Menopause and Mental Health
Understanding the anxiety, changes in confidence, relationships and sense of identity that can accompany perimenopause and menopause.
Menopause And Your Mental Wellbeing
There can come a time in your life when you begin to feel that something isn't quite right.
Perhaps you're becoming anxious about things that never used to worry you. You're forgetting conversations, struggling to concentrate or feeling overwhelmed by situations you've always managed. Your patience feels shorter. You're questioning decisions you would once have made without a second thought.
And somewhere along the way, you begin asking yourself:
What's wrong with me?
Why can't I think clearly?
Am I losing my mind?
For some women, one of the most unsettling experiences of perimenopause and menopause isn't the physical symptoms alone.
When The Changes Creep Up On You
Perimenopause doesn't always announce itself.
It's the transition leading up to menopause, when hormone levels begin to fluctuate. It can last for several years, with symptoms sometimes appearing long before your periods stop.
Perhaps you're sleeping differently, becoming more forgetful or noticing that your emotions feel harder to manage. Initially, you might put it down to stress, getting older, having too much on your plate or simply being exhausted. Because these changes can happen gradually, you may not recognise how different you're feeling until you look back.
When did I become so anxious?
Why am I struggling with things I've always managed?
For generations, conversations about menopause have largely focused on hot flushes and periods stopping. Although perimenopause isn't a new medical concept, awareness of its wider emotional and cognitive effects has often been limited. Many women have therefore reached this stage of life without fully understanding what might be happening to them.
Understanding What's Happening And Finding Support
If you're experiencing changes in your mood, memory, sleep or physical wellbeing, speaking with your GP can be a helpful starting point. There are different forms of support available, including medical treatments such as hormone replacement therapy (HRT), where appropriate, and psychological therapies. NICE also recommends considering menopause-specific cognitive behavioural therapy (CBT) for certain menopause-related symptoms, including sleep difficulties associated with hot flushes and some depressive symptoms. But support isn't only about managing symptoms. Sometimes, having somewhere to talk openly about what's happening can make a difference. Somewhere you don't have to pretend you're coping, explain away your emotions or feel guilty for struggling. Counselling and psychological therapy can offer space to explore changes in confidence, anxiety, relationships, self-esteem and the pressure of managing everyday responsibilities. Therapy doesn't reverse hormonal changes or replace medical treatment, but looking after your emotional wellbeing is an important part of looking after your overall health.
When You Begin To Lose Trust In Yourself
Perhaps you've forgotten part of a conversation and can't remember whether someone told you something.
You lose your train of thought halfway through a sentence. You struggle to find a familiar word. You walk into a room and completely forget why you're there. We've all experienced moments like these, but when they become more frequent or unfamiliar, they can feel unsettling.
You might begin second-guessing your answers, checking decisions you've already made or replaying conversations because you're no longer certain you've remembered them correctly.
Did I really forget that?
Have I already told them this?
Is something seriously wrong with me?
For some women, these experiences can become genuinely frightening. And the more you worry about your memory, the harder it can become to concentrate.
When You're Exhausted Before The Day Day Has Even Begun
Changes in memory and concentration, often described as brain fog, can occur during perimenopause and menopause. However, persistent or worsening difficulties shouldn't automatically be attributed to hormones. Sleep problems, stress, medication and other health conditions can also play a part, so it's important to seek medical advice if you're concerned.
Then there's the physical side of perimenopause and menopause. For some women, sleep becomes increasingly disrupted. Night sweats, difficulty falling asleep or waking repeatedly can leave you exhausted before the day has even begun. And when you're not sleeping well, everything can feel that little bit harder.
Concentrating. Remembering things. Making decisions. Finding the patience to respond calmly when everyone seems to need something from you. Perhaps you've always been patient with your children or taken everyday frustrations in your stride. But lately, you find yourself snapping over something small.
A question from your partner. The children arguing. Someone asking you to make yet another decision. And afterwards, you feel awful.
Why did I react like that?
Why am I taking it out on the people I love?
