Ask the Expert: Why Am I Suddenly Feeling Anxious and Depressed – Is it the Menopause?

Q. Are mental health problems common during perimenopause and menopause

A: We often associate menopause with hot flushes, vaginal dryness or low libido, but studies show that around 50% of women experience mental health symptoms associated with perimenopause and menopause, with perimenopause in particular linked to a higher risk of developing anxiety, depression, schizophrenia, or bipolar disorder.

I’ve seen many patients who’ve developed mental health problems even if they’ve never had a history of it before. It can range from feeling overwhelmed by work issues or finding previously straightforward tasks – like driving or leaving the house – increasingly difficult. Women can also experience relapses of previous conditions like major depression or bipolar disorder .

Q: Are anxiety, depression and mental health issues overlooked during menopause?

A. Women are often in the thick of a whole host of challenges during midlife – from raising teenagers, to looking after elderly parents, to relationship breakdowns and dealing with pressures at work – it can be easy to overlook the role that hormones are playing within this mix.

I often see antidepressants being prescribed for anxiety or low mood, which may be right for some women, but not always appropriate as a first line treatment. What’s often needed is a careful examination of your symptoms – both physical and mental – so that we can assess whether you are in perimenopause or menopause. We can start to stabilise your hormones, as well as making sure you’re getting the right help for all your different needs.

Q: Are women more likely to develop mental health problems during perimenopause? 

A. Perimenopause can be a particularly vulnerable time for women in terms of mental health issues, due to the huge hormonal fluctuations that are taking place. On average, it lasts for four years – although it varies according to the individual – and can be confusing, as you may still be having periods and you may not have other physical symptoms.

Women are therefore often unaware that mental health issues can develop around this time. For example, a recent study by researchers at Cardiff University found that there’s a 112% increase in bipolar disorder and a 30% rise in serious depression during this phase. So it’s something that we all need to be aware of – both patients and doctors. Thankfully, once you’re in the post-menopausal stage, this risk does start to decrease.

Q: Why do we feel more anxious, stressed and panicked during menopause?

A. Sleep disturbances, debilitating physical symptoms and midlife stresses all play their part. However, falling oestrogen levels have a huge impact on our brain chemicals. In particular, they often cause a decrease in serotonin – which helps regulate mood and anxiety – as well lowering our levels of dopamine, the chemical that influences our ability to feel joy, reward and pleasure.

Oestrogen also aids the body’s stress responses, ensuring cortisol and adrenaline levels are kept in balance. If our oestrogen levels are low, these two chemicals can play havoc, resulting in that feeling of ‘fight or flight’. Decreases in progesterone can also lead to a reduction of GABA levels – another calming brain chemical – and once that cushioning is eroded, we can suddenly feel more anxious. So all in all, it’s a huge time of change in our brain chemistry.

Q: What are the best ways to support your mental health during menopause?

A. From diagnosing perimenopause and menopause accurately, to understanding how low levels of oestrogen can lead to anxiety, it’s crucial that both patients and doctors recognise the connection between our hormones and our psychology.

Women’s mental health symptoms have been misdiagnosed for too long. It’s important that as doctors, we fully support women who are going through menopause and ensure they have access to the full range of treatments, including HRT and non-hormonal alternatives.

If you’re struggling with issues such as low mood or depression, it’s important to speak to your GP or menopause specialist. Share details of not only your mental health symptoms, but any physical symptoms too. A diagnosis of perimenopause or menopause can be an important step in addressing a range of symptoms, including those affecting your mental health. 

Q: What treatments are there for psychological symptoms during menopause? 

A. As menopause specialists, we take a holistic approach, making sure we understand your symptoms and all the other factors in your life that are impacting your mental health. Anxiety, stress, low mood and other more serious conditions such as bipolar disorder or suicidal thoughts rarely occur on their own, and it’s vital to take an integrated approach. A tailored treatment plan can include:

• Treating low oestrogen levels using personalised HRT if suitable
• Female testosterone
• Progesterone
• Talking therapies, such as counselling or CBT
• A dietary and exercise plan
• An evidence-based supplements plan

Q: Can HRT improve low mood and anxiety during menopause?  

A. HRT can be hugely beneficial for many perimenopausal and menopausal symptoms, including low mood, anxiety, and other mental health conditions. However, it isn’t a one-size-fits-all, and won’t be right for every woman – some may benefit more from anti-depressants, talking therapies or lifestyle interventions.

If suitable, however, HRT can be highly effective in bringing low levels of oestrogen and progesterone back within the normal range – we can then assess your symptoms at 3-6 months. This helps us see if the problems are hormone-related, and we often find that if your hormones stabilise, there is an improvement both physically and psychologically. 

Q: Apart from taking HRT, is there anything I can do to improve my stress levels or low mood during menopause?

A. HRT isn’t right for everyone – especially those with a high risk of breast cancer. We also know that there are several evidence-based lifestyle changes that can be highly effective in tackling issues such as anxiety, stress and even more serious mental health conditions, like bipolar disorder or schizophrenia. These can be used in conjunction with, or as an alternative to, HRT.

They can include:

• Exercise: increases endorphins and serotonin production and regular activities, like running, swimming, walking, yoga , or meditation, can significantly improve anxiety, depression, sleep, and psychological symptoms in menopausal women.
• Limiting caffeine and alcohol: both can lead to increased cortisol levels, elevating anxiety and palpitations. Alcohol can also be a depressant and disrupt sleep. So it’s a good idea to cut down or eliminate them altogether.
• Diet modifications: I encourage my patients to have a balanced, healthy diet, where 50% of the food on their plate is vegetables, is rich in high quality protein and includes whole grains, legumes and starchy vegetables. This helps stablise blood sugar, preventing insulin spikes that can play havoc with stress levels and anxiety.
• Talking therapies: CBT, counselling and psychotherapy are just some of the talking therapies that can help improve a range of mental health conditions. I may recommend them as part of a tailored treatment plan, alongside HRT and lifestyle modifications.

Q: How can seeing a menopause specialist help with mental health symptoms? 

A. Our menopause specialists are highly experienced in dealing with the complexities of perimenopause and menopause. We don’t just look at your symptoms in isolation, but carefully examine every aspect of your physical and mental health. We are all highly skilled Consultant Gynaecologists and specialist women’s health GPs and work alongside a multi-disciplinary team that includes a specialist nutritionist, Consultant Endocrinologist, ultrasound specialist, psychiatrist, and physiotherapist.

Our multidisciplinary approach allows us to create a personalised treatment plan that suits your individual needs. This can include:

• HRT
• Testosterone
• Anti-depressants
• Physiotherapy
• CBT
• Exercise plans
• Dietary modifications
• Yoga, meditation
• Evidence based supplements

Make an appointment with a menopause specialist

If you are experiencing depression, anxiety, sleep issues, panic or any other symptoms of perimenopause or menopause, make an appointment with one of our team of menopause specialists. To find out more, please telephone 020 7244 4200 or make an appointment online .