Understanding Menopause and Mental Health: What to Expect and When to Seek Treatment

When it comes to open discussion about women’s health, we still have a long way to go. Many of us grew up with parents who didn’t talk about things like menstrual cycles, hormones, and menopause—let alone their impact on mental health. 

As we start to approach menopause, we’re often left to fill in the gaps. We might picture hot flashes and sporadic periods—but most of us don’t have a clear understanding of how strongly menopause can impact our mental health. 

So when we experience symptoms like a lack of concentration or brain fog, difficulty staying present, irritability, anxiety, or low mood, we might not realize that these could be related to menopause or perimenopause. 

Discussing the relationship between menopause and mental health is important. It gives us awareness of what we’re experiencing or what we might experience in the future—and it helps break the stigma, both around mental health and women’s health. 

Today, I’m joined by Dr. Hirsch, founder of the Menopause & Midlife Clinic and author of Unlock Your Menopause Type to talk about the relationship between menopause and mental health, how to identify your symptoms, and how to advocate for treatment. 

Menopause and How It Can Impact Mental Health

Dr. Hirsch developed a passion for women’s health in college and entered a career as an OBGYN and later specializing in midlife women’s health care. Along the way, she realized that knowledge of menopause was lagging behind other women’s healthcare issues. 

We know quite a bit about birth control, pregnancy, and childbirth—but we often don’t talk about this major transition that affects everyone with a uterus. 

Dr. Hirsch wants everyone to not just learn more about their bodies, but to be able to take that knowledge and feel better, regaining parts of their life they might be struggling with, including sleeping better, exercising again, having sex with their partners, or even feeling happy and present. 

She pointed out that many people don’t even understand the definitions of perimenopause or menopause. She defined menopause as a year of no period—but pointed out that it’s not always that easy to identify. Some women don’t have periods prior to menopause for a number of reasons—hysterectomies with ovaries remaining, IUDs or other birth control methods, or endometrial ablations to treat heavy bleeding. 

In these cases, doctors might need to turn to other methods, such as lab work to measure the levels of follicle-stimulating hormones in order to identify menopause. But in the majority of cases, a lack of a period for a year is the primary indicator. 

Perimenopause is the time leading up to menopause when your body prepares for the change, and postmenopause is the stage after menopause has occurred. 

There are many physical symptoms that come along with perimenopause and menopause:

• Hot flashes
• Tossing and turning at night
• Night sweats
• Vaginal dryness
• Dry skin and/or hair
• Dizziness
• Nausea 
• Bloating

But there are also many mental health symptoms, including:

• Irrational fears
• Anxiety
• Low mood
• Brain fog or a lack of concentration

Sometimes these mental health symptoms often get misdiagnosed as anxiety, depression, or even bipolar disorder. Dr. Hirsch pointed out that the nuances of menopause aren’t always taught well even in medical school, nursing schools, or residencies. 

Mental health symptoms of menopause often get misdiagnosed. 

Misdiagnosis is especially common with perimenopause. Not only can perimenopause present with these same symptoms, but it can actually last for longer than most people realize. If doctors don’t consider perimenopause, they might associate symptoms with other conditions. 

How Women’s Health is Often Minimized

Dr. Hirsch pointed out that when we don’t consider perimenopause or menopause as a factor in our symptoms—especially the mental health ones—we might even think that we are the problem. 

We might hear things like, “just drink more water, just take some self-care time, just try to relax. Dr. Hirsch pointed out that society often tells women that they are imagining symptoms or that they’re doing something wrong—but in reality there might be a huge physiologic hormonal decline that is being overlooked. 

Hormones play a role in so much more than sexual or reproductive health. 

She also said that we do a disservice to women’s health in general by calling hormones like estrogen, progesterone, and testosterone sex hormones. They play a role in so much more than sexual or reproductive health. 

Estrogen also plays a big role in our prefrontal cortex decision-making, memory recall, processing speed, core body temperature, and mood. When experiencing menopause, we might have worsening ADHD, depression, or anxiety. 

Dr. Hirsch said that it can be extremely hard to tell if something is related to hormonal health or not. She recommends tracking our symptoms and our cycle sooner rather than later, taking a few minutes to jot down information like:

• What our mood is like
• What our periods are like
• How we slept
• Our energy level
• How present we felt
• Our concentration level
• Our productivity

Busy moms might find even the few minutes to jot down symptoms difficult—another thing on an already crammed to-do list. But taking the time can reveal a lot of information about our hormonal health that can lead to treatment and relief—especially if our symptoms start to impact our quality of life. 

