Understanding Peri-menopause and Menopause 

May is Mental Health Awareness Month in the United States. It is a time to raise awareness and educate the public about mental health and illness and the importance of early treatment. According to the National Institute of Mental Health, mental illnesses are common in the United States, with nearly one in five U.S. adults (52.9 million in 2020) living with a mental illness. 

It is common for peri-menopausal and menopausal women to experience various mental health issues due to hormonal changes occurring in their bodies that interfere with their daily lives. 

Peri-menopause usually starts around the age of 35 to 40 and is the period where a woman’s body begins to gear up for the end of the reproductive years. Many hormonal changes lead up to menopause or the last period. Menopause occurs when a woman has not had her period for 12 consecutive months, which signifies the end of the reproductive years. According to Women’s Mental Health.org, over 1.3 million women reach menopause each year.

In peri-menopausal and menopausal women, symptoms of mental illnesses might include mood changes, ranging from mild to debilitating. 

These mood changes include:

• Irritability 
• Sadness
• Lack of motivation 
• Problems focusing
• Aggressive tendencies
• Stress, depression, and anxiety 

In many cases, hormonal changes affect mood by altering the equilibrium in several neurotransmitter systems in the brain. Estrogen is an important hormone that must be present in the brain to maintain psychic stability, cognitive processing, and memory. Estrogen also protects the brain’s neurons against degeneration. Usually, women in peri-menopause experience high estrogen levels, frequently leading to estrogen dominance, while women in menopause tend to experience the opposite. The Journal of Clinical Endocrinology & Metabolism found an increase in depression during peri-menopause with fluctuations in two hormones, progesterone and estradiol (the most potent form of estrogen). Another study found the incidence of depression doubles during menopause. Women who have struggled in the past with depression or anxiety are likely to see a recurrence. 

While most women do not suffer from severe mood issues such as depression or anxiety due to peri-menopause and menopause, some do and may require medications or other therapies to manage their symptoms. 

Some factors that can contribute to ongoing depression or anxiety include:

• Fear about menopause and getting older 
• Increased stress
• Smoking
• Sedentary lifestyle 
• Lack of adequate physical activity
• Unhealthy relationships
• Lack of adequate finance
• Lack of sleep

Some things that women can do to support their mental health during perimenopause and menopause include:

• Seek help from a trained professional. If you suspect that perimenopause or menopause is affecting your mental health, seek professional help and talk openly about your struggles instead of suffering in silence. 
• Make lifestyle changes such as incorporating more daily movement, getting adequate sleep, and effectively managing stress levels (taking time out for self-care, meditating, having fun, socializing, etc.).
  
• Watch what you eat. Your diet can profoundly impact your emotional state, which affects your mood. Sugars, processed foods, and caffeine adversely impact your emotions and increase anxiety and depression. Instead, choose whole foods like lean organic or sustainably raised animal protein, plant protein, fruits, and vegetables. Emphasize foods rich in omega-3 fatty acids (salmon, flaxseeds, walnuts) and B vitamins like dark green leafy vegetables, eggs, and chickpeas. 
  
• Incorporate relaxation protocols. These include meditation, yoga, massage, aromatherapy, tai chi, deep breathing, etc. In studies, meditation reduced anxiety in perimenopausal and menopausal women. One study that included over 120 perimenopausal women found that practicing meditation for eight weeks resulted in a 24% reduction in anxiety levels. Using essential oils as part of an aromatherapy ritual can also reduce anxious feelings. Choose the ones that resonate with you and just get started.
  
• Incorporate supplements and botanical herbs. Do not underestimate the power of adding high-quality multivitamins, vitamins C, D, B, magnesium, and omega-3 fatty acids to your diet. These supplements help support your mental health, and B vitamins are particularly helpful in calming and reducing brain fog. Certain herbs such as Maca (shown to reduce depression and anxiety), Chaga ( helps your body adapt to stress), and Ashwagandha (helps with sleep and reduces cortisol/stress) are also options to consider.   
  
• Hormone Replacement Therapy (HRT). If HRT is a viable option for you, thoroughly discuss this option with your clinician so that you understand the benefits and potential side effects.
  
• Find a trained coach. Many coaches specialize in peri-menopause and menopause symptoms and can offer natural solutions or other therapies.

Peri-menopause and menopause are a natural part of a woman’s journey as she ages, where hormonal changes can create uncomfortable, frustrating, and even debilitating symptoms, including various mental health illnesses. However, women do not have to suffer silently. Several options range from natural solutions to medications or clinical therapies that can support these conditions and allow you to flourish during this time of change.