How to deal with the mental health effects of menopause and perimenopause

Published January 2023 | 3 min read
Expert contributors Dr Elizabeth Farrell, gynaecologist and medical director of Jean Hailes for Women's Health; Dr Marny Lishman, psychologist
Words by Lucy E Cousins

While this stage of life brings with it physical challenges, it can also have repercussions for your mental health. Here’s why, and how you can feel better.

Even though menopause is experienced by more than half of our population, this life stage is still a mystery for many women. A recent study of women over 40 found more than 90% hadn’t been taught about menopause at school, and more than 60% did not feel informed about it.

Yet, according to Dr Elizabeth Farrell, a gynaecologist and medical director of Jean Hailes for Women's Health, while the majority of women have mild to moderate symptoms during perimenopause and menopause, around 20% of women will have severe symptoms that can impact their quality of life.

These symptoms can be both physical and mental in nature, and while some women won’t notice the changes, for others it can impact their mental health.

How do perimenopause and menopause affect mental health?

Menopause is the time of life when your menstrual cycle has officially stopped for a year. Perimenopause refers to the natural process leading up to menopause when your ovulation and periods may become irregular or stop.

Many of the physical and mental symptoms that affect women at this time – like irregular periods, weight gain, hot flashes, mood changes and sleep problems – are a result of the change in the body’s hormone levels.

“As women, we produce oestrogen, progesterone and testosterone. Testosterone is probably at its highest in our 20s and early 30s, and then it slowly declines,” says Dr Farrell. “But what happens at the menopause is that when you drop the oestrogen level, you alter the ratio in the body between oestrogen and testosterone, so that testosterone becomes a more dominant hormone.”

For some women, she adds, this new hormone ratio can make them feel a bit more mentally “uneven”, and they might find things they managed before without any difficulties now create a sense of disorder or distress for them. This can also be intensified if a woman has a history of depression, anxiety or even some types of trauma.

That’s why, explains Dr Farrell, menopause is sometimes talked about as being a ‘window of vulnerability’, as some women are more sensitive to these hormonal shifts and are affected to a greater degree.

Other mental side effects of menopause

The physical effects of perimenopause and menopause, which can include bloating, weight gain, hair loss and fatigue, can be challenging to experience and can influence how we feel within ourselves.

“Whenever we don’t feel physically well, it often affects our mental health as the body and mind are so connected,” explains psychologist Dr Marny Lishman. “And because of the physical changes [of perimenopause and menopause], women can sometimes not feel like themselves, which can impact their confidence.”

The coinciding life stage that women in their 40s and 50s find themselves in can be a time of stress and uncertainty. They might be reaching their career peak, caring for elderly parents, parenting teenagers, welcoming adult children back home or experiencing problems in their relationships. The highest rate of divorce in Australia in females is 40 to 44 years of age and 45 to 49 years of age in men.

“Suddenly you get to an age where a lot of women might think, ‘I've done all this work all my life, now it's my time’ and so things they would put up with in the past, they're just not prepared to do now,” says Dr Farrell. “It’s a time where some relationships really struggle.”

The good news? There’s lots of help and support available.

When to seek help for mental health issues during perimenopause and menopause

If you’re struggling with the mental health side effects of perimenopause and menopause, Dr Lishman says don’t wait too long to seek help.

“If you’re not operating like you usually would or if you’re getting feedback from family and friends that you might need help, then seek professional advice,” she advises. “Psychologists are there to support you with no judgement and they can offer helpful strategies to encourage you to think differently and behave differently, to help change the way you feel.”

Despite the challenges, perimenopause and menopause can be a really positive time in women’s lives, a time to re-evaluate what is and isn’t working for you in life. It’s helpful to view this transition period as an opportunity to make positive changes in your lifestyle, the way you treat your body and take care of your mental health.

As well as this, she says, be mindful that you listen to your emotions, rather than fight against them. For example, if you’re feeling very irritable – name that emotion, feel where it comes up in your body, breathe through it and name something you can do to soothe that feeling. For irritability you could go for a walk, do 15 minutes of yoga or just sit outside for 10 minutes and drink a cup of tea.

“Your feelings and emotions [can act as] valuable information to change the way you feel. If you listen to them, they can spur you on to engage in behaviours that make you feel better,” Dr Lishman says. Nobody wants to feel permanently grumpy or tearful, so reach out for help, pay attention to the way you are feeling and schedule in time for self-care. And remember that these feelings won’t last forever.

Ideas for mental health self-care during menopause and perimenopause:

• avoid judging yourself harshly for how you might be feeling
• acknowledge that your body is moving into a new phase
• spend time focusing on yourself and your physical and mental health needs
• share your experiences and feelings with your friends
• communicate what you’re experiencing with your partner
• exercise regularly, especially with resistance training
• seek out medical experts you trust and feel comfortable with
• prioritise time in nature, away from social media and screens
• where possible, delegate household responsibilities to reduce stress
• schedule regular ‘moments of pleasure’ into your day. This could be as simple as enjoying a coffee alone in the garden or calling a friend.

If you're struggling with depression or anxiety, and need to speak to someone now, call Lifeline on 13 11 14.

A helping hand with mental health

If you’re concerned about your mood changes or mental wellbeing and need some help to navigate this time, we're here to help. Our partnership with online service GP2U gives you easier access to a doctor over video call, without having to visit a clinic. They may be able to help you get a mental health care plan. Through our partnership with GP2U, all HCF members with health cover can access a standard online video GP consultation (up to 10 minutes) for a fee of $50. See hcf.com.au/gp2u for more information. 

We’ve also partnered with PSYCH2U to offer HCF members easier access to mental health support through online video consultations with a qualified professional. Eligible members^{^} can access a free HealthyMinds Check-in with a psychologist at PSYCH2U helping to guide you to the mental health support you need.