The 6 Types of Menopause

Menopause doesn’t look the same for everyone—and because it can present differently, it’s important to understand the nuances in the types of menopause. In her book, Dr. Hirsch identifies 6 types:

Premature or Early Menopause

This happens when menopause occurs before the age of 45. Premature menopause is associated with long-term health risks such as cardiovascular disease or bone loss. Dr. Hirsch said that it shouldn’t be ignored by doctors, and that the gold standard of care is hormone replacement therapy. 

Sudden Menopause

This happens when something such as surgery or medication puts you into menopause. This can occur with surgeries for ovarian removal or oophorectomy due to high-risk mutations, chemotherapy, or with medications such as Lupron or GnRH to treat endometriosis. Dr. Hirsch pointed out that it’s important for doctors to prepare patients for this sudden onset of menopause and what to expect. 

Full-Throttle Menopause

This happens when you experience symptoms from head to toe—hair loss, brain fog, sleep disturbances, joint pains, vaginal dryness—impacting your entire body. Dr. Hirsch pointed out that treatment is very important and can provide relief and increase quality of life. We don’t have to just accept our symptoms if they are taking a toll. 

Mind-Altering or Mental Health Menopause

This is when menopause presents with mental health changes, such as stress, worsening ADHD symptoms, trouble concentrating, mood changes, or trouble with memory. This presentation is likely to get misdiagnosed and potentially mistreated without awareness. 

Neverending Menopause

We often think of menopausal symptoms as only lasting a little while until our period ceases, but that isn’t always the case. Around 10% of women have symptoms that last their entire life. 

Silent Menopause

Some women don’t experience symptoms—but Dr. Hirsch said it’s important to remember that even when this happens we still need to understand menopause and our long-term health. Our body is still going through a major change. 

It’s also important to remember that even if we didn’t have symptoms in perimenopause, we might have a different experience with menopause—it’s very common to have different presentation in different stages. 

Treatment Options for Menopause

There was a time when we didn’t have treatment options for menopause symptoms—we simply thought it was something we had to deal with as women. But that has changed—and we do have available treatment options. 

We might still receive some pushback from certain doctors who aren’t willing to entertain potential treatments. Dr. Hirsch said that across the globe we treat women and mens’ health differently, with more of a focus on wellness and quality of life for men. We might hear things like, “oh everyone goes through it,” “it’s natural,” or “you’ll get through it.” 

It doesn’t have to be that way. We don’t have to settle—we can learn about treatment options and how to advocate for ourselves. 

One of the options is HRT, or hormone replacement therapy, replacing estrogen that your body is no longer making. There is a lot of online buzz about HRT, with a lot of misinformation. However Dr. Hirsch said that HRT is safe and often highly effective. 

Another potential option to treat symptoms during perimenopause is birth control pills. Dr. Hirsch said that birth control takes away the hormonal swing in your body, stabilizing your hormones and removing the volatility that can trigger symptoms. 

She also pointed out that while there is a perception that birth control is always bad for your body, that isn’t the case. Some people can’t tolerate certain forms—but everyone is different. 

Dr. Hirsch said that with both HRT and birth control pills, the only way to know if something works for you is to try it. Work with your doctor on a treatment plan to see what works—and if it doesn’t, then discuss a different plan of action. 

Advocating for Your Physical and Mental Health During Menopause

It isn’t always easy to find a practitioner who understands the nuances of perimenopause and menopause. We often have to advocate for ourselves to get our symptoms taken seriously and to receive treatment. 

Dr. Hirsch said that with the rise of social media, sometimes patients actually know more than their doctors about specific things. Sometimes general practitioners didn’t receive training on the topic. 

While we shouldn’t self-diagnose, we can and should advocate for ourselves and our health. This can come from learning and tracking our cycles so we have something to refer to. 

Don’t back down if doctors refuse to prescribe treatment—we shouldn’t have to suffer. 

Dr. Hirsch said not to back down if doctors refuse to prescribe treatment—we shouldn’t have to suffer. 

And if your doctor is not responsive or is not taking you seriously, don’t be afraid to ask for a second opinion or try to seek a specialist. There aren’t many specialists in the field, but The Menopause Society is a good place to start if you feel that you need to find one. 

The other big piece of advocating for yourself is awareness—of your own body, your mood and mental health symptoms that might be related to menopause or perimenopause, and of your right to feel well. 

As moms, we often put ourselves on the backburner and ignore symptoms for far too long. But we deserve to be well, physically and mentally. It’s never too late to advocate for yourself and prioritize your health. 

^{‍This post includes links to outside resources we endorse–if you make a purchase we might receive a commission at no extra cost to you. As an Amazon Associate I earn from qualifying purchases.}