Mental health and menopause

Menopause is a natural stage in life when your monthly periods come to an end. During both menopause and perimenopause (the stage of life leading up to menopause), hormonal and other changes can impact your mental health. You may experience changes in your mood throughout these times.

You may feel:

• low in mood
• more anxious
• fatigued
• angry or irritable
• forgetful or have trouble concentrating (often called brain fog)

Some people develop symptoms of depression or anxiety for the first time during perimenopause or menopause. If you've had depression or anxiety in the past, you may find your symptoms return.

Mental health changes can happen at the same time as physical symptoms of perimenopause or menopause, such as hot flushes, night sweats and tiredness. This can make it harder to cope.

Mental health symptoms during menopause and perimenopause can affect your emotions, thinking and physical wellbeing.

Common emotional symptoms include:

• mood swings
• feeling angry or irritable
• feeling anxious, stressed or worried

Physical symptoms that can affect your mood include:

• fatigue
• poor sleep
• appetite changes
• changes in libido (sex drive)
• heart palpitations

Thinking (cognitive) symptoms include:

• poor concentration
• trouble finding words
• feeling mentally "foggy" (brain fog)
• difficulties making decisions

Not everyone will have all these symptoms, and symptoms may come and go or become worse at certain times.

Mental health issues during menopause and perimenopause are usually caused by a mix of hormonal changes and life factors.

Hormone changes

During perimenopause, levels of hormones such as oestrogen and progesterone rise and fall. After menopause, oestrogen levels stay lower.

Oestrogen affects brain chemicals linked to mood, such as serotonin.

Read more about oestrogen and how it affects your body.

Sleep problems and physical symptoms

Physical symptoms, such as night sweats and insomnia can lead to poor sleep and affect your mental health.

Stress and life stage factors

Midlife can be a busy and stressful time. Some people are dealing with:

• parenting or caring responsibilities
• relationship changes
• financial pressure
• workplace problems
• health issues

Read more about stress and ways to manage it.

Past mental health history

Mental health symptoms are more likely during menopause if you have had:

• depression or anxiety in the past
• postnatal depression
• severe premenstrual symptoms

You should see your doctor if your mental health symptoms:

• last longer than 2 weeks
• are getting worse
• affect your work, relationships or daily life
• affect your sleep on most nights

A general practitioner (GP) is usually the best first step. They can help work out whether symptoms are related to menopause, another health condition or a mental health disorder.

Your doctor can refer you to other health professionals such as:

• a psychologist
• a psychiatrist
• gynaecologist

There is no single test to diagnose perimenopause and menopause-related mental health issues. Diagnosis is based on your symptoms and medical history.

To diagnose your mental health issues, your doctor will ask questions about your symptoms, your periods and your general health. They may ask:

• when your symptoms started
• when you had your last period
• how you are sleeping
• if you have hot flushes or night sweats
• if you have had depression or anxiety before

Your doctor might use a questionnaire to check for depression or anxiety. They may also do tests such as a blood test to rule out other causes of symptoms such as thyroid problems or low iron.

Psychological therapy

Psychological therapy can help you understand your symptoms and learn coping strategies.

Support options include:

• counselling
• cognitive behavioural therapy
• mindfulness-based therapy
• stress management programs

Your GP may be able to provide a Mental Health Treatment Plan, which can give you Medicare-subsidised sessions with a psychologist.

Medicines

Medicines may be recommended if your symptoms are moderate or severe, especially if lifestyle changes alone are not helping:

Menopausal hormone therapy

Menopausal hormone therapy (MHT, also known as hormone replacement therapy or HRT) may help with mood symptoms, especially if you also have physical symptoms, such as hot flushes or night sweats.

Hormone therapy is not suitable for everyone. Your doctor will discuss the benefits and risks and help you choose the safest option for you.

Antidepressants

Antidepressants can help treat perimenopausal depression. They may also help some people with hot flushes.

Complementary medicines and therapies

Some people choose to explore complementary medicines and therapies for their symptoms. Talk to your doctor before starting any new treatment.

Lifestyle changes

Lifestyle changes can support both physical and emotional symptoms.

Helpful tips to manage symptoms include:

• regular exercise
• quitting smoking
• reducing alcohol and caffeine
• eating healthy meals regularly
• practising relaxation techniques such as breathing exercises
• keeping good sleep habits
• spending time with supportive friends and family

You might benefit from keeping a diary to track mood changes, sleep patterns and menopause symptoms. This can help you and your doctor understand triggers and patterns.

Many people use more than one approach. Speak with your doctor about what treatments could work best for you.

If mental health symptoms are not managed, they may lead to complications such as:

• worsening depression or anxiety
• relationship difficulties
• trouble at work
• social withdrawal
• suicidal thoughts

Getting support early can help prevent symptoms from becoming more severe.

You may not be able to prevent mental health symptoms during menopause, but you can support your mental wellbeing by maintaining healthy habits.

If you have had depression or anxiety in the past, it may help to speak to your doctor early in perimenopause. They can help you plan for support and treatment if symptoms return.

Support services are available and include:

• Australasian Menopause Society (Opens in new tab) has many fact sheets about menopause (Opens in new tab).
• Beyond Blue (Opens in new tab) has resources on perimenopause, menopause and mental health. If you or a loved one needs help, call 1300 22 4636 or chat online (Opens in new tab).
• Lifeline (Opens in new tab) provides crisis counselling, support groups and suicide prevention services. Call 13 11 14, text 0477 13 11 14 or chat online (Opens in new tab).
• Medicare Mental Health (Opens in new tab) gives advice and will connect you to local mental health services. Call 1800 595 212.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.

Information for Aboriginal and/or Torres Strait Islander peoples

Jean Hailes for Women's Health (Opens in new tab) has menopause information for First Nations communities.

The Institute for Urban Indigenous Health (Opens in new tab) has further information about menopause and perimenopause.

Languages other than English

If you prefer to speak a language other than English, you can visit the Transcultural Mental Health Centre (Opens in new tab) website.

If you need an interpreter, call the Translating and Interpreting Service (TIS National) on 131 450.

Information for sexually and gender-diverse families

Transhub has information about menopause and oestrogen cessation (Opens in new tab).

LGBTIQ+ Health Australia has tailored menopause and perimenopause fact sheets (Opens in new tab) for lesbian, bisexual and queer cisgender women.