Mental health issues associated with menopause are frequently ignored. Yet during this transition period, symptoms of depression and anxiety, alcohol/substance abuse issues, and mood swings increase. For women diagnosed with schizophrenia or bipolar disorder, symptoms may intensify during perimenopause or menopause.
During perimenopause and menopause, many women report low self-esteem, trouble concentrating, decreased motivation, inability to sleep, as well as cognitive issues like having trouble finding words and struggling with short-term memory. Such cognitive problems lead many women to fear they may be facing dementia or Alzheimer’s. During this stage of life, women often face other chronic stressors, such as caring for aging parents, navigating divorce or co-parenting issues, and dealing with other health issues. Many women lack the energy to do the things that would help them better manage their symptoms, like eating healthier, exercising, and spending quality time with friends.
Dr. Louise Newson developed an online questionnaire regarding symptoms associated with perimenopause and menopause. With over 80 indicators, this comprehensive list includes symptoms affecting women’s cognition, mood, sense of self, nervous system, skin/hair, digestive system (including weight gain), menstrual cycle/genitourinary system, musculoskeletal system, and more, clearly demonstrating the mind/body connection.
The Harvard Study of Moods and Cycles found that the earlier women begin going through menopause, the greater their risk for experiencing first-time depression, especially if they are experiencing symptoms like hot flashes and night sweats (vasomotor symptoms). For women who have never experienced past depression, research indicates that the risk of severe clinical depression is low. However, factors like a prolonged transition period, life stressors, and poor sleep may increase their risk of depression.
Let’s Start Thinking Ahead
According to the Centers for Disease Control and Prevention (2023), the life expectancy for women has reached the highest level in U.S. history at 81.1 years. Unfortunately, many of the latter years are spent dealing with frailty (due to bone density loss), cognitive decline, and myriad health issues, including poor heart health and GSM (genital and urinary symptoms). A significant number of aging women will also experience depression and anxiety.
Because women are living longer than ever before, it is essential to consider that hormones may play a key role in shaping our quality of life as we age. Though it is never too late to become more active and engage in strength-building exercise, the sooner we pay attention to our lifestyle choices, the better. The Menopause Society (2025) introduced a new study suggesting that the timing of when women start hormone therapy significantly impacts their future health. The study examined over 120 million patient records, comparing the impact of when estrogen therapy was initiated—during perimenopause, after menopause, or not at all. The study found that if estrogen was given to perimenopausal women 10 years before menopause, there were no significantly higher rates of breast cancer, heart attack, or stroke compared to the other two groups.
Other research studies have found that HRT can improve bone density, improve genitourinary menopause syndrome and cardiovascular risk markers, reduce mortality risk, and reduce the risk of Alzheimer’s disease in postmenopausal women when initiated early in menopause.
Choosing the right professionals
Choose professionals who are adequately educated or trained to assess or address perimenopause and menopause concerns.
Historically, most medical studies used male subjects, excluding females and generalizing the findings to women. Finally, research is now focusing on women as subjects, and there is more information on perimenopause/menopause and hormone therapy than ever before. However, not all professionals have received additional training or certification regarding this. The Menopause Society and Dr. Mary Claire Haver’s list of recommended doctors are two resources that can help you connect with qualified providers who can prescribe HRT.
If you are a medical or mental health provider, I encourage you to pursue additional education/training in the best interest of the women you serve.
There is no one best treatment for perimenopause, menopause
There are many factors to consider when addressing this topic with your provider. For example, do you have a history of mental health issues? What is your health history, including breast cancer, bone density, and heart problems? How are your current symptoms impacting your relationships or your ability to function? Have you had a hysterectomy? Where are you in your perimenopause/menopause transition? What are your lifestyle choices in terms of using substances and exercising? Are you experiencing adequate sleep, and how often? How do you want to improve your quality of life?
According to Harvard Medicine Magazine, many doctors today fail to prescribe FDA-approved hormones, many women are afraid to take them, and many health plans won’t cover estrogen replacement. Further, a common strategy for dealing with perimenopausal symptoms is to prescribe antidepressants and anti-anxiety medications. Unfortunately, “a concerning number of studies, however, have found perimenopausal depression and anxiety resistant to these drugs.”
A qualified provider who is trained to address the perimenopause transition can help you weigh the myriad factors that can impact treatment considerations best for your individual needs and health factors. Consider working with a medical provider and a mental health professional, who can offer you a safe space to address stress, mood, or sexual issues. Sign a release so these providers can communicate and work together to support your best care.
Further, there are many good research-based books available to help you understand a life transition that persists for decades. Seek knowledge so you can ask educated questions. Dr. Casperson’s new book, The Menopause Moment, is one such example for helping you understand perimenopause and menopause comprehensively. Gaining knowledge gives you a better sense of control over your health, confidence in advocating for what you need, and normalizes seeking help for something as important as your quality of life.
