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 may influence the occurrence and severity of mood disturbances during the menopausal transition.1,3
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We all go our own way.
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 changes 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 changes and menopause
Mood changes in menopausal women is also affected by other co-existing factors such as:5,6
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 changes secondary to physiological changes
Mood changes and anxiety may 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 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