Menopause: The Stages And How They Affect Mental Health.

Black and white outline of the womb with flowers

Most women or persons assigned female at birth see menopause as one stage of their lives that they reach at the end of their reproductive lives. However, menopause is a more nuanced end of the reproductive cycle and comprises three main (sometimes four) stages. It affects hormonal health, physical health, and mental health. Knowing how menopause works can help prepare you for this important stage of your life.

What Is Menopause?

Menopause is when the ovaries are no longer producing reproductive hormones. It occurs when you have not had a menstrual period for 12 consecutive months. It can be both a natural process or it can be induced by surgery or medication.

Stages of Menopause.

There are three distinct stages of menopause - Perimenopause, Menopause and Postmenopause. All three have distinct symptoms and causes. There is a fourth stage which is not as common and has little to no symptoms known as Premenopause which we will also look at below.

Premenopause.

Premenopause means before menopause. Although not commonly used in the medical community it is when estrogen levels start to drop and the reproductive cycle begins to end. However, its main difference from perimenopause is there are no noticeable changes to your body or signs of menopause.

Perimenopause.

Perimenopause means around menopause. This is the more commonly recognised first stage of menopause. It is when your body begins producing fewer hormones, making your menstrual cycle less regular. It signals the end of the reproductive cycle. It usually starts in the mid-40s but some women can experience it as early as their mid-30s.

What hormonal changes happen during perimenopause?

The main hormonal change is the decrease in estrogen. This causes a decrease in progesterone. These hormonal changes start the slowdown of the reproductive system by stopping the production of eggs. However, during perimenopause, these hormonal changes are not consistent and menstrual periods can still take place.

Infographic showing the symptoms of perimenopause

Signs and symptoms of perimenopause.

Irregular or skipping periods.
Heavier or lighter periods than usual.
Low libido.
Hot flashes.
Night sweats.
Vaginal dryness. (especially causing discomfort during sex.)
Increased bladder problems: urine urgency or increased infections.
Insomnia.
Changes in mood like irritability, depression or mood swings.
Headaches.
Joint and muscle aches.

Treatment for perimenopause.

Often perimenopause will not require treatment however if any of the symptoms affect your everyday life then your doctor can recommend one of the following treatments.

Antidepressants: these can help with the treatment of hot flushes, mood swings, anxiety or depression.
Hormone replacement therapy (HRT): uses estrogen or estrogen and progesterone to increase hormone levels if you have gone into menopause early.
Hormone therapy (HT): Similar to HRT, this therapy uses estrogen or estrogen and progesterone to increase your hormones. Likewise, doctors use this to bring on menopause at a more natural age of 45.
Gabapentin: This medicine is a seizure medication that also relieves hot flashes for most people.
Oxybutynin: A medication for overactive bladder that can also relieve hot flashes.
Fezolinetant: This is a newer treatment for severe hot flashes.
Birth control pills: These medications stabilize your hormone levels and typically relieve symptoms.
Vaginal creams: Treatment with vaginal creams and lubricants can decrease pain during sex and relieve vaginal dryness.

What can you do to make perimenopause symptoms more manageable?

While there is no cure for perimenopause, there are a few things that may help make symptoms more manageable.

Perform weight-bearing exercises like walking, hiking or strength training.
Use a fan or keep your house at a cooler temperature.
Eat plenty of fruits, vegetables, whole grains, lean protein and healthy fats.
Dress in layers so you can remove clothing if you begin to sweat or get hot flashes.
Improve sleep hygiene by avoiding TV and computer screens. Try doing relaxing activities before bed.
Practice meditation or other stress management techniques.
Limit alcohol and caffeine.
Quit using tobacco products like cigarettes.
Maintain a weight that’s healthy for you.

Menopause.

Menopause is the period at the end of the reproductive cycle. It is signalled by 12 months of no periods. It usually starts at the age of 45.

What hormonal changes happen during menopause?

Much like perimenopause, menopause is caused by a decrease in estrogen and progesterone. Unlike perimenopause, these hormonal changes are consistent and the production of eggs is stopped completely in most cases. These hormonal changes also affect calcium and cholesterol levels.

Signs and symptoms of menopause.

Signs and symptoms of menopause overlap with perimenopause. However, the following symptoms are distinct to menopause:

Cold flashes.
Dry skin, dry eyes or dry mouth.
Breast tenderness.
Racing heart.
Difficulty concentrating or memory loss.
Weight gain.
Hair loss or thinning.
Vaginal atrophy.
Relaxation of the pelvic muscles.

Treatment for menopause.

