How Hormones Affect Mental Health During Menopause and Perimenopause
Menopause and perimenopause are natural transitions in a woman’s life, yet the hormonal shifts they bring can significantly impact mental health. From mood swings and anxiety to depression and brain fog, these changes can feel overwhelming.
According to The Menopause Charity, 90% of women experience some menopausal symptoms and in 10% of women the impact is so severe they leave their jobs. Sadly, though, a lot of women struggle to find help and information about menopause and mental health (fortunately, it is improving).
It’s not all doom and gloom – knowledge is power and understanding how the hormones affect you mentally is the first step in taking back control. This blog explains a little about how hormonal changes in menopause can impact your mood and energy levels.
What is Perimenopause and Menopause?
Perimenopause
Perimenopause is the transition leading up to menopause, lasting anywhere from a few years to over a decade. During this time, hormone levels fluctuate unpredictably, causing symptoms that can come and go. Most women enter perimenopause in their early 40s, but it can start much earlier.
A key sign of perimenopause is changes in the menstrual cycle. However, if you’re using certain contraceptives (such as the hormonal coil or the pill), you might not notice these shifts.
Menopause
Menopause is officially diagnosed once you’ve gone 12 consecutive months without a period. While symptoms often ease after menopause, some women continue to experience problems with anxiety and low mood.
The Science of Hormonal Changes During Menopause
Many women find it helpful to understand what’s happening in their bodies as they start going through perimenopause. Many powerful biological changes affect your brain and mood—here’s a little bit about what happens.
Oestrogen
Oestrogen plays a vital role in mood regulation, sleep, and cognition. It influences neurotransmitters like:
- Serotonin – the “happiness” chemical that helps regulate mood
- Dopamine – linked to motivation, pleasure, and focus
During perimenopause, oestrogen levels fluctuate dramatically, eventually declining. This affects serotonin production, which can lead to increased anxiety, sadness, and irritability. Lower dopamine levels can also contribute to a lack of motivation and low mood.
Progesterone
Progesterone is often called the “calming hormone” because it promotes relaxation and better sleep. However, its levels drop during menopause, which can lead to:
- Increased irritability and restlessness
- Difficulty falling or staying asleep
- Heightened stress and anxiety
Cortisol
As oestrogen declines, the body becomes more sensitive to cortisol, the stress hormone. This can make women feel constantly on edge, amplifying anxiety and making it harder to relax.
TestosteronE
Although testosterone is often thought of as a male hormone, women also rely on it for:
- Energy and motivation
- Cognitive sharpness
- Libido
Testosterone levels gradually decline during menopause, which can contribute to fatigue, brain fog, and low self-esteem.
Life’s stressors
As if the hormonal changes weren’t enough to deal with – perimenopause tends to coincide with other stressors in life, for example:
- Caring for ageing parents
- Children becoming more independent or leaving home
- Navigating career changes
- Developing other health conditions
Sometimes it’s impossible to figure out if mood changes are caused by hormonal fluctuations or life stresses.
The Emotional Toll of Menopause
Considering all of that, it’s no surprise that many women struggle. I have worked with women who have struggled with:
- Social Anxiety & Isolation: The fear of experiencing brain fog, emotional outbursts, or hot flushes in public can lead many women to avoid social situations, impacting their social life.
- Guilt & Self-Doubt: Mood swings and irritability can strain relationships, leading to feelings of guilt or resentment.
- Loss of Identity: Many women feel like they’ve “lost themselves” due to emotional and physical changes.
- Relationship Challenges: Changes in libido and body confidence can affect intimacy and communication with partners.
- Mood Swings – sudden emotional ups and downs, sometimes without a clear trigger
- Anxiety – racing thoughts, nervousness, and feelings of impending doom
- Depression – lower serotonin levels may lead to persistent sadness or low mood
- Brain Fog – memory lapses, difficulty concentrating, and mental sluggishness
- Irritability & Anger – difficulty controlling emotions, leading to frustration
- Poor sleep can worsen anxiety and irritability
If you recognise yourself in any of this, know that you can get help through this and you can get your life back.
How Therapy Can Help
Psychotherapy can be transformative for women experiencing menopause-related mental health challenges. Although we can’t stop the biological changes happening in your body, therapy can help you identify what is in your control and empower you to cope in the best way possible. I use a range of techniques to help women struggling through menopause.
Cognitive Behavioural Therapy (CBT)
CBT helps identify and challenge negative thought patterns, such as catastrophising or self-criticism. It provides practical tools for managing anxiety, low mood, and self-doubt.
Acceptance and Commitment Therapy (ACT)
ACT encourages women to accept difficult emotions while living in a way that is aligned with their values and goals. This approach can be helpful for those struggling with loss of identity or self-esteem.
Self-Compassion Practices
Menopause can be a time of self-doubt. Learning to treat yourself with kindness and understanding can improve emotional well-being.
Therapy provides not just relief but also long-term coping strategies, helping women navigate menopause with confidence.
For more about my therapy services for menopause click here
Menopause is a major life transition, but it doesn’t have to feel overwhelming or isolating. Understanding how hormones impact mental health can help you take back control and give yourself more self compassion.
If you’re struggling with menopause-related mental health symptoms I can help. You are not alone and you deserve support.
Want to talk? I offer a free 20 minute introductory chat to find out more.