Menopause and Mental Health

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While we use the term “woman” in this article, menopause is a life stage that can be experienced by transgender, non-binary, and gender-diverse people too.

Menopause is a natural life stage that women go through. It occurs when a woman's ovaries stop producing eggs, leading to a decrease in estrogen and progesterone levels and spans up to half of a woman’s life. This major life transition often brings not only physical changes, but also significant mental health shifts.

While menopause is most often discussed in the context of cisgender women, it’s important to recognize that individuals who are transgender, non-binary, or gender-diverse may also experience menopause. Hormone changes, gender-affirming care, and surgeries can bring on similar symptoms. Each person’s experience is unique, but the emotional and psychological effects can be equally significant.

Oftentimes, much of the focus is on the physical symptoms experienced during menopause, but mental health changes can impact well-being as well. Understanding the mental health challenges associated with menopause can empower women to manage this phase of their life more effectively and seek support where needed.

Hormonal shifts and their biological impact

Menopause unfolds in three stages: perimenopause, the transition leading up to the end of menstruation; menopause, marked by 12 consecutive months without a period; and postmenopause, the years that follow.

The hormonal changes in menopause, particularly in perimenopause, when hormone levels can fluctuate the most dramatically, can be an extremely difficult time for many women. Egg production slows and hormones fluctuate leading to what can feel like a storm of symptoms that may wax and wane. Symptoms often include night sweats, hot flushes, headaches, brain fog, irritability, muscle aches, and joint pain. Many women experience weight gain or shifts in weight distribution (to the middle section) and for some women, depression and anxiety may occur.

Estrogen and progesterone can have direct effects on mood and cognitive function. Estrogen, for example, is linked to serotonin production, a key neurotransmitter involved in mood regulation. The decline in estrogen can lead to fluctuations in serotonin levels, potentially contributing to mood swings, irritability, and depressive symptoms.

For some women, these hormonal fluctuations may increase susceptibility to anxiety and depression, even if they haven't previously experienced these issues. In others, this is especially common during perimenopause, the transitional phase leading up to menopause, when hormonal changes are often the most intense.

Increased risk of depression and anxiety

Research has shown that women in perimenopause and early postmenopause are at an increased risk of experiencing depression and anxiety. Some studies suggest that women are up to four times more likely to experience depressive symptoms during perimenopause than at other times in life. In fact, research suggests that between 19% and 36% of women may experience depression during the menopause transition. While hormone changes are a major factor, sleep disturbance, life stressors, and physical symptoms all play a role. These overlapping challenges can make it harder to pinpoint the exact cause of mood changes, which is why comprehensive care and awareness are so important. For women with a history of mood disorders, menopause can exacerbate these conditions, making effective management even more essential.

Several factors contribute to this increased risk:

Hormonal fluctuations can destabilize mood, as mentioned above.

Sleep disturbances are common in menopause, often due to hot flushes and night sweats, and can worsen symptoms of anxiety and depression.

Hot flushes can exacerbate anxiety because they can come out of nowhere and can be embarrassing if they occur during meetings at work or during on-site client calls. Hot flushes can also be triggered by anxiety.

Life transitions, such as children leaving home, changes in career/income, separation or divorce, and/or caring for aging parents, can coincide with menopause, adding stress and emotional strain.

Changes in lifestyle, such as a decrease in exercise or changes in eating habits can impact mood regulation.

Cognitive symptoms: brain fog and memory changes

Many women report cognitive changes during menopause, often described as “brain fog.” This may include difficulties with concentration, memory lapses, and slower processing of information. These symptoms, while generally temporary, can cause frustration and anxiety, especially in professional and personal contexts.

Research has found that estrogen may play a role in cognitive function by promoting neural health. As estrogen levels decrease, some women may notice changes in memory and cognition. Fortunately, studies suggest that cognitive symptoms typically improve in postmenopause, although this process may take several years.

Self-esteem and body image

The physical changes of menopause, such as weight gain, changes in skin texture, changes in sexual function, and hair thinning, can affect self-esteem and body image. This shift in self-perception may contribute to feelings of sadness, frustration, and even embarrassment. In a society that often values youth and appearance, these changes can impact a woman’s sense of identity and self-worth.

