The Relationship Between Menopause and Mental Health: Symptoms, Impact, and Treatment

Women’s health concerns have long been overlooked and under researched. In a medical system historically driven by men and focused on men’s needs, women often fall through the cracks. A prime example of this is the lack of provider training, support, and education around menopause—especially when it comes to mental health symptoms. 

Concerns around menopause are often dismissed, viewed as “part of aging” and “just something you have to deal with.” 

But the truth is that menopause can have a very large impact on mental health. The hormonal changes that accompany perimenopause and menopause can trigger a wide range of symptoms, including fatigue, brain fog, mood swings, anxiety, and depression. 

For moms who have navigated postpartum mental health symptoms, the odds of struggling with these hormonal changes increase. And with research showing that perimenopause can start earlier and last longer than we once thought, it’s more important than ever for moms to equip themselves with knowledge about symptoms, hormone levels, and treatment options. 

This week on The Momwell Podcast, I’m joined by Dr. Haver Claire Haver, author of The New Menopause, to unpack how menopause can impact mental health and how we can advocate for ourselves and seek effective treatment options. 

How Medical Research Overlooks Menopause and Women’s Health

There is a long history of women being overlooked, minimized, and misunderstood in the medical field, often leading to inadequate medical treatment. Doctors and practitioners are often untrained in hormonal health and the nuances of women’s health, especially when it comes to menopause. 

Dr. Haver explained that the issue isn’t necessarily that there isn’t research on the topic—there are plenty of documented studies about menopause and hormonal health. But this vital information often gets buried in obscure journals, and ultimately dismissed by the larger medical community. 

In her own practice as an OB-GYN, she wasn’t trained in the nuances of hormonal health or menopause. It wasn’t until she went through menopause herself that she realized many doctors aren’t being given the adequate training to understand menopause, let alone its impact on mental health. 

This can lead to doctors dismissing women’s concerns or minimizing their experiences, attributing their symptoms to “just part of motherhood” or “just part of getting older.” Doctors often become more focused on the physical symptoms, overlooking the connection with mental health and the way that women’s brain health and men’s health differ, often due to hormones. 

Menopause is so much more than hot flashes or a cessation of periods.

Menopause is so much more than hot flashes or a cessation of periods. It can impact mental and cognitive health—and it even affects heart, kidney, gut, bone, and skin health. Dr. Haver explained that women’s hormones are more difficult to study, and because of that, the medical system has continued to focus on men in the bulk of research—even lab rats have largely been male. 

But in overlooking hormonal health for women, we’ve done a disservice to the female population. Dr. Haver pointed out that we're not little men with breasts and uteruses. We have very different biological happenings in multiple organ systems of our body—not just in our reproductive organs.

The Role of Estrogen on Menopause and Mental Health

One of the reasons menopause impacts our health in such massive ways is the result of estrogen—an impactful hormone which protects several aspects of a woman’s overall health. 

Any loss of estrogen can be detrimental because of its protective nature. Dr. Haver said that during menopause, estrogen levels can drop to less than 1% of our reproductive years when we become postmenopausal, it can take a big toll on our bodies. 

Menopause isn’t the only time that estrogen drops—this also occurs during postpartum. And though the loss isn’t as extreme during postpartum, Dr. Haver said that we can learn a lot from postpartum data, which is essentially a mini postmenopausal experience. 

Postpartum and menopause can have many similar symptoms, such as vaginal dryness and painful intercourse, or even hot flashes and night sweats. They can also both cause mental health and cognitive concerns, including irritation, mood swings, depression, and anxiety. Dr. Haver said that estrogen is so effective in protecting brain function, its depletion could even contribute to postpartum depression. 

Many other health issues, often attributed to aging, could actually be due to estrogen depletion, including: 

• Heart palpitations 
• Gut issues
• Loss of bone strength
• Muscle mass loss  

But when women experience symptoms in the menopausal stage, the real impact of their hormonal health could go overlooked. Without training in these nuances, doctors might consider these individual symptoms just part of the aging process. When this happens, they miss out on the chance to treat these concerns—putting women’s long-term health at risk. 

We are just in the tip of the iceberg when it comes to research on estrogen and it's impact. 

Dr. Haver said that we are just in the tip of the iceberg when it comes to research on estrogen and its impact on women’s physical and mental health. The more knowledge we acquire about how estrogen affects our body the more equipped we will be to stay healthy as we age.  

The Impact of Perimenopause and Menopause on Mental and Physical Health

Estrogen is just one component of hormonal health. The ebbs and flows of our hormones can affect everything from our mood to the way we respond to medications. Dr. Haver said that our hormone levels can cause our triglyceride and cholesterol levels to fluctuate to a point where even diagnosing medical conditions becomes difficult.

