Perimenopause: Mental Health and Wellbeing
Whilst hormonal fluctuations during menopause have impacts on physical health, they can also significantly influence psychological and emotional well-being.
Perimenopause can be both a window of risk for first-time or recurring mental health concerns and also a window of opportunity that invites us to re-evaluate our lives & address patterns that cost us our peace of mind.
Read on to find out more or download the free guide to read later.
Perimenopause as a Window of Risk
For those with previous mental health episodes, including anxiety, body image or eating- related disorders (1), mood disorders and trauma, menopause is often a time when these issues may re-emerge or amplify.
Conversely, it is also a period where individuals* might encounter their first significant mental health challenge (2).
During the menopausal transition shifts in hormone levels can interfere with the neurotransmitters responsible for regulating mood. This may shed light on why feelings of mood swings, sleep issues, depression, and anxiety can occur in this phase (3).
Research shows a strong link between Adverse Childhood Experiences, trauma and the associated increased risk of risk of major depressive disorder (MDD) in the perimenopausal.
Balancing the impacts of untended trauma and mental health symptoms often means professional support is required, with greater self-care and lifestyle interventions able to be layered in once this initial support is in place.
Fostering awareness and processing of these experiences with the assistance of a qualified and menopause- informed mental health professional.
The Role of Sleep
The quality of sleep - one of the critical pillars of mental health - often deteriorates during perimenopause, when hormonal changes and vasomotor symptoms can affect the ability to get and stay asleep (6). The
impact of sleep can not only lead to fatigue but can exacerbate anxiety and depression, making prioritising sleep and rest a cornerstone of mental health management.
Mental and Emotional Wellbeing
It is important for both individuals experiencing perimenopause and their healthcare providers to be aware of the range of potential concerns, including:
Mood swings or mood changes
Increased irritability
Less ability to manage stress Loss of motivation
Loss of confidence Social withdrawal
Body image (7) challenges
A lot of individuals mistakenly think that their perimenopause symptoms are due to chronic stress, or even burnout (particularly when perimenopause collides with significant midlife stressors).
A profound feeling of 'having less to give' or ‘just not feeling like myself’ plus a desire to focus inward is common.
Many individuals report feeling the urge to prioritise their own needs, time, and resources, an echo of the drive for independence characteristic of adolescence (8).
Perimenopause as a Window of Opportunity
Psychological themes that consistently emerge in the menopause transition are centred around body and emotions, loss and grief, identity and autonomy, values and purpose and the question of how they want to move forward into their next phase of life.
After perhaps decades of focussing on external pursuits and the care of others, perimenopause offers a perfectly timed invitation to do a life review, urging individuals to evaluate their current path, habits, and relationships and consider the sustainability of their roles and expectations of themselves.
If perimenopause was seen as a rite of passage with physical, emotional and mental shifts similar to those experienced at puberty, pregnancy and post-partum), we could perhaps see the perfection of mother nature forcing us to turn inward for the unfolding of our midlife metamorphosis.
Self-Care Strategy
Embracing a holistic view of mental health and well-being, which encompasses physical health, mental resilience, self-awareness and compassion, emotional regulation, and social connectivity is essential.
Learning coping strategies and self-care tools to support nervous system regulation, stress management and the physical processing of trauma can be helpful at this time. Somatic psychotherapy, yoga therapy, and Eye Movement Desensitisation and Reprocessing (EMDR) are examples of body-based therapies, that when embraced, can aid in navigating the menopause transition with greater ease and self-compassion.
Professional Support
Seek assistance from a menopause-informed mental health or medical professional if your mental health symptoms are impacting your ability to function and enjoy work, life and play.
Whilst some people find that using Hormone Therapy (HT) dials down menopausal symptoms and may offer relief from mood, stress resilience and issues with anxiety or depression, holistic treatment and support will likely require a layered approach that may include lifestyle adjustments, therapeutic strategies, and possibly medical interventions.
Crisis Support
In Australia, you can access crisis support for acute mental health symptoms through the following services:
Lifeline 13 11 14
Suicide Call Back Service 1300 658 467 or Call 000 for an Ambulance.
All About Her Centre for Menopause is a collective of health professionals for Australian women whose lives are impacted by menopause, and education and training for the psychologists and health professionals who support them.
We exist to ensure that perimenopausal, menopausal and postmenopausal women feel understood, seen and supported at every step along the way.
References.
References: Baker, J. H., & Runfola, C. D. (2016). Eating disorders in midlife women: A perimenopausal eating disorder? Maturitas, 85, 112–116.; (2)
Kulkarni, J., Gavrilidis, E., Thomas, N., Hudaib, A.-R., Worsley, R., Thew, C., Bleeker, C., & Gurvich, C. (2018, August 15). Tibolone improves depression in
women through the menopause transition: A double-blind randomized controlled trial of adjunctive tibolone. Journal of Affective Disorders, 236, 88-92.;
(3) Kuck, M. J., & Hogervorst, E. (2024). Stress, depression, and anxiety: Psychological complaints across menopausal stages. Frontiers in Psychiatry, 15, Article 1323743.; (4) Epperson, C. N., Sammel, M. D., Bale, T. L., Kim, D. R., Conlin, S., Scalice, S., Freeman, K., & Freeman, E. W. (2017). Adverse Childhood Experiences and Risk for First-Episode Major Depression During the Menopause Transition. The Journal of Clinical Psychiatry, 78(3), e298-e307.; (5) Penn Medicine. (2017, March). Trauma and stress in teen years increases risk of depression during menopause. Last modified March 29, 2017.
https://www.pennmedicine.org/news/news-releases/2017/march/trauma-and-stress-in-teen-years-increases-risk-of-depression-during-menopause; (6) Sleep Foundation. (n.d.). Menopause and sleep. Last modified January 18, 2024. https://www.sleepfoundation.org/women-sleep/menopause-and-sleep;
(7) Vincent, C., Bodnarus, A., Prud’homme, O., Giroux, I (2023): Associations between menopause and body image: A systematic review, Sage Journal,
19.; (8) Orenstein, G. A., & Lewis, L. (2024). Erikson's Stages of Psychosocial Development. In StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK556096/; (9) Bouse, K. (2023, October). Towards Self-Actualisation Psychological Support Through Menopause. [Conference session], Asia-Pacific Women's Mental Health Conference 2023, Melbourne, Australia.
*All About Her - The Centre for Menopause acknowledges that all people born with ovaries and who live long enough will experience the menopause transition. This includes cisgender women, transgender men, non-binary individuals, and any other individual with ovaries. We use the terms
individuals/people to be inclusive of the many who do not identify as women, but who will nonetheless experience this significant life stage.
Disclaimer: The information presented is for general understanding only and should not substitute professional medical advice. If you are concerned about your health, talk to your doctor or healthcare team for personalised guidance.
© All About Her Centre 2024