The “menopause” is the final menstrual period. The menopause transition is from the onset of menstrual cycle changes or vasomotor symptoms until one year after the final menstrual period. (Roberts, H., & Hickey, M. 2016). Menopause is a natural biological process that occurs when a woman ceases menstruation, typically around the age of 45-55. During menopause, the ovaries gradually decrease their production of estrogen and progesterone, leading to hormonal fluctuations and cessation of menstrual cycles. Irregular periods, hot flashes, night sweats, mood swings, and other symptoms characterize the menopause. While menopausal symptoms vary in severity and duration among women, they can significantly impact the quality of life and daily functioning. The impact of menopause extends beyond the physical, significantly affecting mental health. Understanding the psychological and emotional challenges that accompany menopause is crucial for improving the quality of life for women undergoing this transition. (Roberts, H., & Hickey, M. 2016).
Hormonal Changes and Mental Health
The Role of Estrogen
Estrogen, a key hormone in the female reproductive system, significantly influences mood regulation and cognitive function. During menopause, estrogen levels decline, leading to various mental health challenges. Estrogen's influence on neurotransmitters, such as serotonin and dopamine, underscores its importance in maintaining mood stability. Reduced estrogen levels can result in mood swings, anxiety, and depression. (Berent-Spillson, A. et al., 2015)
Neurotransmitter Imbalances
Human studies have shown that estrogen is involved in the modulation of neurocircuitry contributing to the development of depression, including at the serotonergic, noradrenergic, and dopaminergic systems. During menopause, with fluctuating and decreasing estrogen levels in the central nervous system (CNS), a subsequent diminution of estrogenic neuroprotective effects could have negative psychological effects on some women. The decline in estrogen affects neurotransmitter systems, contributing to mood disorders. Serotonin, often called the "feel-good" neurotransmitter, is closely linked to mood regulation. Lower estrogen levels can reduce serotonin production and receptor sensitivity, leading to increased vulnerability to depression and anxiety. (Herson, M., & Kulkarni, J. 2022)
Psychological Symptoms of Menopause
Mood Swings and Irritability
Mood swing, also known as mood disorder, refers to a condition when a woman experiences and expresses a load full of emotions within a span of a few hours. The changes in moods range from happiness to anger, frustration, sadness to depressive psychosis, all within a very short period. Mood swings are a common psychological symptom of menopause. Women may experience sudden and intense changes in mood, ranging from irritability to tearfulness. These mood fluctuations can strain relationships and impact daily functioning. Understanding that these changes are hormonally driven can help women and their loved ones navigate this challenging time with greater empathy and support. (Sarang, N. 2019).
Anxiety and Panic Attacks
Anxiety is another common mood symptom that some menopausal women may experience. The term anxiety is often used to describe a wide variety of symptoms that may include features of various anxiety disorders, such as panic disorder (eg, suddenly feeling fearful for no reason) or generalized anxiety (eg, excessive and uncontrollable worry, irritability), or physical symptoms, such as shortness of breath, racing heart, and tension. Recognizing these symptoms as part of the menopausal transition is essential for seeking appropriate treatment and support. (Bremer, E et al., 2019)
Depression
Depression is the most common illness worldwide, with around 350 million people affected and the burden of depression is rising globally. It can have detrimental effects on an individual's relationships, capacity to work in or outside the home, financial status as well a risk of self-harm and suicide. Depression during menopause is not uncommon. The interplay between hormonal changes and psychological factors can contribute to the onset or exacerbation of depressive symptoms. Feelings of sadness, hopelessness, and a loss of interest in previously enjoyable activities can significantly impair quality of life. Addressing these symptoms early through therapeutic interventions can make a substantial difference. (Vivian-Taylor, J., & Hickey, M. 2014).
