Menopause and mental well-being: when hormones go haywire

Warning signs and symptoms of the menopause

The transition into the menopause typically begins around the age of 45. Some women are more affected than others, mentally as well as physically. Irritability, loss of sex drive, difficulty concentrating, low mood, anxiety and inner restlessness often creep in slowly, making them difficult to pin down. That’s what makes this life phase so tricky: Many women – and even more so the people close to them – only realise it’s due to the menopause once the level of distress is already high. However, knowing the cause can help everyone manage things more easily and avoid misunderstandings.

Checklist:

Psychological symptoms and changes in personality during menopause:

• Irritability without an obvious reason
• Mood swings
• Sleep problems and insomnia despite exhaustion
• Feeling overwhelmed in everyday life
• Difficulty concentrating
• Loss of libido despite a happy relationship

Mood swings during menopause

“I was constantly irritable and snapped at people, even when nothing was really wrong.” This is how many women describe their experience of entering the menopause (also known as perimenopause). In addition to the well-known hot flushes, many women report instability of mood and nerves. These changes in personality can take their toll on family members, friends and colleagues.

Emotional turbulence: caused by hormones

“The fluctuations in oestrogen are like a second puberty,” explains Gilliane Alder, chief psychologist for psychosomatics and psychiatry at Klinik Gais. The brain suddenly receives other signals than usual, which has a direct effect on mood. Irritability, anxiety and low spirits – more than half of all women experience such psychological symptoms during this phase. Around 40 percent say it affects their daily lives.

Menopause: When oestrogen, progesterone and FSH fall out of sync

While oestrogen levels roller-coaster before eventually dropping, progesterone declines steadily. Meanwhile, the follicle-stimulating hormone (FSH) rises. “This hormonal turbulence affects not just the body, but the mind as well,” Alder says. It’s no wonder your body and mind start playing ping pong when there’s no clear explanation of what’s going on.

A vicious circle in body and mind

“Many women say they don’t recognise themselves anymore,” adds Dr Karin Camastral-Urech, gynaecologist and senior consultant at the Department of Gynaecology, Cantonal Hospital Winterthur. On the one hand, this is down to the psychological effects of the menopause; on the other, it’s a reaction to physical symptoms. Sleepless nights, hot flushes, vaginal dryness – all these contribute to a vicious cycle of exhaustion, irritability and reduced sex drive. “If you’re not sleeping well, you lack energy during the day. You become more sensitive, and everyday life and relationships become challenging – it’s a downward spiral that can be difficult to escape without support. And of course, painful sex due to vaginal dryness doesn’t help matters,” the gynaecologist adds.

When everyday life becomes overwhelming

Suddenly, everything feels like too much: The woman has no patience or concentration at work, and she’s having rows with her partner or children at home. “I just didn’t feel like myself anymore. I’d wake up already thinking ‘everything annoys me’ – and then it's difficult to be in a friendly mood at work,” one woman recalls.

Irritable at work, overwhelmed at home

Psychologist Gilliane Alder notes: “Alongside the symptoms of perimenopause, many women also experience a change in their needs. These new needs often clash with daily responsibilities. Conflict and misunderstandings in the family, relationship and job are practically inevitable.”

Misunderstandings and self-stigma

“Oh, she’s just going through the menopause” – comments like these don’t help. “Because this phase is still rarely discussed openly, many women retreat,” Alder says. In addition to external stigma, many also stigmatise themselves: Instead of asking for help, many women place the blame on themselves. They feel they just have to keep going. Feelings of guilt, shame and self-doubt lead them to stay silent.

How to treat mental issues during menopause

What can you do to address mental issues during menopause? There are several ways to get support:

Hormone replacement therapy: a possible key

Many women report that HRT, when given in the right dosage, brings relief to both body and mind. Both Gilliane Alder and Karin Camastral-Urech agree that tailored HRT can ease not only physical symptoms but mental ones too. Many women feel more emotionally stable as a result.

Complementary approaches

But there are also other ways to support your mental well-being without using hormones. These include plant-based remedies:

• St John’s Wort may ease low mood.
• Black cohosh helps stabilise mood.
• Lavender can soothe inner agitation.
• Ginkgo and ginseng may improve focus and ease exhaustion.
• Many women also respond well to acupuncture.

Get advice

“Complementary medicine can be ideal in combination with other therapies, and individual adjustment is key,” says Dr Karin Camastral-Urech. “Whether it’s hormones, herbal products or another route – what matters is that women speak to a qualified professional.”

Psychological support for menopausal symptoms

“Many women come to therapy with a mountain of problems – and only then realise with relief that some of them are purely hormonal,” Gilliane Alder says. It’s important to get a clear picture: “We look together at what’s causing the most distress. Is it their relationship? The physical symptoms? Or anxieties? Then we focus our support on what’s affecting them most.”

Looking more closely: Where does the body end and the mind begin?

Body and mind often become entangled during the menopause, making it all the more important to take a closer look. Take loss of libido, for instance: It may be due to vaginal dryness, or it may stem from long-standing relationship issues. “It’s worth taking the time to reflect on the interaction between physical, mental and social factors and to ask yourself what needs to change,” Alder says.

Activate your own resources: What does me good?

In difficult times, the things that used to bring joy are often those that disappear. “Many women rediscover old resources in therapy – or find the courage to try something new,” says psychologist Gilliane Alder. Whether it’s exercise, painting, music or taking a walk: Anything that sparks joy supports mental well-being and activates the brain’s feel-good hormones. And those around you can help, too – by creating space for you to enjoy “me-time”.

Conclusion: Embrace the menopause and be open to change

The menopause is not an illness, but a natural phase of life. “No one has to just muddle through. There are plenty of ways to ease the symptoms and genuinely improve your quality of life,” says gynaecologist Karin Camastral-Urech. Psychologist Gilliane Alder adds: “It’s about accepting this phase. Saying to yourself: This is where I am right now – and I’m going to live my life in a way that works for me.”