“I don’t understand what’s happening to me,” Sarah* shared during our first session. “I’ve always been someone who could handle stress, but lately, the smallest things send me into a rage or leave me feeling completely hopeless. My GP suggested it might be perimenopause, but I thought that was just about hot flushes?”
Like so many, Sarah had been left totally in the dark about what was happening in her own body. Understanding menopause and mental health can make the transition a whole lot easier to handle.
The same hormones that control your menstrual cycle also affect the brain chemicals that regulate mood and calmness. When these hormones fluctuate dramatically during perimenopause, the transition period that can last months to years before menopause, the effects ripple through your entire system. Recent research reveals that there is an increased risk of depression and anxiety during perimenopause and the menopausal transition.
Depressive symptoms are often more severe compared to pre- and post-menopause and the decline in oestrogen is thought to be the main cause of increased risk of depressive disorders. This isn’t about “hormonal mood swings” – it’s real changes in your brain chemistry that need care and support.
This blog post focuses primarily on menopause as experienced by cisgender women, as the majority of current research and clinical understanding centres on this population. However, it’s important to acknowledge that menopause also affects transgender men, non-binary, intersex, and other people assigned female at birth who may experience hormonal changes regardless of their gender identity. The transgender, intersex, and gender-diverse community may face unique challenges during menopause, including interactions between hormone therapy and natural hormonal changes, dysphoria related to menopausal symptoms, and navigating healthcare systems that may not be affirming or knowledgeable about their specific needs.
Mild mood disturbances are a common symptom of the menopause transition, but the range of mental health impacts can be broader:
- Feelings of anxiousness or panic
- Irritability and mood swings
- Sadness or persistent low mood
- Loss of confidence or self-esteem
- Feeling overwhelmed
- Forgetfulness and difficulty concentrating
- “Brain fog” – feeling mentally unclear
- Difficulty making decisions
- Problems with memory formation
- Sleep disturbances and fatigue
- Low energy levels
- Hot flushes that can mimic panic attacks
Hormones play a big role – but so do life stresses, career, kids, ageing parents, relationships – it all piles on. As JoAnn Manson explains in Harvard Medicine Magazine’s ‘The Mental Health Aspects of Menopause,’ “Hormonal and physiological changes overlap with, and compound, the stressful life circumstances many women experience in midlife.”
Perimenopause typically occurs during a person’s 40s and early 50s—a life stage often characterised by multiple competing demands. These include high-pressure career responsibilities, caring for teenagers or ageing parents, relationship transitions, financial pressures, and identity shifts as children become independent.
Certain things can make this stage even tougher, like:
- Longer perimenopause periods with extended hormonal fluctuation
- Sleep disturbances often caused by night sweats and hot flushes
- Stressful life events occurring simultaneously with hormonal changes
- Previous mental health history, particularly past depressive episodes
- Severe vasomotor symptoms including intense hot flushes and night sweats
One of the most challenging aspects is the confusing overlap between physical and emotional symptoms. Hot flushes and panic attacks share common features like sweating and sudden anxiety, creating cycles where physical symptoms trigger anxiety, sleep disruption worsens mood, fatigue reduces emotional resilience, and worry about symptoms creates additional stress.
There’s still not enough research on how menopause affects trans and gender-diverse people — but what’s clear is everyone deserves care that’s affirming and respectful.
Reassuringly, most people (though not all) don’t experience major depression during menopause, and those who do typically have a history of previous depressive episodes. This emphasises that while this transition can be challenging, severe mental health impacts aren’t inevitable and if they are there are strategies to help.
Foundation Building
- Sleep hygiene: Addressing night sweats and creating optimal sleep conditions
- Nutrition: Supporting hormonal balance through diet
- Exercise: Regular movement that doesn’t overstress an already challenged system
- Stress management: Techniques specifically adapted for hormonal fluctuations
Therapeutic Approaches
- Hormone therapy: Working with medical professionals to address underlying hormonal imbalances
- Cognitive-behavioural therapy: Addressing thought patterns that may intensify symptoms
- Mindfulness practices: Supporting emotional regulation during hormonal turbulence
- DBT skills: Practical tools for managing intense emotions
Window of Tolerance Strategies
- Early recognition: Learning to identify when hormonal fluctuations are affecting your emotional state
- Adapted regulation techniques: Modifying standard strategies to account for hormonal influences
- Expectation adjustment: Understanding that your emotional capacity may fluctuate and planning accordingly
One of the most powerful things we can do is break the silence around menopause and mental health. Recent research found that only 7% of women felt adequately supported during menopause, we could use better understanding and resources.
Many women suffer in isolation, feeling like they’re “going crazy” or losing their minds. Wondering why they suddenly feel incompetent in every direction of life. Understanding that these experiences are common, treatable, and temporary can provide enormous relief and hope. Professional support is particularly beneficial if you’re experiencing:
- Persistent low mood or hopelessness
- Anxiety that interferes with daily life
- Cognitive changes that concern you
- Sleep disturbances affecting your functioning
- Relationship difficulties related to mood changes
- Identity confusion or loss of sense of self
- Thoughts of self-harm
We can rally support to scaffold this challenge through medical care, therapy, and lifestyle adjustments working together. Many find that therapy during menopause not only helps them navigate the transition but also develops emotional skills that enhance their overall quality of life.
Menopause is a major change — but it’s not just about getting through it, it’s about finding ways to thrive on the other side. Many women report that understanding the science behind their experiences, accessing appropriate support, and developing new tools for emotional regulation transforms not just their menopause experience, but their entire relationship with their mental health.
If you recognise yourself in any of these descriptions, know that you’re not alone and you’re not “broken.” Your experiences make perfect sense when viewed through the lens of hormonal neuroscience. With understanding, support, and appropriate strategies, you can navigate this transition whilst maintaining – and even enhancing – your emotional wellbeing.
If you found this helpful, you might also love our post on “Understanding Your Window of Tolerance” – it gives you practical tools to navigate these ups and downs.
This information is provided for educational purposes and does not constitute individual professional advice. For personalised assessment and treatment planning regarding anxiety support, please consult with a qualified mental health professional. All treatment approaches mentioned are delivered in accordance with professional ethical guidelines and evidence-based practice standards.
At Psychological Therapy Services, we offer specialised support for women navigating menopause-related mental health challenges. Our approaches integrate evidence-based therapeutic techniques to support you through this important life transition.
*Names changed to protect client confidentiality
