Depression, Mood Swings, Brain Fog

What You Need to Know

Introduction

Menopause can significantly impact a woman’s physical and mental health, primarily due to declining estrogen levels in the body. Mental health challenges during the menopausal transition can be substantial — not only for the affected woman but also for her environment and society.

Alongside hot flashes, night sweats, fatigue, and vaginal dryness, many women also report emotional and psychological symptoms such as anxiety, sleep disturbances, irritability, difficulty concentrating, and low self-esteem — complaints that are often mistaken for or resemble clinical depression.

The National Institute for Health and Care Excellence (NICE, 2015) defines menopause as the absence of menstruation due to the natural end of a woman’s reproductive phase. The transition typically does not happen suddenly but progresses gradually through perimenopause to postmenopause. A woman is considered postmenopausal when 12 months have passed since her last period.

Symptoms of menopause are varied: hot flashes, mood swings, cognitive difficulties (“brain fog”), vaginal symptoms, bloating, and joint pain — many of which are not initially associated with menopause.

Emotional changes related to life circumstances differ from clinical depression but are often confused. Symptoms such as depressed mood, anxiety, and cognitive impairments are closely linked to hormonal changes and are often treatable and reversible.

While many women expect hot flashes and night sweats, they are less prepared for emotional symptoms like depressed mood or anxiety — which can seriously impact both professional and personal life. These patients deserve particular attention.

Symptoms

Hormonal changes during peri- and early postmenopause often lead to rapid and intense emotional shifts. Estrogen positively influences neurotransmitters in the brain. A lack of estrogen can negatively affect mental health.

Mood swings may shift abruptly from joy to irritability or anger. Anxiety symptoms often worsen during perimenopause — a hot flash may even trigger a panic attack.

Common symptoms include:

• Hot flashes
• Night sweats
• Fatigue
• Irritability
• Sleep disturbances
• Difficulty concentrating
• Negative mood

Risk factors for depressive symptoms:

• History of depressive episodes
• Increased life stress
• Pessimistic worldview
• Dissatisfaction in relationships
• Low self-esteem
• Negative body image
• Unhealthy lifestyle (little exercise, high alcohol consumption)
• Past trauma (e.g., abuse)

Psychological factors in women

Mental health is influenced by multiple factors. Women are about twice as likely as men to suffer from affective or anxiety disorders. Biological factors like hormonal shifts in menopause contribute to increased mood disorders.

Interesting facts:

• Prevalence of depressive symptoms decreases with age
• Many women seek help for the first time in midlife
• Menopause often triggers openness about long-suppressed symptoms

Diagnosis

• Comprehensive history including psychological predispositions
• Attention to sleep rhythm
• Labs typically only for differential diagnosis
• Consider early menopause when applicable

Treatment

The midlife period often involves significant life changes and stress (e.g., divorce, career change). Combined with hormonal shifts, this may lead to feelings of being overwhelmed.

Studies show that menopause can significantly affect mood and mental health — increasing susceptibility to stress, depression, and anxiety. A clear diagnosis and interdisciplinary treatment approach are essential.

For women with psychiatric conditions:

• Hormonal changes may worsen symptoms
• Some antipsychotics (e.g., risperidone) can stop menstruation, leading to misdiagnosis
• Treatment should consider biological, psychological, and social factors
• Relationship patterns, work stress, and cultural background should be integrated
• A stable therapeutic relationship improves outcomes

Coping with anxiety, depression and sleep disorders

Sleep Disorders

Common during peri-, meno-, and postmenopause:

• Difficulty falling or staying asleep
• Early awakening
• Daytime fatigue

Causes include:

• Hormonal imbalances (especially estrogen and progesterone)
• Anxiety
• Hot flashes
• Bladder issues
• Joint pain
• Decrease in melatonin with age

Treatment options:

• Sleep hygiene (regular schedule, dark/quiet space)
• Avoiding alcohol, nicotine, caffeine in the evening
• Exercise (not directly before bed)
• Cognitive behavioral therapy (CBT)
• Hormone therapy (MHT)
• In severe cases: melatonin, benzodiazepines

Depression

According to DSM-IV, symptoms include:

• Persistently depressed mood (>2 weeks)
• Loss of interest and joy
• Hopelessness
• Appetite and sleep changes
• Suicidal thoughts
• Difficulty concentrating

Treatment options:

• Mild depression: Hormone therapy (MHT), CBT
• Moderate to severe depression: Antidepressants (e.g., SSRIs), psychotherapy, possibly MHT

Conclusion

• Mental health may be significantly impacted during menopause.
• Hormonal influences on mood are complex and individual.
• Psychosocial factors, lifestyle, body image, and relationships matter.
• Holistic, interdisciplinary treatment improves outcomes.
• Preventive care (sleep hygiene, stress reduction, exercise) is critical.
• Depression and anxiety must be taken seriously and treated accordingly.