Could the menopause affect mental health?

Reduction in serum levels of estrogen during menopausal transition results in mood changes. Psychological symptoms such as mood swings, anxiety and low mood are commonly seen in menopausal women.

The prevalence of mood disorders and irritability are higher in perimenopausal women compared to premenopausal women. The mood disturbances in perimenopausal women could be due to sleep disturbances caused by hot flushes and night sweats.1 Several psychosocial factors influence the occurrence and severity of menopause mood swings.1,3

Mood changes

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Psychological symptoms of menopause

Anxiety, low mood, fatigue, irritability and memory impairment are some of the psychological symptoms of menopause.2 The symptoms of menopause may include mood swings, irritability, nervousness and frequent changes in mood.3

Causes of mood swings during menopause

Mood changes during the menopausal transition can result from a number of factors. Vasomotor symptoms may lead to sleep disturbance that becomes severe enough to adversely affect quality of life. Thus mood changes during the perimenopause could be secondary to poor sleep, due to hot flushes.1

Another hypothesis proposes that changes to the neuromodulatory function and/or in reproductive-hormone levels contribute to the constellation of mood and vasomotor symptoms seen in some perimenopausal women.1

Influences associated with mood swings and menopause

Mood changes in menopausal women is also affected by other co-existing factors such as:5,6

Life stress

Hot flushes

Night sweats

Little or no physical activity

Dissatisfaction with partner

Cigarette smoking

Negative attitude towards menopause and ageing

History of post-partum depression

Family history of depression

Anxiety during menopause

Symptoms of anxiety and depression are more prevalent in the perimenopause than in the menopause.2,3

Women may experience mild mood and anxiety symptoms a few years prior to menopause.2 Several factors such as past history of anxiety, relationship and family problems, socioeconomic status and lifestyle influence the severity of anxiety in perimenopausal women.6 There is a strong association between anxiety and hot flushes.7

Mood swings secondary to physiological changes

Mood swings and anxiety commonly occur secondary to somatic symptoms such as hot flushes, night sweats and insomnia, which consequently result in fatigue and lethargy.6

Management of psychological symptoms during the menopause8

  • Consider HRT to alleviate low mood that arises as a result of the menopause
  • Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause
  • Ensure that menopausal women and healthcare professionals involved in their care understand that there is no clear evidence for selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) to ease low mood in menopausal women who have not been diagnosed with depression
  • References

    1. 1) Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition the Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2006 Apr;63:385-90.
    2. 2) Saˇgsöz N, Oˇguztürk O, Bayram M, Kamacı M. Anxiety and depression before and after the menopause. Arch Gynecol Obstet. 2001 Jan;264:199-202.
    3. 3) Cohen LS, Soares CN, Joffe H. Diagnosis and management of mood disorders during the menopausal transition. The American Journal of Medicine. 2005 Dec;118(12B):93S-97S.
    4. 4) Freeman EW, Sammel MD, Liu L, Gracia CR, Nelson DB, Hollander L. Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry. 2004 Jan;61:62-70.
    5. 5) Mitchell ES, Woods NF. Depressed mood during the menopausal transition: is it reproductive aging or is it life? Women’s Midlife Health. 2017 Dec;3:11.
    6. 6) Deeks AA. Psychological aspects of menopause management. Best Pract Res Clin Endocrinol Metab. 2003 Mar;17(1):17-31.
    7. 7) Freeman EW, Sammel MD, Lin H, Gracia CR, Kapoor S, Ferdousi T. The role of anxiety and hormonal changes in menopausal hot flashes. Menopause: The Journal of The North American Menopause Society. 2005 May;12(3):258-66.
    8. 8) NICE. Menopause: diagnosis and management. NG23. Available at: www.nice.org.uk/guidance/ng23 (accessed January 2021).

Zumenon®

Zumenon® is indicated for estrogen deficiency symptoms in postmenopausal women at least 6 months since last menses.

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