Low mood and menopause

It is common, as hormones change in perimenopause and menopause for women to suffer from a decline in their mental health, research shows this may happen to 45-68% of women. Emotional symptoms of menopause like low mood, anxiety, irritability, rage, fluctuating mood swings, loss of confidence and tearfulness can occur, making it very difficult for women to manage relationships, to work and these symptoms can significantly affect their quality of life. Let’s discuss low mood, depression and menopause and how important it is to take time to connect with others if this is affecting you.

Mental health problems can happen to anyone

Women who have never experienced mental health problems before may need support with this at midlife. Women with a history of mental health problems may find that the hormonal changes during the menopause can cause an recurrence or worsening of their mental health. Women with a history of PMS (premenstrual syndrome) or postnatal depression can be particularly vulnerable at this time.

What are the best ways to support women?

The NICE menopause guideline recommends HRT as the first line treatment for the low mood that can occur as a result of menopause. They also recommend CBT (cognitive behavioural therapy) or other forms of talking therapies. It is important to get the right kind of talking therapy, and an experienced psychologist will be able to help decide which is best.

It is important to look at other ways to support mental health. Many women in menopause feel the need to spend time alone and may isolate themselves from their support networks, they may turn to unhealthy habits in order to try and support themselves. It might be that you are reading this as a woman, or as someone trying to support a woman. These are some things that you can do to support health and wellbeing:

• Making connections with friends and family and try to avoid toxic relationships.
• Set boundaries and say ‘No’ when you need to.
• Reduce alcohol as this can be poorly tolerated in midlife, it is a depressant, affects REM sleep and can have a significant effect on emotions.
• Find ways to reduce stress and make time to self care daily. This will reduce cortisol levels and is important to balance hormones. Cortisol naturally rises as we age and if our body is on fight or flight mode, this can affect the balance of other hormones. Using mindfulness or meditation or a simple walk can help.
• Spend time with nature and with animals as a way to self care.
• Explore better nutrition, it is easy and commonly done to turn to high sugar foods to ease low mood, these cause a huge sugar burst which temporarily may help you feel better, but the fall in blood sugar that follows will not support your mood. Eating regular nutritious meals and a healthy balanced diet is best.
• Increase movement and exercise, this releases natural endorphins and done in daylight can help improve sleep, which supports mental health.
• Prioritise sleep to support good mental health. Try and keep a regular sleep and wake time, have a read of my sleep and menopause article for more help with this.
• Take Vitamin D in winter and take a high quality omega 3 supplement

Low mood caused by hormonal flutucations or depression?

Let’s talk about low mood, depression and menopause in more detail and how the mood changes found at the time of menopause might overlap with depression.

How do changing hormones in menopause affect our mood?

Oestrogen has positive effect upon Serotonin, a neurotransmitter which is responsible for our happiness and feeling of wellbeing. Progesterone, in most women helps to induce a feeling of calm, by stimulating neurotransmitter GABA. These hormones fluctuate in perimenopause, they have an affect upon the brain and can leave women feeling their moods are out of control.

Do antidepressants help low mood in perimenopause and menopause?

Mood changes in perimenopause and menopause can affect women who have never had mental health problems in the past. Women can describe their mood as being flat, with loss of joy or loss of mojo. This type of hormonal mood change does not respond to antidepressants, and can be successfully treated using Hormone Replacement Therapy, HRT, and this is recommended as first line therapy. Some women, however, require treatment with HRT and antidepressants to manage their mood. The lifestyle changes above can support mental health with or without HRT or antidepressants. If you are currently taking antidepressants you do not have to stop them to start HRT, they can work well together and some women need to take HRT and antidepressants.

HRT (hormone replacement therapy)

HRT can help with the symptoms of menopause, vasomotor, emotional, cognitive and phsyical but anxiety can be a difficult symptom to treat and taking HRT does not always resolve this. It could be that the dose of HRT needs to be changed, if oestrogen levels are too high or too low it can make anxiety worse. Some women are progesterone sensitive and can experience mood symptoms from taking progestogen in contraception or in HRT. If this is happening there are lots of alternative progestogens to try, it is important to keep taking this hormone if you take HRT and have a womb, to protect from endometrial cancer.

If HRT does not help, and you have made adjustments and supported yourself with lifestyle changes then you may want to consider an antidepressant. Lets first talk more about low mood and depression.

What is depression

Everyone has spells of feeling down, but depression can make you feel persistently sad and down for weeks or months at a time. You may feel hopeless and lose interest in things you used to enjoy. In its mildest form, depression can mean just being in low spirits. It doesn’t stop you leading your normal life, but makes everything harder to do and seem less worthwhile. This sort of low mood could be seen in perimenopause. At its most severe, however, depression can be life-threatening, making you feel suicidal.

The symptoms of depression can be complex and vary widely between people. It is possible to have depression at the time of perimenopause and menopause, so if your mood is not lifting with other treatments like HRT then please speak with a Dr.

The symptoms of Depression

The psychological symptoms of depression include:

• continuous low mood or sadness
• feeling hopeless and helpless
• having low self-esteem
• feeling tearful
• feeling guilt-ridden
• feeling irritable and intolerant of others
• having no motivation or interest in things
• finding it difficult to make decisions
• not getting any enjoyment out of life
• feeling anxious or worried
• having suicidal thoughts or having thoughts of harming yourself

The physical symptoms of depression include:

• moving or speaking more slowly than usual
• changes in appetite or weight (usually decreased, but sometimes increased)
• constipation
• unexplained aches and pains
• lack of energy
• low sex drive 
• changes to your menstrual cycle
• disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning

The social symptoms of depression include:

• avoiding contact with friends and taking part in fewer social activities
• neglecting your hobbies and interests
• having difficulties in your home, work or family life

Some of these psychological, physical and social symptoms of depression are commonly found in perimenopause and menopause so formal diagnosis and severity assessment is needed to ensure the correct diagnosis is made.

Psychological talking therapies

Psychological talking therapies like counselling or cognitive behavioural therapy and psychosocial support can be invaluable.

Antidepressants

Pharmacological treatments, medications like antidepressants may be recommended, and supportive follow-up will be needed. They can help with severe anxiety or depression and can be used in menopause if HRT and lifestyle is not helping. They can be taken alongside HRT. In some women they are used on a cyclical basis, for example if moods are low due to PMS or PMDD.

Some patients require further specialist care with a psychiatrist and every person needs to know how to manage if they have a crisis.

As with everything, each case is individual

Each individual case is different, some women in perimenopause and menopause will have low mood, and may also have depression and will need to be treated appropriately. There can be an overlap of symptoms, but with a detailed assessment and full history an appropriate treatment plan and support can be offered to everyone.

Emergency help for mental health

If you feel you need support with your mental health please contact your GP. If you feel that you are at risk of suicide please contact your GP, the samaritans on 116 123, or cal 111 or 999.

This information is derived from the NHS website and from the NICE guidelines NG222. This advice is an accurate and comprehensive as possible, it should not be used as a substitute for the individual advice you receive from consulting your own Dr.

Updated June 2023 Dr Carys Sonnenberg

To book an appointment at Rowena Health Menopause Specialist Clinic online if you are in the UK or in person at our Guildford Clinic, please click the link. We can help support your mental health, as well as your hormonal, general and sexual health.