Psychological changes during

menopause
Introduction to menopause:

• Menopause is the phase of a woman’s life

when she stops ovulating and stops her
monthly menstrual bleeding. Menopause is
associated with significant hormonal
changes – in particular, the rapid cessation
of oestrogen production by the ovaries and
rapid decline in oestrogen available to the
woman’s body.
• Cont,

• These hormonal changes cause a range of

symptoms in the period leading up to
menopause, known as peri-menopause or
the menopausal transition. At this time,
menstrual cycles become irregular and
hormone levels fluctuate.
Symptoms of menopause:

• often persist post-menopause (i.e. for more

than one year after a woman’s final menstrual
cycle). Symptoms that occur peri- and post-
menopause include vasomotor symptoms (e.g.
hot flushes), sexual symptoms and mood
changes.
• What causes mood swings during
menopause?

• The causes of mood changes associated

with menopause are not well understood
and there are a few different theories.
• Some health professionals argue that the
mood changes occur as a result of the
hormonal changes of menopause.
• Cont,

• Other health professionals argue that

mood changes associated with menopause
are due to sleeplessness resulting from hot
flushes and other life changes (e.g. kids
leaving home) that occur at this time of life.
• Cont,

• Women experience many stresses at the

same time as menopause, and it is also
possible that these stresses could be
responsible for the mood changes that
commonly occur in the menopausal period.
• Cont,

• Stressors which occur at the same time as

menopause may be external (e.g. having to
care for an ageing parent) or internal (e.g.
regret about past life choices). Problems with
current relationships or a lack of social
support may worsen mood symptoms
during menopause.
• Other symptoms of menopause:

• including hot flushes and sexual

dysfunction, can also have an effect on
mood and relationships. Changes to the
body and associated issues with body
image, as well as attitudes towards
ageing, can all affect a woman’s mood as
she transitions to menopause.
Types of mood swings during
menopause:

• Regardless of whether mood changes are

directly associated with menopause or occur
as a result of other factors, many women
experience mood changes in the
menopausal period.
• Cont,

• They can take mild forms such as feeling

irritated and upset, or more severe forms
such as rapid temper changes and
aggression.
 Feelings commonly experienced
include:
 Anxiety, which may be accompanied by:
 Rapid heartbeat;
 Rapid breathing;
 Sweating;
 Dizziness;
 Depressed or unstable mood;
 ;
• Cont,
 Low self-esteem;
 Irritability;
 Tearfulness;
 Lack of motivation or energy;
 Poor concentration;
 Poor sleep;
 Reduced confidence;
 Forgetfulness; and
 Panic attacks.
 Depressed mood vs. clinical
depression

• Many women complain of low mood or

mildly depressed feelings during
menopause. However, it is important to
note that feeling mildly depressed or in a
bad mood is not the same as having
clinical depression, especially if there is a
factor causing the depressed feeling
• Cont,

• Clinical depression refers

to chronic depressed feelings in the
absence of factors that might
reasonably cause one to feel sad or
depressed (e.g. loss of a loved one).
Who experiences mood swings
during menopause?

• Some women are more likely than others

to experience mood symptoms during
menopause. They include:
 Women whose peri-menopausal
period exceeds 27 months;
• Cont,

 Women who experience moderate to

severe hot flushes. Experiencing hot
flushes is associated with a 4.6 times
increased risk of developing
depression;
• Cont,

 Women with a history of depression are

4–9 times more likely to experience
depressed mood in the menopausal
transition;
• Cont,

 Women with other factors that increase

the risk of depression, including:
 Poor relationship satisfaction;
 Significant life stress;
 Low self-esteem;
 Negative body image;
 Lack of exercise; and/or
 Excessive alcohol intake.
 Cultural influences and mood
changes in menopause

• These differences are thought to arise

because of the different social meanings of
menopause and the relative value different
cultures place on younger and older female
bodies.
• Cont,
• Western cultures tend to emphasise
youthful women and give them the most
visible and valuable female roles in society.
This can make women approaching or
passing menopause feel under-valued.
Similarly, cultures that emphasise fertility
and women’s child-bearing roles tend to
undervalue post-menopausal women.
• Cont,
• On the other hand, some cultures
associate menopause with strength and
wisdom, and may even attribute special
powers of healing to women in the
menopausal period. These cultures view
menopause and ageing as natural and
desirable events, reducing the
apprehension women feel when they
approach menopause..
• Cont,

These societal factors are all

thought to influence the extent to
which women experience
psychological symptoms during
the menopausal transition.
Investigating mood swings during
menopause

• For many women, menopause may be a

catalyst to discuss existing issues with their
doctor, and it is important to tell the doctor
whether or not the symptoms began before
other menopausal symptoms.
• Cont,

• One of the key areas of questioning is

the woman’s history of psychological
illness (e.g. depression), as those who
have experienced psychological
conditions in the past are more likely
to also experience such symptoms
during menopause.
• Cont,
• Women with a history of psychological
illness who display symptoms of
depression in the menopausal transition
will generally be referred to a
psychological health specialist for further
assessment. The specialist will be able to
determine whether the woman’s
symptoms are a result of menopause, or
if they are cause by a psychological
illness that requires treatment.
• Cont,