Cognitive Changes and Menopause
Memory and Concentration
Many women report experiencing cognitive changes during menopause, often referred to as "brain fog." This can include difficulties with memory, concentration, and overall cognitive function. The decline in estrogen affects brain regions involved in memory processing, such as the hippocampus, leading to these cognitive challenges. While these changes are usually temporary, they can cause considerable distress. A recent review of studies also concluded that cognitive complaints were associated not only with the menopausal transition but also with specific areas of objective cognitive decline, affecting verbal memory, attention, and working memory. (Hogervorst, E et al., 2022)
Executive Function
Executive functions, such as planning, organizing, and multitasking, may also be affected during menopause. Women may find it challenging to manage multiple tasks or maintain focus on complex activities. These cognitive difficulties can impact work performance and daily responsibilities, contributing to stress and frustration. (Hogervorst, E et al., 2022)
Social and Emotional Factors
Impact on Relationships
The psychological symptoms of menopause can strain relationships, particularly with partners and family members. (Heidari, M et al., 2019) Mood swings, irritability, and decreased libido can affect intimacy and communication. Open dialogue and education about menopausal changes can help partners provide better support and maintain strong relationships during this transition. (Namazi, M et al., 2019)
Social Isolation
The combination of physical and psychological symptoms can lead to social withdrawal. Women may feel embarrassed by hot flashes or other physical changes, leading them to avoid social situations. Additionally, anxiety and depression can reduce the desire to engage in social activities, contributing to feelings of isolation and loneliness. (Afridi, I. 2017)
Coping Strategies and Treatment Options
Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) is considered the gold standard for the management of menopause. By supplementing estrogen and sometimes progesterone, HRT can alleviate both physical and psychological symptoms. Vasomotor symptoms of menopause may include hot flashes and diaphoresis that vary in intensity and duration. Other symptoms of menopause can include vaginal atrophy and dryness, leading to dyspareunia and an increased risk of infection. These symptoms can be impactful on a woman’s life and HRT has data to support its efficacy.
However, HRT carries significant risks that are generally well known, including the risk of stroke, cardiovascular disease, breast cancer, and venous thromboembolism, so it's essential to discuss this option with a healthcare provider. (Cameron, C. R. et al., 2024)
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Psychological Interventions
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is an effective psychological intervention for managing mood and anxiety disorders associated with menopause. CBT helps individuals identify and challenge negative thought patterns, develop coping strategies, and improve emotional regulation. This therapeutic approach can significantly reduce symptoms of depression and anxiety. CBT is consistently effective when delivered in groups, self-help books, and online formats (with or without additional support). (Hunter, M. S. 2021)
Mindfulness and Stress Reduction
Mindfulness-based stress reduction (MBSR) programs can help women manage the psychological impact of menopause. Mindfulness practices, such as meditation and deep breathing, promote relaxation and emotional well-being.
Mindfulness-based therapies offer an alternative approach to increasing self-acceptance and coping by providing systematic training in mindfulness meditation as a self-learned approach to stress reduction. Mindfulness-based stress reduction (MBSR) is a clinical program that utilizes skills such as sitting and walking meditation, yoga, and a somatically focused skill named the body scan. These techniques can reduce stress, improve mood, and enhance overall mental health. Mindfulness-based therapies have been effective in improving physical and psychological outcomes in a variety of clinical and non-clinical settings in the last three decades. (Wong, C et al., 2018)
Lifestyle Modifications
Regular Exercise
Physical activity is beneficial for both physical and mental health. Regular exercise can reduce symptoms of anxiety and depression, improve cognitive function, and enhance overall well-being. Activities such as walking, yoga, and swimming are particularly effective. (Rathnayake, N et al., 2020)
Healthy Diet
A balanced diet rich in nutrients can support overall health and well-being. Foods high in omega-3 fatty acids, antioxidants, and vitamins can improve brain health and mood regulation. Avoiding excessive caffeine and alcohol, which can exacerbate anxiety and mood swings, is also advisable. (Rathnayake, N et al., 2020)
Sleep Hygiene
Adequate sleep is crucial for mental health. Establishing good sleep hygiene, such as maintaining a regular sleep schedule, creating a relaxing bedtime routine, and avoiding stimulants before bedtime, can improve sleep quality and reduce the impact of menopausal symptoms on mental health. (Rathnayake, N et al., 2020)
Social Support
Support Groups
Joining a support group can provide emotional relief and a sense of community. Sharing experiences and coping strategies with others going through similar challenges can reduce feelings of isolation and provide practical advice. According to a study, Education through support groups was found effective in reducing the early symptoms of menopause. Thus, joining support groups can be used as an appropriate strategy for enhancing women’s health and dealing with annoying symptoms of menopause. (Shafaie, F. S et al., 2014)
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Counseling and Therapy
Individual or group counseling can offer valuable support during menopause. A mental health professional can provide guidance, coping strategies, and emotional support tailored to the unique challenges of menopause. Counseling has beneficial effects on lifestyle modification in both menopausal women and their spouses regarding improvement of nutritional habits and physical activity. (Tiznobaik, A et al., 2018)
Conclusion
Menopause is a significant transition that affects both physical and mental health. Understanding the psychological symptoms and their underlying causes is essential for providing effective support and treatment. Hormonal changes during menopause can lead to mood swings, anxiety, depression, and cognitive challenges, significantly impacting women's quality of life. However, with appropriate interventions, including hormone replacement therapy, psychological support, lifestyle modifications, and social support, women can manage these symptoms effectively.
