Many women in their midlife begin to experience persistent fatigue that does not improve despite better self-care. They may describe vague symptoms like brain fog, low mood, irritability, heightened anxiety, insomnia, and poor memory. Many women in this stage of life are experiencing lifestyle changes such as children leaving home, caring for aging parents, work-related stress, and shifts in relationships, therefore it can be challenging to unpack cause and effect. Perimenopause and menopause can present health challenges for many women; fluctuating oestrogen, progesterone, and testosterone can lead to psychological, physical, and genitourinary symptoms.
What is the menopause and perimenopause transition?
During perimenopause, women undergo fluctuations in oestrogen, and a reduction in progesterone and testosterone. These hormonal changes effect menstrual cycles, which may become irregular, varying between frequent and infrequent, and range from excessive flow to minimal flow. Menopause is established when menstrual cycles cease for at least 12 consecutive months due to consistently low oestrogen levels. While menopause commonly occurs around the age of 51, it can also affect younger women. Approximately 1 in 20 women under 45 years old experience menopause, and 1 in 100 women under 40 years old. Women, on average, spend about one-third of their lives in the post-menopausal stage.
How does the menopause and perimenopause affect mental health?
It is known that oestrogen offers a protective effect on the brain by boosting certain “feel-good” neurotransmitters, like serotonin and dopamine. Fluctuating oestrogen levels in decline can contribute to mood alterations, irritability, depression, anxiety, insomnia, cognitive changes, memory issues, decreased focus, and poor concentration. These mental health symptoms may persist for 7 to 14 years and can significantly disrupt a woman’s life, impacting her health, career, and relationships. Research indicates that women in the perimenopausal stage exhibit a sevenfold increase in suicidal ideation compared to women in other age brackets. Depressive symptoms manifest in as many as 68% of perimenopausal women.
Women who have previously experienced postnatal depression, premenstrual syndrome (PMS), or premenstrual dysphoric disorder (PMDD) can be more susceptible to the hormonal changes that occur during perimenopause and menopause.
What are the psychological symptoms?
Psychological symptoms are commonly more intense during the premenstrual phases of perimenopause, persisting into menopause and post menopause.
Many of my patients experience the following symptoms. These may be sporadic, recurring, enduring, mild, moderate or severe:
– Worsening anxiety, particularly in the early hours of the morning
– Panic attacks
– Low mood
– Crying episodes
– Loss of confidence
– Reduced self esteem
– Feelings of low self-worth
– Negative thoughts
– Suicidal thoughts
– Memory problems
– Low concentration
– Brain fog
– Low motivation
– Cognitive changes
How does the perimenopause and menopause affect physical health?
Fluctuating hormones, transitioning from very high to very low oestrogen levels along with decreased progesterone and testosterone, may result in irregular menstrual cycles, weight gain, accumulation of visceral fat in the abdomen, elevated blood pressure, increased cholesterol levels, heightened risk of heart disease and stroke, sarcopenia (muscle mass loss with aging), reduced bone density leading to osteoporosis, cognitive change that can influence the risk of dementia and Alzheimer’s disease, and symptoms related to vasomotor and urogenital issues.
Common reported vasomotor symptoms are:
– Hot flashes
– Night sweats causing insomnia
– Dry skin
– Dry eyes
– Joint pain
– Body aches
Common urogenital symptoms are related to:
– Urinary frequency
– Urinary incontinence
– Urinary urgency
– Nocturia (going the toilet more often at night)
– Increased urinary tract infections,
– Painful intercourse
– Vaginal atrophy (thinning of the vaginal skin),
– Sore vulvae
– Skin changes in the the genital area
– Loss of libido.
It is worth noting that 1 in 100 women under the age of 40 undergo menopause, implying that they will likely experience long-term health effects due to oestrogen deficiency. This deficiency can result in decreased fertility, heart disease, diminished bone density known as osteoporosis, mental health issues, dementia, and an elevated risk of premature mortality.
How can a trusted family physician help?
It is essential to seek a family physician with expertise in menopause and mental health. An experienced family physician will evaluate women from a holistic approach, taking into account mental health in addition to physical menopausal symptoms, family and medical histories, cardiovascular and bone health, and various relevant factors. Our approach at Osler Health is entirely personal – treatment is tailored to the specific symptoms experienced by each woman and is approached through collaborative decision-making. Our approach is through the Lifestyle Medicine where your physician will review patient health against the six pillars of Lifestyle Medicine.
Dr Valerie Druon is a Family Physician and Deputy Medical Director for Osler Health Star Vista. Dr Valerie has recently completed a module with UK Royal College of psychiatrists on mental health in menopause. Dr Valerie is known for her support of women during perimenopause and menopause.