• The menopause has the potential to be a highly disruptive time – hormonal changes can bring a host of symptoms such as low mood, anxiety, sleep problems

  • Dr Philippa Kaye, author of The M Word, explores the psychological impact of menopausal symptoms

  • If you would like support at this time of transition, find a therapist here 

Do you remember what it was like being a teenager? A hormonal, angry, tired, irritable teenager? Or perhaps you have teenagers of your own now and recognise the mood swings, fatigue and more? We, as a society, seem to be kinder, or perhaps just more understanding, of our adolescents than we are to menopausal women. Puberty takes a period of years, and so does the perimenopause, the period of time leading up to the menopause. Menopause means your last period and we can’t say that you have ‘gone through’ it until you have not had a period for a year, even though you can be symptomatic for many years both before and after the last period itself.

Hormonal changes in the menopause

There are receptors for the hormones oestrogen, progesterone and testosterone all over the body, not just in the reproductive organs, but everywhere from the brain downwards! So, just as adolescents have symptoms of puberty not just related to changes in their genitals or underarm hair, so too will women experiencing the perimenopause and post-menopausal symptoms. 

While the symptoms of puberty are relating to burgeoning and increasing hormone levels, those of the perimenopause and menopause are related to the falling levels of oestrogen, progesterone and testosterone. Yes, women also have testosterone, although in far smaller amounts than men, and the decreasing levels have an impact such as fatigue.

Menopause symptoms

Four out of every five women will experience symptoms relating to the menopause. These are not always the night sweats and hot flushes, which perhaps are the most famous menopausal symptoms. One in four women will experience severe symptoms. Many women will also experience psychological symptoms which can include low mood and depression, anxiety and stress. Insomnia, fatigue and loss of libido can all have both physical and psychological causes and often the two are intertwined. 

Another psychological symptom relating to the perimenopause is what is commonly described as ‘menopausal brain fog’. This overarching term is meant to encompass the difficulties with concentration and memory that often accompany the years before and after the menopause. This is often much more than walking into a room and not remembering why you have done so. It can have a real impact on all areas of your life from your personal relationships to social life and work life.

The impact of the menopause on your work and in the workplace should not be underestimated. Over 70% of women between the ages of 16 and 64 are currently working, in comparison to 53% in 1971 and every one of these women will either have gone through or will go through the menopause. The impact of the menopause at work is significant with up to 10% of women giving serious consideration to giving up work due to their symptoms. The brain fog and issues with mood and anxiety can have a real impact on your ability to work.

So what can we do?

The good news is that we do have treatment options for all the symptoms of the menopause, be they physical or psychological. If you have not had depression or anxiety which required treatment in the past then it is likely that any changes in mood or anxiety around the menopause are likely to be related to the hormone changes of the menopause itself. The guidance suggests that if you have not had depression or anxiety before you should not be offered antidepressants (which we use for both depression and anxiety) as the first line treatment. Instead, hormone replacement therapy (HRT) is the first line medical treatment for these symptoms. Indeed I have patients who describe the lifting of the fog as the levels of the hormones rise while on HRT, and unfortunately also many patients and women describing that they had been prescribed various different antidepressants initially instead of HRT.

Of course you don’t have to go down the medication route if you do not wish to, or are not able to. Eating well, exercising, relaxation and mindfulness techniques can all be helpful as can cognitive behavioural therapy (CBT), which interestingly works for lots of symptoms from psychological ones to hot flushes!

The main message is this, if you are struggling with symptoms during the perimenopause or after the menopause itself, be they physical or psychological, then please see your doctor as there are lots of options available.

The M Word: Everything You Need to Know About the Menopause by Dr Philippa Kaye is published by Summersdale

Further reading

The impact of the menopause on relationships

7 ways to make the menopause work for you

Can hypnotherapy relieve the symptoms of the menopause

How biodynamic massage therapy helped me through the menopause