By fostering open dialogue, raising awareness, and promoting positive attitudes toward menopause, society can better support women during this critical phase of life. Addressing the mental health impact of menopause not only improves individual well-being but also enhances the overall quality of life for women, enabling them to navigate this transition with resilience and strength.
Understanding menopause's impact on mental health and implementing supportive measures can transform this phase from a period of struggle to an opportunity for growth and self-discovery. Embracing menopause with knowledge and compassion empowers women to thrive and lead fulfilling lives during and after this significant transition.
References
Roberts, H., & Hickey, M. (2016). Managing the menopause: An update. Maturitas, 86, 53-58.
Berent-Spillson, A., Briceno, E., Pinsky, A., Simmen, A., Persad, C. C., Zubieta, J. K., & Smith, Y. R. (2015). Distinct cognitive effects of estrogen and progesterone in menopausal women. Psychoneuroendocrinology, 59, 25-36.
Herson, M., & Kulkarni, J. (2022). Hormonal agents for the treatment of depression associated with the menopause. Drugs & Aging, 39(8), 607-618.
Sarang, N. (2019). Life of women during menopause: Can physical exercise give relief?. Int. J. Phys. Educ. Sports Health, 6(3), 23-26.
Bremer, E., Jallo, N., Rodgers, B., Kinser, P., & Dautovich, N. (2019). Anxiety in menopause: a distinctly different syndrome?. The Journal for Nurse Practitioners, 15(5), 374-378.
Vivian-Taylor, J., & Hickey, M. (2014). Menopause and depression: is there a link?. Maturitas, 79(2), 142-146.
Hogervorst, E., Craig, J., & O'Donnell, E. (2022). Cognition and mental health in menopause: a review. Best Practice & Research Clinical Obstetrics & Gynaecology, 81, 69-84.
Heidari, M., Ghodusi, M., Rezaei, P., Abyaneh, S. K., Sureshjani, E. H., & Sheikhi, R. A. (2019). Sexual function and factors affecting menopause: a systematic review. Journal of menopausal medicine, 25(1), 15.
Namazi, M., Sadeghi, R., & Behboodi Moghadam, Z. (2019). Social determinants of health in menopause: an integrative review. International journal of women's health, 637-647.
Afridi, I. (2017). Psychological and social aspects of menopause. Menopause: A Multidisciplinary Look at, 49.
Cameron, C. R., Cohen, S., Sewell, K., & Lee, M. (2024). The art of hormone replacement therapy (HRT) in menopause management. Journal of Pharmacy Practice, 37(3), 736-740.
Hunter, M. S. (2021). Cognitive behavioral therapy for menopausal symptoms. Climacteric, 24(1), 51-56.
Wong, C., Yip, B. H. K., Gao, T., Lam, K. Y. Y., Woo, D. M. S., Yip, A. L. K., ... & Wong, S. Y. S. (2018). Mindfulness-based stress reduction (MBSR) or psychoeducation for the reduction of menopausal symptoms: a randomized, controlled clinical trial. Scientific reports, 8(1), 6609.
Rathnayake, N., Alwis, G., Lenora, J., Mampitiya, I., & Lekamwasam, S. (2020). Effect of Health‐Promoting Lifestyle Modification Education on Knowledge, Attitude, and Quality of Life of Postmenopausal Women. BioMed research international, 2020(1), 3572903.
Shafaie, F. S., Mirghafourvand, M., & Jafari, M. (2014). Effect of education through support group on early symptoms of menopause: a randomized controlled trial. Journal of caring sciences, 3(4), 247.
Tiznobaik, A., Taheri, S., Momenimovahed, Z., Kazemnejad, A., & Mirmolaei, S. T. (2018). Effects of counseling on lifestyle of menopause women and their spouses: a randomized controlled trial study (RCT). Electronic Journal of General Medicine, 15(4), 5.
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