Causes

The menopause transition usually starts around age 47 (although there are individual differences) with the start of menstrual changes and ends with the final menstrual period. Perimenopause includes the menopause transition and the 12 months following the final menstrual period (early postmenopausal stage). From a natural biological point of view, menopause is caused by:  

• Natural ageing process: Menopause is a natural stage in a woman’s life characterised by a decline in reproductive hormones, particularly oestrogen and progesterone. This hormonal change leads to the onset of menopause and its related effects.  

• Ovarian reserve depletion: The depletion of the ovarian reserve, unique to each woman, is a key contributor to menopause. As this reserve decreases, hormonal production becomes irregular, causing the hallmark symptoms of menopause. This can be engendered by surgery or therapy.

Symptoms

Symptoms of menopause can vary widely from person to person, making it essential to recognise that everyone’s journey through this life stage is unique. Nevertheless, several symptoms are commonly associated with menopause, including:  

• Vasomotor symptoms which include:  
  • Hot flashes: Sudden and intense sensations of heat, often accompanied by sweating and a rapid heartbeat.  
  • Night sweats: Hot flashes occur during sleep, leading to disrupted and restless nights.
• Mood swings: Emotional fluctuations that can range from irritability and anxiety, to feelings of sadness or even euphoria.
• Sleep disturbances: Difficulty falling or staying asleep, often linked to night sweats and mood swings. Many perimenopausal women experience insomnia symptoms.
• Vaginal dryness: Reduced vaginal lubrication, which can cause discomfort during intercourse.
• Changes in sexual desire: Fluctuations in libido, which can impact sexual relationships. 
• Bone health: A decrease in bone density, potentially leading to an increased risk of osteoporosis.
• Cognitive changes: Most often include trouble with memory and/or concentration.

Mental health during menopause 

All of the above physical or cognitive symptoms can be a source of distress that leads to poorer mental health. Moreover, the menopause transition often coincides with important and often stressful life events, physical health conditions and role transitions. This can be from employment to retirement, potentially increasing vulnerability to mental health conditions.  

Menopause itself is believed by some scholars to also cause psychological changes, such as increases in depressive and/or anxious symptoms. Here are some mental health conditions believed by some to be associated with menopause:  

• Anxiety: Studies show that many women experience anxiety in different shapes and intensities throughout the menopause transition.  
• Depression: Experiencing strong hot flushes and night sweats, as well as having been previously diagnosed with depression, have been shown to be risk factors for depression during menopause.  
• Loneliness: The unique challenges of menopause may lead to feelings of isolation, making it seem like no one truly understands what you’re going through and leading to social withdrawal.  
• Stress: Coping with the various physical and emotional changes during menopause can create a sense of emotional pressure and stress.  
• Eating disorders: Some may attempt to regain control over their changing bodies by trying to manage their diet. This can be because they have concerns over their body image or may experience body dysmorphic disorder (BDD). 

Supporting your mental health during menopause

Navigating mental health challenges during menopause can feel daunting and isolating. You’re not alone in your struggles. Many people identified as women have experienced similar feelings and support is available to guide you.  

Here are some things you can do:  

1. Self-awareness and self-care: Recognise and understand the signs and symptoms of menopause. Self-awareness can help you manage the physical and emotional changes more effectively, self-care practices like healthy eating, doing any form of movement that feels good and adequate sleep will positively impact your energy level and mood. 
2. Stress management techniques: Use techniques such as mindfulness, grounding, meditation, deep breathing exercises, progressive muscle relaxation or yoga. These practices can help manage stress and anxiety associated with menopause. 
3. Communicate with others: Talk about your experience with your loved ones, colleagues at work and your healthcare provider. You can also seek support groups. Discussing your experiences openly will help you get peer support and don’t be afraid to seek help.  
4. Talk to your employer: If applicable, talk with your employer about your menopausal symptoms. Share your needs and any accommodations that might help you perform your best at work. 
5. Sleep hygiene: Because sleep disturbances can be a commonly experienced symptom of menopause, it is important to maintain good sleep hygiene. Sleep regular hours and talk to your GP if you think you might experience symptoms of insomnia.  
6. Talking therapy: Cognitive Behavioural Therapy (CBT) has been shown to be effective in helping to manage symptoms of menopause.