Menopause is a natural part of life, something every woman will go through. And yet, there are still so many myths and misconceptions about the menopause transition.
There are around 15.5 million women in the UK who are experiencing menopause right now – many of whom will be affected not only by menopause symptoms, but by the personal, social, and economic impact that the lack of understanding and awareness about menopause creates. More needs to be done to demystify the menopause transition, so women feel they can talk openly about their different experiences.
The symptoms of menopause are incredibly wide-ranging, and go far beyond annoying hot flushes and night sweats. Some women experience feelings of sadness or irritability, while others may struggle to focus, feel tired and tense, or have problems sleeping.
Because women going through perimenopause or menopause often experience shifts in emotion, this can also lead to some women getting misdiagnosed and being prescribed antidepressants – when what they’re really experiencing is fluctuations in their oestrogen levels.
So what’s the link between menopause and depression? And how can we make sure we get the right support when we’re going through this process? We’ve partnered with My Menopause Centre – who aim to empower women with their online menopause clinic, and evidence based information and advice – to explore the answers to these questions.
What is menopause?
Menopause is a natural part of the ageing process. It’s the time when a woman’s periods stop – either suddenly or over time – because her ovaries stop producing oestrogen and making eggs. In the UK, the average age that menopause occurs is 51, but the transition period usually occurs between the ages of 45 and 55.
While women are said to be menopausal once their periods have stopped for a whole year, the entire menopausal process actually lasts for longer than this. Perimenopause (which means ‘around menopause’) refers to the period before menopause actually happens, when your body begins to transition to menopause and your oestrogen levels start to decline.
“Emotional symptoms - such as irritability, or feeling tearful, sad, or anxious - are a common symptoms of the menopause transition. They can start early in the perimenopause and linger after periods have stopped. Once a woman hasn’t had a period for over a year, she’s regarded as post-menopausal. The physical and psychological effects of perimenopause and menopause tend to settle down at some point, but they can last up to 15 years or longer.”
What is depression?
Depression is a mental health condition that affects the way someone thinks, feels, and behaves. Symptoms can include losing interest in things you used to enjoy, feelings of sadness, emptiness, apathy or hopelessness, fatigue or low energy, and difficulty sleeping – or sleeping too much.
Other symptoms can include having trouble remembering things, problems making decisions, or finding it hard to focus. Some people experience changes in their appetite and weight, slower movement or speech, or recurrent thoughts about harming themselves.
How are menopause and depression linked?
Hormone changes during the menopause transition can significantly affect mood. A 2018 review found that depression is more common during perimenopause. In the two to four years after someone’s last period, the risk of depression seems to decrease again.
But it’s important to bear in mind that women going through menopause are often misdiagnosed as suffering from depression and anxiety – when in actual fact, the emotional difficulties they’re experiencing are really due to the fluctuations in their oestrogen levels.
“You can see that there is overlap of symptoms of the menopause and depression. Many women are offered antidepressants to help symptoms, but HRT can be more effective if symptoms are related to the menopause.”
In scenarios like these, women are frequently prescribed antidepressants rather than menopause-specific treatments, like hormone replacement therapy. When they’re wrongly prescribed antidepressants, many women find that it doesn’t work for them, so they stop taking it – and the problems persist.
However, as we’ve seen, many common menopausal symptoms like sadness, irritability, mood changes, and tiredness are common symptoms of depression, too. While there’s no real evidence that menopause actually causes depression, the emotional and physical symptoms can sometimes be overwhelming and make it difficult to cope.
“For some women, psychological symptoms are more debilitating and have a greater impact on their life than physical symptoms such as hot flushes and night sweats.”
If you’re suffering from anxiety or depression, symptoms can worsen in the menopause.
Before we look into the ways you can try to improve your situation, it’s important to understand why exactly menopause can create these feelings of depression. There are several reasons for this…
Physiological factors
There are very real physical reasons why a woman may experience symptoms of depression during the menopause transition. During perimenopause, hormone levels can fluctuate dramatically before stabilising once the actual menopause occurs. Rising and falling levels of oestrogen and progesterone can affect our brain chemistry, structure, and function.
Oestrogen enhances the effect of neurotransmitters like serotonin, which helps stabilise mood and creates feelings of happiness and wellbeing – so when the production of oestrogen declines, it’s no wonder that it can affect our mood and the way we feel.
Some people are also just more prone to hormone-related mood changes, and a 2015 study found that women who suffered from premenstrual symptoms, postpartum depression or who have a family history of depression may be more likely to feel depressed during perimenopause.
Psychosocial factors
Aside from the physical reasons, there are also psychological and social factors why menopause can have such an impact on mental health. While many women feel positive about getting older and going through the menopause, others feel as though they’ve lost their confidence and self-esteem.
