Journal / Menopause

Menopausal Side Effects: How Can Menopause Affect Your Mental Health?

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Menopausal Side Effects: How Can Menopause Affect Your Mental Health?

Menopause and Mental Health

The menopause journey doesn’t have a clear starting or ending point. The transition phase into menopause is called perimenopause and may last for 5 to 10 years, with menopause lasting about 10 years. You will likely notice symptoms while you are in perimenopause like irregular periods, hot flashes, night sweats, sleep disturbances, vaginal dryness, and weight gain. But there are other menopausal side effects, related to mental health, we’re not paying enough attention to. Women frequently experience mental health issues like stress, anxiety, mood swings, and depression related to the hormonal changes brought on by perimenopause, and menopause. These mood changes are specifically due to the drop in estrogen, progesterone, and testosterone. 

Mood & Depression

Unfortunately, healthcare providers often do not correlate these depression symptoms with menopause, and the consequences can be profound. While menopause is not a disease to be cured, the symptoms can certainly be treated. According to the North American Menopause Society (NAMS), nearly  23% of women experience mood swings before, during, or after menopause.1 While we know that estrogen, progesterone, and testosterone are hormones that drive the reproductive system, they also play important non-reproductive roles throughout the body, including the brain. Cognitive functions involving attention, mood, memory,  cognition, are all regulated by hormones.

You Said It

We asked you to share, and share you did. 

  • “The most challenging aspect of going into menopause has been disorienting moods…like, I’m so angry so often. And such an increase in depression. It’s really hard.” Kelly

    • “I find that my emotions are all over the place.” Laura

    • Brain fog!!!  Liz

  • “I’m having another crying episode and anxiety has kicked in. why is this happening to me?” Charlene

Mood Disturbances During Menopause

With aging and menopause, you are likely overwhelmed by a roller coaster of emotions and maybe even feel out of control. You’re not crazy – it’s a common symptom of perimenopause. Up to 70% of women describe irritability as their main emotional problem during the early stages of the menopausal transition.2 The effects of decreased hormones can lead to lowered libido, vaginal changes, sleepless nights, embarrassing hot flashes, reduced energy, poor self-image, and so much more, what a terrible mixture. By understanding the true source of these new or exacerbated symptoms, a woman can start to feel happier and healthier.

All symptoms of menopause vary widely between women, including mental health symptoms. For some, mood swings are an annoyance. For others, it can develop into something more serious. Fluctuating hormones and lifestyle changes drive these moods. For instance, low levels of estrogen can trigger nervousness or anxious behavior. Irritability and sadness may be triggered by the lack of restful sleep and low levels of progesterone.

Changes in the family and environment can also impact mood.  The age of menopause includes loss of friends and family members due to age and illness, departure of children, and lack of employment are possible culprits of mental health issues.

Changes in family + Decreased hormones =  women at higher risk of developing depression

Hormonal fluctuations during perimenopause and menopause can create a perfect storm of events. Estrogen and progesterone influence the serotonin levels in your brain, and when they drop so does serotonin. Serotonin is a ‘feel-good’ neurotransmitter that regulates anxiety, happiness, and mood. So, you are already feeling not great and then you add in hot flashes, stress, weight gain, increased aging, sleep disturbance, etc., and it can lead to emotional distress, irritability, mood swings, and depression. Depression affects 1 out of every 5 women during their perimenopause/menopause journey.3 

Things that a person might normally let roll off their back suddenly become urgent and a crisis. 

Women with a history of depression may be more vulnerable to recurrent depression during menopause, even if they found medication effective previously. The  North American Menopause Society identifies three different conditions that are associated with depression:1

  • Depressed mood –  is a normal, brief period of sadness or loneliness that can be experienced by everyone. It should not linger or interfere with your work, sleep, or recreation and rarely requires treatment. 

  • Depression as a symptom – an adjustment reaction to a range of medical or psychological problems, or tragic life events such as death of a loved one, divorce, or losing a job. It does not require treatment in most cases and is usually short-term, but can progress to clinical depression. 

  • Clinical depression – a medical condition that goes beyond life’s ordinary ups and downs. You may go through insomnia, restlessness, difficulty concentrating or losing interest in activities you once enjoyed. The symptoms are severe enough to interfere with your work and daily activities and require treatment. 

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Panic Attacks 

The connection between menopause and anxiety is clear. Women are more likely to experience panic attacks during perimenopause and menopause.1 A panic attack is the sudden onset of intense fear or anxiety that reaches a peak quickly, within minutes. It can be accompanied by palpitations, shortness of breath, sweating, and trembling. There is a clear connection between panic attacks and hot flashes. For some women, a hot flash can be followed by a sense of doom or panicky feeling. 

Hormone Replacement Therapy to Ease Emotional Problems

While our society still hasn’t fully embraced the pain associated with emotional problems, women experiencing mental imbalances can experience potentially devastating consequences. Experts have found that exercise, proper diet, getting enough sleep, and cultivating positive relationships can be very helpful for those who are struggling with the emotional ups and downs of menopause. Physical activity can stimulate the production of serotonin (or the feel-good neurotransmitter), which can improve mood and relieve stress. Eating foods rich in protein and omega-3 fatty acids may reduce mood swings, and of course, counseling is always helpful.

During perimenopause and menopause, it can feel like the cards are stacked against maintaining an upbeat, stress-free outlook, but hormonal replacement therapy (HRT) can help do just that. Hormones work together to influence mood. If the hormone system doesn’t work properly women can struggle with mental health problems. Fortunately, taking HRT, improving diet, and adding a few lifestyle changes can refine mental balance.

Hormone replacement therapy (HRT) can be a good option for some women to alleviate mood swings and emotional changes. You do need to consult with a doctor to know if you are the right candidate for the treatment. Please note, HRT alone is not effective in treating severe depression but in combination with antidepressant drug therapy and/or psychotherapy can be very effective. 


When hormones are in balance, neither too high nor too low, women can look and feel their best. But when hormones are imbalanced, like in menopause or perimenopause, a range of mental health symptoms that include mental fatigue, anxiety,  irritability, depression can be just the beginning of a cascade of menopausal symptoms.

Menopause symptoms can be prevented, treated, and reversed. The key is a proactive HRT approach that deals with the natural decreases in the hormones estrogen, progesterone, and testosterone. Of course, paying attention to healthy eating habits, and leading an active lifestyle, are also important in maintaining your mental health, decreasing depression, and improving feelings of wellness.

Want to know if HRT is the right option for you? Complete an online visit with Winona and get to talk to a doctor in our network! 

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”