Because of changes in hormones, many women experience a wide range of symptoms throughout the menstrual cycle and during the postpartum period. But Dr. Haver said that perimenopause is essentially hormone fluctuations on steroids.

During menstruation, the brain is usually able to account for the changes in hormone levels, But perimenopause can cause massive increases in estrogen and drops of progesterone which are so extreme that the brain is unable to make the necessary adjustments. 

This can cause mental health difficulties. In fact, Dr. Haver said there is a fourfold increase in the rate of depression and anxiety for a woman during perimenopause. 

The drop in progesterone and estrogen during perimenopause can also trigger insomnia, leading to sleep deprivation which increases the risk of other mental and physical health concerns. 

Mental health symptoms due to hormone changes can include:

• Irritability
• Brain fog
• Slow thinking
• Memory loss

Physical health symptoms due to hormone changes can include: 

• Vertigo 
• Ringing in the ears
• Rise in cholesterol rates
• Musculoskeletal syndrome (pain in the joints, muscles, or tendons) 
• Frozen shoulder

These symptoms can affect our lives every day—and yet, there is still a tendency to overlook them. Dr. Haver said that there is a big resistance in the medical community to embrace the new research and respond to menopausal symptoms with treatment. 

We can’t continue to overlook women’s issues and deny them the treatment they need.

She feels as if there is an old guard that stays adamant that menopause is not a big deal, and that we should just accept these as part of the aging process. But those leading the new charge believe this is no longer acceptable—we can’t continue to overlook women’s issues and deny them the treatment they need and deserve. 

How to Seek Providers Trained in Menopause and Mental Health

One of the struggles women face when seeking care for menopausal symptoms is that doctors are often inadequately trained. Dr. Haver pointed out that many general practitioners only receive an hour of training each in menopause and OB-GYN studies. A recent study showed that only 7% of graduating OB-GYN residents felt confident in menopause care.

In 2023 only 7% of graduating OB-GYN residents felt confident in in menopause care

Dr. Haver hopes that this will continue to change. In the meantime, it’s in the best interest of women to actively advocate for themselves by seeking physicians with specialized menopause training.  

The Menopause Society (formerly The North American Menopause Society) is a reliable source for finding providers specialized in menopause care. Dr. Haver has also created a recommended provider list.

It’s vital that women receive adequate care. But since so few have been able to access it, they often look outside of the medical system, turning to chiropractors or seeking help through natural wellness trends. 

Dr. Haver pointed out that these areas have a lack of reliable science-based data. They might take advantage of the systemic issues to sell overpriced hormone supplements, which he said is often unnecessary—there are regulated treatment options available that are not only scientifically backed and safe, but that are often more affordable. You just might have to advocate for yourself to gain access to these treatments. 

Treatment Options for Menopause Struggles and Mental Health Symptoms

There are numerous treatment options for menopause symptoms and mental health issues, primarily hormone replacement therapy (HRT),  which can be highly effective as a safeguard against potential health issues. 

Dr. Haver said that it’s frustrating that the FDA hasn’t approved testosterone for HRT in females, but that there are plenty of options available. 

The primary HRT options are:

• Estrogen
• Progesterone
• Androgens/testosterone

These are the main sex and reproductive hormones in the body. The common treatments are bioidentical versions—the same hormones that are made in our bodies. HRT can be administered both orally and in non-oral form, including gels, creams, patches and rings. 

HRT is not a one-size-fits-all all approach and can take some experimentation to determine what works for individuals. 

Dr. Haver said that timely hormonal replacement is valuable. Research shows that estrogen is incredibly protective for our cardiovascular system, our bones, and our brain, if given in a window of opportunity. HRT treatments can benefit all of our body systems. 

She also pointed out that part of the reason why HRT has been underused is because of a misinterpretation of data. Early research indicated that there were cardiovascular benefits of HRT, but the larger medical community dismissed this, attributing it to women with access to HRT already being healthier and wealthier. 

It took some time, but eventually, more research came out. Now, the American Heart Association has published research indicating that if a woman starts hormone therapy within 10 years of menopause, she has a 50% less chance of developing cardiovascular disease.

Dr. Haver also pointed out that there are non-hormonal treatment options to manage these symptoms, including lifestyle changes such as diet and exercise. HRT might not work for everyone, and some people might not want to use hormonal treatments. But she believes that women deserve access to quality information so they can make informed decisions about treatment options. 

Therapy can also be a vital treatment form for mental health symptoms. A holistic approach to treatment that targets symptoms and addresses both mental and physical health concerns can help women navigate the menopausal stage and offer long-term relief and protection. 

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