• Women should be aware that not all

mood disorders which occur at the
time as menopause are due to
menopausal changes. It is useful to
consider whether or not there are other
factors which may be affecting mood.
Such factors include:
• Cont,

 1.Life circumstances: Including:

 Roles and responsibilities at work and
in the home;
 Whether or not there have been recent
role changes; and
• Levels of satisfaction with life roles;
• Cont,

 2.Relationship dynamics: Including:

 The presence or absence of a partner;
 Quality of the intimate relationship,
including whether or not sexual
symptoms of menopause have impacted
on the relationship;
• Cont,

 Changes in relationships with family

members, including parents (e.g.
becoming the carer for one of your
parents) and children (e.g. who may be
leaving home);
• Cont,

 Support networks, including the

availability of supportive friends. A lack
of social support is associated with a
higher likelihood of experiencing
menopausal symptoms;
• Cont,
 3.Medical disorders which may be affecting
mood;

 4.Attitude towards menopause: Having a

negative attitude towards menopause – for
example, seeing it as a crisis rather than the start
of a new phase of life – has been shown to
increase the likelihood of menopausal
symptoms. Cultural issues may also be
contributing to menopausal mood changes (e.g.
the extent to which post-menopausal women are
viewed as socially valuable or desirable within
the cultural group); and
• Cont,

 Body image: The physical changes

that occur at menopause may cause
some women to become dissatisfied
with their bodies, which can
contribute to depression.
Treatment:
Hormone replacement therapy:
• Oestrogen
• Oestrogen is the primary hormone
produced by a woman’s ovaries. It is
implicated in numerous reproductive
functions, including regulating
menstruation, female sexual response (e.g.
lubrication) and female sexual development.
• Cont,

• There is some evidence that oestrogen

can enhance the effects of
antidepressants (selective serotonin
reuptake inhibitors) in the treatment of
depression. Oestrogen appears to be
more effective in the peri-menopausal
period than post-menopause.
• Progesterone

• Progesterone is a hormone produced by

the ovaries which plays an important role in
regulating menstruation, pregnancy and
breastfeeding.
• Cont,

• Progesterone alone appears to have a

negative effect on mood in menopausal
women. When progesterone is added to
oestrogen for hormone replacement therapy
(which is standard for all women who have
not undergone hysterectomy), it reduces the
mood-enhancing effects of oestrogen.
• Androgens
• Androgens, including testosterone, are
hormones produced by both males and
females. Two different hormones from the
androgen group, testosterone (produced by
the ovaries and the adrenal gland) and
dehydroepiandrosterone (produced naturally
by the adrenal gland) have both been
demonstrated effective in small trials for
improving depressed mood in menopausal
women. Testosterone has also been shown to
improve menopausal
• Tibolone

• Tibolone is a synthetic hormone with

oestrogenic, progesterogenic and
androgenic properties, meaning that it
fulfils similar functions in the human
body to hormones from the oestrogen,
progesterone and androgen groups.
• Cont,

• Initial evidence suggests that tibolone

improves mood in post-menopausal
women. Further research is needed to
confirm the results of early trials.
Tips for reducing mood changes
of menopause:

• Women experiencing menopause-related

mood changes may try the following tips to
reduce the impact of mood changes:
 Exercise regularly to promote better sleep,
which can in turn improve mood;
• Cont,

 Ensure regular mental stimulation (e.g. by

doing crosswords or puzzles) to maintain
cognition and reduce symptoms of poor
concentration and forgetfulness;
 Engage in social activities to improve
mental function;
• Cont,
 Reduce alcohol consumption, as excessive
alcohol can have a negative effect on
memory;
 Learn some relaxation or stress reduction
strategies to help cope when symptoms
arise;
 For severe symptoms or to cope with
stressful events, seeing a counsellor may
be useful;
• Cont,

 Talking to trusted family members and

friends can also be useful;
 Examine your attitude to ageing and other
changes which are occurring (e.g. body
changes). Focus on the positive things that
await you post-menopause, and try to
look forward to the next stage of your life;
• Cont,
 Find a role that will satisfy you and make
you feel important. You may wish to get a
job, work as a volunteer, enrol in a course or
join an interest group;
 Work on your relationships. Satisfying
relationships with an intimate partner, family
and friends are all important aspects of
coping with and reducing the impact of
mood changes associated with menopause;
• Cont,
 Treat other symptoms of menopause,
including sexual dysfunctions and hot
flushes, as these can significantly impact
on a woman’s quality of life and her
mood;
 Keep a diary of your thoughts and
feelings. This may help you identify things
that trigger bad moods and develop
strategies for coping with them;
• Cont,

 Treat yourself by taking time out and

doing something special that you have
always wanted to do;
 Think about your achievements and focus
on these when you are feeling down;
 Identify the things that cause stress and
try to reduce them.