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Women continuously tell us that they are ‘going mad’

How the menopause can affect mental health and how to manage it

For many women, heading into menopause can be a time of worry and concern. From experiencing physical symptoms such as hot flashes and sweating, to the less spoken about mental health symptoms, it can be a concerning time. For those in menopause or nearing the time it’s likely to occur, there are ways to take action to mitigate the symptoms of menopause and manage the experience better.

Menopause is a natural process that occurs when a woman transitions from her reproductive years to her non-reproductive years, says Dr Fiona Barry, PhD, member of the Meno Active Formulation Team, Revive Active. “In very simple terms it occurs because the ovaries, the primary production site of a woman’s sex hormones, mainly oestrogen and progesterone, shut down. This doesn’t happen overnight, nor does it happen in a controlled, gradual way. It is just like puberty, except in reverse, and on steroids!”

“Half of the world’s population will go through menopause, once they reach a certain age, and of that half three-quarters will experience adverse health effects that range from mild to severe,” says Dr Barry. “Only one-quarter of women will be lucky enough to breeze through menopause while barely noticing it so it is imperative that women learn about menopause so that they can understand what is happening to them and what to expect.”

Loretta Dignam, founder and CEO, The Menopause Hub, says the average age of menopause is 51 which is counted from the day that a woman has her last menstrual period and a woman becomes post menopause after 12 consecutive months with no periods. Perimenopause is the phase leading up to this and menopausal symptoms last on average 7.4 years.


“In terms of symptoms, women can start to experience symptoms, as a result of hormonal changes, oestrogen and progesterone fluctuations, from her early to mid-forties.” She says that 80-85 per cent of women will experience symptoms and 30 per cent will be severe, i.e. debilitating.

Perimenopause, which is the transitionary period preceding menopause, is usually the most difficult part of menopause and can, unfortunately, last for years, says Dr Barry. “This is the time when hormone levels are oscillating wildly, with hormonal highs being closely followed by hormonal lows.

“During the early phase of perimenopause the menstrual cycle is still regular but many of the cycles are ‘anovulatory’, which means that ovulation does not take place. Ovulation is required to produce progesterone and so a woman may experience symptoms because the ratio of her hormones has been disturbed and the relative level of oestrogen and testosterone in her system are now higher.”

Symptoms of menopause

Professor Rose Anne Kenny, medical gerontology at Trinity College and St James’s Hospital, says that there’s a whole spectrum of symptoms with menopause including sleep being disrupted which has a knock-on effect with respect to fatigue and mood changes. “It worries people. As a result of that sometimes people are pre-menopausal and might not be aware of what the symptoms are due to which causes anxiety.” She says the most important thing to do, if you have symptoms, is to speak to a doctor and see if these symptoms are related to menopause and if so, “it’s time to start hormone replacement therapy”.

In addition, there can be sweating and irritability as well as fatigue which can cause anxiety if not explained properly. “Low mood can be caused by the fact that reproductive years are finished, hormonal changes can cause depression and there can be explained or unexplained symptoms.”

Weight gain also happens during this time. “It’s important to be aware of that because you can manage it,” says Prof Kenny. “Knowing that your BMI will change so you can manage it before you put on too much – which can cause depression in some people.”

In some people, symptoms can go for a long time, she says. “I had a colleague who has seen people in their seventies with symptoms.”

Dignam says women can experience over 40 symptoms of menopause including “the infamous hot flushes and night sweats, and others including heart palpitations, insomnia, joint aches and pains, headaches, migraines, dry eyes, etc. Genitourinary symptoms such as vaginal dryness (which only gets worse as women age), bladder issues (urinary tract infections, UTIs), incontinence (leakage), painful sex and low libido.

“Women continue to suffer in silence and do not realise what is happening to them – 80 per cent of women in our survey in 2019 (1,250 women) were unprepared for menopause and 66 per cent knew little or nothing about menopause. So it is no wonder that we are blindsided. Myself included.”

Mental health concerns

Stress and anxiety are two of the main mental health symptoms related to menopause and these are impacted by hormonal changes happening in the body which can cause mood swings, irritability and short temper which can impact not just the person but also those closest to them, says Brian Fitzpatrick, managing director, Oriel Marine Extracts. “Many people underestimate the impact of hormonal changes in the body but this should not be the case and better support is required.

“Stress, anxiety and mood swings are not a long way from insecurity and feeling like no one understands which can lead to its own problems of loneliness and in some cases depression.”

Psychological/mental/emotional symptoms can include anxiety, mood swings, depression, anger (sometimes referred to as red rage), flat mood, brain fog, memory loss, and lack of confidence, says Dignam. The latter particularly impacts women in the workplace.

“These mental/emotional symptoms can be very frightening for women, especially if they have never experienced this before. Women continuously tell us that they are ‘going mad’. For others who have experienced mental health issues in the past, the rollercoaster hormones can trigger recurring episodes.”

Dr Barry says there is no doubt that the more prepared a woman is and the healthier she is coming into this phase of her life, the easier she will find it.

Managing mental health symptoms

“It is not our bodies that are incompatible with menopause, it is our lifestyle,” says Dr Barry. “Preparation is key and education facilitates that. Menopause should not be medicalised or pathologised, it is a natural phase of a woman’s life. The best approach is a holistic one. No one thing will fix it all, even HRT, it is a combination of everything that yields the best result.”

She says that for some women their symptoms may be so severe that natural remedies don’t give them adequate relief and for these women they may have no choice but to go the medical route. In this instance, hormone replacement therapy (HRT) would be the treatment of choice.

“Eating better, more social activity, join groups or classes, use these very inexpensive tools to get me-time and to make friends, get natural social interaction and support,” says Fitzpatrick. “Nothing happens overnight and you need to give it some time. But the earlier you begin the better.”

In addition, says Dignam, mindfulness, yoga and meditation are useful techniques that can help women experiencing mental health issues during menopause. “However, given that the hormonal imbalances during menopause and perimenopause are the cause of most of these issues, various complementary practices may be only able to help the woman so far, so medical treatment may be important.”

Prof Kenny says there are non-medical ways to help with symptoms, such as sharing symptoms with friends or family. “Biologically, a problem shared is a problem halved as stress hormones are less stimulated when we share problems, so share about these issues with a friend who is having similar issues.”

Exercise also helps, says Prof Kenny. “Increase exercise – in whatever form you enjoy, and preferably with someone else. Other things that help can be cold exposure such as cold showers. It gives a great wellbeing feeling and is good for the hormones. Yoga and meditation and other relaxation techniques can reduce stress around this time.”

Education is key for managing menopause, says Dr Barry. “When a woman understands her body she is in a position to help herself. She can make informed decisions around her healthcare. She may decide to try natural solutions, such as diet and lifestyle changes or natural treatments such as acupuncture or she may decide that she needs a more medical intervention, such as HRT. Either way, she can be her own advocate, she has control over her own health, this is so important.”

Edel Corrigan

Edel Corrigan is a contributor to The Irish Times