s sleep, and I’m anxious all the time.” This woman, in her late 40’s, is a friend, not a client. She has called me because I’m a psychologist and she is concerned about her mental well-being. Her symptoms, though, might have their roots in something besides her mental health – they may be a sign she’s in the menopausal transition.

It’s not surprising I’m the person she called. “Sometimes the first person to encounter a patient with these symptoms is her therapist or her psychiatrist,” shared Dr. Corinne Menn, during her webinar Unmasking Menopause: Mood, Sleep, Cognition, and Solutions with the Anxiety and Depression Association of America (ADAA). The menopausal transition remains a period that is confusing for many women and medical doctors alike. Long thought of as simply impacting reproduction, there is plenty of evidence to show that this time of shifting hormones can come with more than 30 symptoms, many coming from the brain and impacting mental and emotional well-being.

Understanding Menopause: More Than Hot Flashes

The word “menopause” evokes the image of an older woman wilting under the experience of a hot flash (I asked an AI program to create images of “typical women” going through the menopausal transition and all it produced was women collapsed in a chair with a fan or hankie in their hands). But hot flashes and night sweats are only a part of the picture for perimenopause (the time when estrogen and progesterone levels fluctuate and periods become irregular) and post menopause (when there has not been a menstrual period for 12 consecutive months). According to Dr. Menn, symptoms such as “new onset panic attacks, insomnia, mood swings, low libido, brain fog, attention issues, anxiety, depression, fatigue, and irritability,” may send women to mental health providers and other professionals fearing that something is emotionally or mentally wrong with them.

The timing of symptoms can also confuse both women and professionals. Long portrayed an issue of “old age,” the average woman begins perimenopause in her mid to late 40’s with an average age of 51 for full menopause. And this can vary greatly. Some women enter perimenopause in their 30’s. Black women, Dr. Menn says, often enter perimenopause earlier and experience symptoms for a longer period of time. Lack of education and preparation leaves many women not recognizing what is happening and upset and confused by their symptoms.

You're Not Alone: Support, Treatment, and Solutions for Menopausal Transitions

Many women, like the one who called me, are reassured simply to learn that their symptoms may be due to the menopausal transition and that they are not alone or unusual. Validation and education can go a long way. Lifestyle modifications (including proper nutrition, exercise that emphasizes strength training, and sleep hygiene habits), potential hormonal and non-hormonal therapies, cognitive behavior therapy, and psychiatric medications all may play a role in supporting women.

If you see yourself reflected in this article know that you are not alone and help is available. If you suspect you may be impacted by the menopausal transition, you may wish to explore some of the resources listed below.