The way we feel about our physical appearance can have a profound effect on our mental health, too, and if people believe that going through the menopause makes them less womanly or youthful, they may be more likely to experience negative feelings.
A 2021 study that looked at cultures where old age, and not youth, is revered, found that women reported less negative symptoms while experiencing perimenopause and menopause – which does suggest that how our society views age can in fact shape the way we feel about the transition.
There’s also the fact that menopause symptoms can affect someone’s ability to work – and over two-thirds of women in the UK believe symptoms of the menopause have had a negative impact on their work and career. Workplace discrimination due to the menopause is very real, and many women feel they’re not receiving enough support, both professionally and socially.
“I meet many women who have changed or are thinking of changing their careers as a direct result of symptoms of the menopause transition.”
Why are symptoms of menopause often misdiagnosed?
So why are the symptoms of menopause so frequently misdiagnosed?
Unfortunately, much comes down to the fact that even in this day and age, the menopause taboo still exists. While conversations about menopause are becoming more common, we’re still not talking about it half as much as we should do. A survey by My Menopause Centre found that 47% of people (and 72% of perimenopausal and menopausal women) believe it’s still a taboo topic in society.
Because the perimenopause and menopause symptoms differ for everyone, there’s also no one-size-fits-all approach to managing the transition. Many people don’t understand the effect hormones can have on the brain – and because the symptoms often come on so gradually, many women experiencing the transition themselves don’t always realise that their symptoms are due to menopause.
There’s also the fact that these symptoms of menopause are not specific to the transition itself. Experiencing feelings of sadness, anxiety, or irritation is not at all uncommon and could be down to family problems, work stresses, or financial concerns. Similarly, if you’re feeling tired or finding it hard to focus, you may just think that you’ve been pushing yourself too hard and not getting enough rest.
Because so many of the symptoms can often be explained away, many women try to brush aside their experiences. They might believe (wrongly) that they’re not coping with life very well, or are too stressed – and then they might decide to take time out, or step away from certain activities.
While in some cases this might be good advice, it can also leave women feeling isolated, or as though they’ve failed in some way, which can further exacerbate a loss of confidence and self-esteem. Therefore, it’s really important to be able to have open conversations about the way you’re feeling, so you’re able to seek the right type of support.
How to cope with feelings of depression
It can be hard to tell the difference between clinical depression and the depression-like symptoms that accompany perimenopause or menopause. If you’ve never experienced depression before, and these negative feelings suddenly begin in your 40s, they’re more likely to be related to the menopause.
While the symptoms of clinical depression can overlap with menopausal symptoms, clinical depression tends to be more intense. You may feel so overwhelmed with feelings of sadness, hopelessness, and worthlessness that you’re unable to live your life normally. Some women may even feel suicidal.
If you’re struggling with feelings of depression and aren’t sure whether it’s due to the menopause, then it’s important to speak to a health professional as soon as you can. You might want to think about booking a menopause consultation with a specialist – or alternatively, you may want to speak to your GP.
However, there are plenty of lifestyle changes you can make to help improve your quality of life and alleviate feelings of depression. Exercise, diet, and nutrition are really important, and reducing or cutting out alcohol can also help with certain symptoms.
Practising self-calming skills like yoga, meditation, and mindfulness can also be really beneficial – and it’s important to keep socialising with friends and family, and to feel connected to other people. To find out more about the best ways to cope with the menopause, you might want to read our article on managing your menopause journey.
Above all, it’s crucial to be kind to yourself. Menopause can sometimes trigger concerns about getting older, so if you feel worried or sad about that, try to frame your thoughts more positively. Remember that menopause is just a natural part of life – and although it’s normal to feel sad about losing your childbearing years, try to also feel excited about the freedom that lies ahead.
“In my experience, a holistic approach is often needed in managing symptoms of the menopause. HRT in combination with lifestyle changes can be an effective way of managing symptoms and helping prevent long term health consequences of the menopause such as osteoporosis and heart disease.”
Final thoughts
While there’s a link between menopause and depression, the nature of the connection isn’t yet clear. Feeling sad, anxious, and irritated are common occurrences for women going through perimenopause and menopause, and it can be hard to distinguish between clinical depression and the emotional rollercoaster that is menopause.
If you’re worried about how you’re feeling, it’s a good idea to book a menopause consultation with a specialist or speak to your GP. It’s important to speak up about how you’re feeling to your loved ones, too; speaking openly about your experiences can relieve some of the pressure you’re feeling – and it also goes a long way to eradicating the taboo that still surrounds menopause.
If you’d like to learn about some other resources that might help you, it’s also worth taking a look at the wider menopause section of our site.
Have you experienced feelings of depression while going through the menopause? Or do you have any tips or advice that you would offer to other women who are struggling with menopausal symptoms? Join the conversation and leave a comment below.