You might find yourself apologising more often, feeling guilty about your reactions or wondering when you became someone who gets irritated so easily.
— Liana McDonald
When Your Relationships And Intimacy Begin To Change
It's difficult to be the person you want to be when you're running on so little sleep and feeling overwhelmed by things you don't fully understand.
Perimenopause and menopause can also affect how you feel about your body, your relationships and physical intimacy. Perhaps sex was always an important part of your relationship. Something you enjoyed, something that brought closeness and connection. Now, you might find your desire has changed. Maybe you're exhausted, experiencing physical discomfort or simply don't feel the way you used to.
You might miss that part of yourself.
Your partner may feel confused or rejected, and you may struggle to explain something you're still trying to understand yourself. Sometimes, the people we love notice that something has changed before we've fully recognised it ourselves. Of course, every woman's experience is different. Some notice significant changes in sexual desire, mood or relationships, while others experience very few.
And not everything we feel during midlife is necessarily related to hormones. Our relationships, stress levels, physical health, medication and personal circumstances all play a part. But recognising that perimenopause may be contributing to these experiences can help open conversations that might otherwise be filled with confusion, guilt or misunderstanding.
When You've Spent Years Looking After Everyone Else
For many women, perimenopause arrives during an already demanding stage of life. There may be children to support, ageing parents to care for, relationships to maintain and responsibilities at work. Perhaps you've spent years being the person everyone turns to.
The organiser. The problem-solver. The one who remembers the appointments, keeps everything moving and makes sure everyone else is okay. But now, things that once felt manageable seem to require so much more effort. And instead of recognising that you might need support yourself, you begin criticising yourself for not coping as well as you think you ought to.
I'm letting everyone down.
I used to be able to manage all of this.
When You Don't Quite Recognise Yourself Anymore
Beyond the individual symptoms, there can be something deeper happening. A change in how you see yourself. Perhaps you've always been confident at work, comfortable making decisions or able to manage whatever life throws at you.
Now, you're questioning your abilities, worrying about making mistakes or avoiding situations that suddenly feel overwhelming. You might miss the confidence you once had. You might feel frustrated with your body or wonder whether you'll ever feel like yourself again.
For some women, there can be a sense of loss for the person they remember being. For others, this stage of life may bring relief, freedom or a growing understanding of their own needs. There isn't one experience of menopause, and it doesn't have to be a negative one.
And Sometimes, Understanding One Experience Leads To Another
For some women, perimenopause can also be the stage of life when they begin to recognise longstanding difficulties with attention, organisation or managing emotions. Changes in oestrogen may influence systems in the brain involved in attention and executive functioning. For women with ADHD, including those who have never been diagnosed, these changes may make existing difficulties more noticeable.
Perhaps you've spent years finding ways to manage, compensate or hide the things you've struggled with. And suddenly, those strategies don't seem to work as well as they once did. This doesn't mean perimenopause causes ADHD, or that brain fog automatically suggests ADHD. ADHD is a neurodevelopmental condition, and research into its relationship with hormonal changes is still developing.
But for some women, this period of life prompts questions that lead to a greater understanding of themselves. In my next blog, I'll explore ADHD in women, why it can go unrecognised for so long and why some women only begin seeking answers later in life. Perimenopause and menopause can affect far more than your periods or physical health.
They can influence how you sleep, how you think, how you respond to the people you love and how you feel about yourself. And when those changes happen gradually, without a clear explanation, it's understandable that you might begin wondering whether something is wrong. But you don't have to make sense of everything on your own.
Whether that means speaking with your GP, having more open conversations with those closest to you or finding somewhere to explore how you're feeling, support is available.
The Following Sources Informed This Article:
1. Information about symptoms, emotional wellbeing and treatment.
NHS Inform Scotland – Menopause
2. Evidence-based recommendations on menopause care and treatment.
NICE – Menopause: Identification and Management (NG23)
3. Information about the physical, emotional and social aspects of menopause.
World Health Organization – Menopause
4. Guidance on symptoms, diagnosis and treatment options.