Workplace pressures

Some of the changes can also spill over into professional life. Many women report that symptoms like hot flushes, fatigue, or brain fog make it difficult to maintain their usual focus and energy at work. Because menopause remains a taboo topic in many workplaces, some women may avoid discussing what they’re going through, fearing stigma or misunderstanding. This silence can lead to frustration, isolation, or self-doubt, further affecting mood and confidence.

Many workplaces are creating menopause-inclusive workplaces to help reduce these pressures and promote well-being.

Barriers to care and equity in menopause support

Many women face challenges getting appropriate support. Symptoms are sometimes dismissed or treated separately, rather than as part of a broader hormonal transition. This can lead to delays in diagnosis and treatment, worsening both mental and physical health.

The challenges are even greater for women and gender-diverse people who face additional barriers in healthcare. Racialized individuals, 2SLGBTQIA+ people and those from lower-income backgrounds are more likely to encounter bias or lack of understanding from healthcare providers. As a result, they may feel unheard, experience greater distress, or even hesitate to seek support.

Strategies to support mental health during menopause

While menopause can present mental health challenges, there are strategies that can help women navigate this period with greater ease. First, understanding and accepting that menopause is a normal part of the aging process and can be a shared experience for women and gender-diverse people who menstruate can be helpful. Addressing the changes that happen with self-compassion can also be beneficial.

• Seek support and treatments from your primary care provider: If you are experiencing physical symptoms of menopause, speak to your primary healthcare provider. Appropriate treatment, such as management of hot flushes, night sweats, and sexual health concerns (including genitourinary syndrome of menopause) can significantly improve your quality of life. Ask for a referral to a menopause specialist if you feel your concerns are not taken seriously.

• Exercise: Regular physical activity can help improve mood, reduce anxiety, and enhance cognitive function. Exercise boosts endorphins—often called the “feel good” hormones which can elevate mood, and exercise also supports better sleep and may even alleviate some physical symptoms of menopause.

• Mindfulness and stress-reduction techniques: Practices such as mindfulness, meditation, and deep-breathing exercises can help manage stress and improve mood stability. Engaging in activities that promote relaxation, such as yoga or journaling, may also be beneficial.

• Therapy and counselling: Psychotherapy, particularly cognitive behavioural therapy (CBT), has been shown to be effective for managing mood swings, anxiety, and depressive symptoms during menopause. A mental health professional can offer tailored strategies to address specific symptoms and support women through this transition. Reach out to your Employee and Family Assistance Program (EFAP) provider for support.

• Hormone therapy: For some women, hormone therapy (HT) may help alleviate severe symptoms related to hormonal changes, including mood disturbances. However, HT is not suitable for everyone, and its risks and benefits should be carefully discussed with a healthcare provider.

• Social support: Engaging with family, friends, or support groups to talk openly with others going through similar experiences can provide a sense of community and reduce feelings of isolation, encouraging a more positive outlook on aging. Talking openly with loved ones about one’s experiences can also foster understanding and support.

• Be aware of claims about magic supplements: As menopause becomes more visible, it’s important to seek information and treatments from credible, evidence-based sources. Unfortunately, social media influencers market products with misleading and even dangerous claims. Trusted healthcare providers can help you evaluate safe, effective options, such as menopause hormone therapy, medications, supplements, and lifestyle changes.

The Importance of Destigmatizing Menopause and Mental Health

Despite being a universal phase of life, menopause is often shrouded in stigma and silence, which can make it harder for women to seek help. Many women feel pressure to “push through” symptoms without addressing the mental health impacts, leading to prolonged suffering. Raising awareness and normalizing conversations about menopause can help women feel less alone and more empowered to seek support.

Menopause is not an ending, it’s a transition to another stage of life that offers opportunities for renewal, growth, and deeper self-understanding. Prioritizing mental health throughout this period allows women to move forward with confidence, balance, and strength.

With the right tools, support, and self-compassion, women can navigate this phase with resilience and continue to thrive in this new chapter of life. By focusing on mental well-being alongside physical health, women can emerge from menopause feeling empowered and prepared for the years ahead.

If you’re finding it difficult to manage the emotional or mental health changes that come with menopause, reach out to your Employee and Family Assistance Program (EFAP). We can connect you with professionals who understand what you’re going through and can help you explore practical ways to cope.

References

Gunter J (2021) The Menopause Manifesto: Own your health with facts and feminism. Toronto: Random House Canada