Estrogen progestogen therapy (EPT): This is also called combination therapy because it uses doses of estrogen and a hormone similar to progesterone. Progesterone is available in its natural form or as a progestin (a synthetic form of progesterone). This type of hormone therapy is for those who still have their uteruses.
Estrogen therapy (ET): In this treatment, it is a low dose of estrogen alone. Estrogen comes in many forms, such as a patch, pill, cream, vaginal ring, gel or spray. Estrogen therapy can’t be used alone (without a progestogen) if you still have a uterus.
Birth control pills: These medications stabilize your hormone levels and typically relieve symptoms.
Antidepressants: these can help with the treatment of hot flushes, mood swings, anxiety or depression.
Gabapentin: This medicine is a seizure medication that also relieves hot flashes for most people.
Oxybutynin: A medication for overactive bladder that can also relieve hot flashes.
Fezolinetant: This is a newer treatment for severe hot flashes.
Vaginal creams: Treatment with vaginal creams and lubricants can decrease pain during sex and relieve vaginal dryness.
Non-hormonal treatment: although hormonal treatment is successful for most people, it’s not always the answer for everyone. Some non-hormonal treatments include:
- Joining support groups.
- Changing what you eat.
- Avoiding triggers to hot flashes.
- Getting regular physical activity or exercise.
- Hypnotherapy.
- Cognitive behavioural therapy (CBT).

What are the health risks of menopause?

Osteoporosis: estrogen plays an important role in maintaining bone density. On average women can lose up to 25% of bone mass due to menopause before the age of 60. Regular check-ups to check bone density are a must.
Cardiovascular disease: the decrease in estrogen can lead to high blood pressure, while the decrease in physical activity can lead to cholesterol.
Breast cancer: while menopause does cause breast cancer, the changes in hormones can be a factor in the increased risk for breast cancer.

Postmenopause.

This is the period after menopause when the symptoms of menopause decrease or stop completely. It is also when the body has completely stopped producing eggs.

Signs and symptoms of postmenopause.

Most of the signs and symptoms of menopause will have passed at this point, however, there are a few things that are associated only with postmenopause:

Postmenopausal bleeding: this is not caused by hormonal changes. It is often caused by vaginal dryness.
Genitourinary syndrome: Decreased estrogen levels cause the tissues in your vagina to become thin and dry. This can lead to pain during sex as well as problems with urinary tract health.
Mental Health Problems: moodiness, anxiety and depression.

Treatment for postmenopause.

Hormone therapy: this would only be used if the person was experiencing postmenopause under the age of 60.
Antidepressants: these can help with the treatment of hot flushes, mood swings, anxiety or depression.
Vaginal creams: Treatment with vaginal creams and lubricants can decrease pain during sex and relieve vaginal dryness.
Gabapentin: This medicine is a seizure medication that also relieves hot flashes for most people.
Oxybutynin: A medication for overactive bladder that can also relieve hot flashes.
Fezolinetant: This is a newer treatment for severe hot flashes.

Stages Of Menopause And Mental Health.

With the different stages of menopause come major changes in hormone levels. These hormone changes not only affect the body but can also affect the mind. Each stage can cause the following mental health symptoms:

Low mood, feeling unhappy or depressed.
Feeling tense or nervous.
Memory problems.
Panic attacks or anxiety.
Loss of confidence.
Anger or irritability.
Poor concentration (brain fog).

What causes these symptoms?

Mental health during the phases of menopause can be affected by the following:

Changes in hormones: the changes in hormones can affect the levels of serotonin in the body. Serotonin is the brain chemical that promotes well-being and happiness. The decrease in serotonin can lead to the symptoms of depression etc.
Sleep problems: lack of sleep is 10 times more likely to lead to depression.
Physical changes to your body: these changes can affect your self-confidence. This can lead to some of the above symptoms.

Treatment Options.

Other than the treatments mentioned in each phase which include antidepressants and hormone replacement therapy, the following are treatment options for mental health symptoms during menopause:

Talking Therapies.

Cognitive behavioural therapy (CBT).
Psychotherapy.
Counselling.

Complementary Therapies.

Aromatherapy: some people find oils such as lavender, juniper and geranium relaxing and help with sleep. They can either be used in a diffuser, in a warm bath or in a carrier oil as part of a massage.
Acupuncture: a series of small needles inserted into the body. They can be used to relax the body. This can help with sleep problems and body aches.
Meditation: Meditation is a practice that involves focusing or clearing your mind using a combination of mental and physical techniques. This can help with stress and sleeplessness.

Alternative Remedies.

Before using any alternative remedies, please check with your doctor first.

St John’s wort: this herb can help with the treatment of mild to moderate depression as well as hot flushes.
Black cohosh: it mimics estrogen and therefore can help with symptoms of menopause.
Red clover: can help with symptoms of menopause.

Conclusion.

Menopause as a whole is a major change in a woman’s or person-assigned woman at birth life. And with this major change comes a bunch of symptoms and therefore it is no surprise it comes with mental health challenges. Knowing about the changes can help you prepare in some way and maybe lessen the effects slightly.