Is menopause bad for your mental health?

Dr Lydia Brown

It’s widely accepted that menopause is associated with poor mental health. News headlines around the world claim that menopause increases the risk of depression, can ‘destroy’ mental health, or even lead to risk of suicide.

Similarly, the scales of menopause symptoms used in clinical practice typically include mental health issues – like mood changes, anxiety and irritability.

The menopause transition, also known as perimenopause, usually starts around age 47. Picture: Getty Images

All of this information feeds into the assumption that mental health issues are ‘normal’ during menopause, and that menopause is a time of poor mental health.

But it also contributes to furthering the unhelpful stereotype of the ‘moody menopausal woman’.

Our new Lancet paper on menopause and mental health casts doubt on the idea that menopause transition leads to an inevitable decline in mental health.

The menopause transition, also known as perimenopause, usually starts around age 47 and involves a phase of irregular menstrual cycles culminating in the final menstrual period.

It’s driven by underlying hormonal changes associated with ovarian ageing and comes with a range physical symptoms – the most well-known are probably the hot flushes.

Many argue that these hormonal changes and their symptoms (or a combination of these factors) can contribute to a decline in mental health.

Our team reviewed evidence from prospective studies (these kinds of studies look at outcomes, like the development of a disease, during the study period) that tracked changes in women’s mental health symptoms across the menopause transition.

We found no consistent evidence that menopause is linked with a universal or uniform increase in mental health risk. Picture: Getty Images

Specifically, we considered studies that investigated the risk of depressive symptoms and disorders, as well as risk of anxiety, bipolar, psychosis and suicide.

Overall, we found no consistent evidence that menopause is associated with a universal or uniform increase in risk for any of these conditions.

But we also found a relative lack of prospective studies investigating menopause and mental health.

While this research is limited, we know the most about the relationship between menopause and depressive symptoms or disorders, so this was our area of focus.

Our work found that only two prospective studies have investigated the risk of developing Major Depressive Disorder (or MDD), assessed uniformly by a clinician.

Neither study found that the menopause increased the risk of developing new-onset MDD – although the more robust study found that women with a personal history of MDD were at elevated risk during the transition.

Twelve studies examined the risk of developing clinically depressive symptoms (this has a lower threshold than MDD) over menopause – and findings from these studies were mixed.

While high-impact prior papers found that menopause can double or even quadruple the risk of developing depressive symptoms – our findings offer a more nuanced picture.

Some women may be more mood-sensitive to menopausal hormonal changes than others. Picture: Getty Images

We did not find consistent evidence for a universal or uniform increase in depressive symptoms during the menopause transition, but instead found subgroups of women who may be at elevated risk.

The differences between the consequences and symptoms

We need more longitudinal studies to improve our understanding of exactly who is at risk of mental health symptoms or disorders over the menopause transition, but our findings indicate that a combination of menopause-specific and general risk factors for depression are at play.

When menopause-related risk factors and other triggers (like stressful life events, financial difficulties or a lack of social support) happen at the same time – then a woman may be especially vulnerable.

We found that severe hot flushes, sleep disturbance, surgical menopause (caused by the removal of both ovaries) and a transition that lasts for a long time can elevate risk of depressive symptoms.

On top of this, some women may be more mood-sensitive to menopausal hormonal changes than others – and this also might help explain why subgroups of women are at greater risk.

To me, it comes as no surprise that severe hot flushes can contribute to mood disturbance – especially when they interfere with sleep.

Disruptive physical symptoms of any kind can impact our mood.

It comes as no surprise that severe hot flushes can contribute to mood disturbance. Picture: Getty Images

For example, if you have a bad cold you might feel frustrated or grumpy (especially if it disrupts your sleep), but this doesn’t mean that this frustration is a symptom of having a cold, rather, it’s a consequence.

A diversity of experiences 

A recent survey of more than 7000 Australians and Europeans found that around 60 per cent of people self-reported psychological symptoms associated with their menopause – which the study authors defined as mood changes, depression or concentration/memory loss.

Leave a Comment

Your email address will not be published. Required fields are marked *