“I don’t know what’s wrong with me.”
It’s something we hear often — from women in their 40s and 50s who are overwhelmed, exhausted, or disconnected from themselves. These women are not always depressed. They’re not always anxious. But they’re not feeling like themselves.
Sometimes, this is a psychological issue. Sometimes it’s circumstantial. But often, it’s something we overlook: menopause and mental health are deeply linked — and yet, they’re rarely discussed together.
The Neurological Impact of Menopause
Menopause isn’t just about the end of menstruation. It’s a significant neuroendocrine event that alters how the brain functions.
Oestrogen plays a major role in:
- Regulating serotonin, which affects mood and sleep
- Supporting dopamine, which influences motivation and focus
- Modulating GABA, which helps with calm and emotional regulation
- Buffering the effects of cortisol, our primary stress hormone
When oestrogen levels fluctuate or drop — particularly in perimenopause, which can begin years before the last period — these systems can become destabilised. The result? Mental health symptoms that are real, often distressing, and frequently misdiagnosed.
Common Mental Health Symptoms During Perimenopause and Menopause
Women may experience:
- Increased anxiety or panic
- Low mood or tearfulness
- Emotional sensitivity or irritability
- Loss of motivation or flatness
- Difficulty concentrating (“brain fog”)
- Sleep disruptions (especially early waking)
- A sense of disconnection from their identity or purpose
These can mimic conditions like depression, generalised anxiety disorder, ADHD, or trauma-related presentations — but the root cause may be hormonal.
Why This Often Gets Missed
1. Assumptions About Age
Perimenopause can begin in a woman’s late 30s or early 40s — much earlier than many clinicians expect. If cycles are still regular, hormonal changes may be dismissed or overlooked entirely.
2. Cultural Silence
For many women, menopause was never discussed openly — by mothers, doctors, or educators. Shame and stigma can prevent disclosure unless the clinician specifically asks.
3. Lack of Training
Most mental health professionals weren’t taught about the link between menopause and mental health. It’s not part of the standard formulation models — and as a result, the hormonal piece is often left out.
4. Clinical Bias
Symptoms are commonly viewed through a psychological lens. Clinicians might attribute them to burnout, trauma, relationship stress, or ageing — all valid, but not always complete.
A Case Example
A 46-year-old woman presents with mood swings, poor sleep, and difficulty focusing at work. She describes feeling “out of control” and “unmotivated.” Therapy is helpful but only marginally effective.
Eventually, she shares that her periods have become erratic. She wakes every night drenched in sweat. Her memory is slipping, and she’s afraid she’s losing her mind.
This isn’t just burnout or stress — it’s a hormonal transition. And until that’s recognised, any treatment plan will be incomplete.
What Can Clinicians Do?
1. Ask About Hormonal and Menstrual Changes
Even if clients don’t mention it, ask gently:
- Have you noticed changes in your cycle?
- How are you sleeping?
- Are there times when your mood shifts more than others?
- Do you feel different in your body lately?
These questions create space for conversation and insight.
2. Collaborate with GPs and Medical Specialists
Mental health professionals don’t need to diagnose perimenopause — but we do need to notice patterns that suggest a medical referral may help.
Working with GPs, nurse practitioners, or women’s health specialists can ensure clients get support on both fronts.
3. Be Cautious With Diagnostic Labels
It’s easy to mislabel hormonal symptoms as psychiatric disorders. If symptoms are cyclical or resistant to standard treatment, pause. Ask more questions. Explore whether there’s a biological layer influencing presentation.
4. Use Language That Validates
Many women feel embarrassed by their emotional shifts or fear they’re “losing it.” Clinicians can help reduce shame by offering normalising, non-dismissive language:
- “This isn’t unusual during hormonal transitions.”
- “You’re not imagining this — there are real changes happening.”
- “It’s okay to need more support right now.”
5. Support Identity Transitions
Menopause often affects how women see themselves — as professionals, mothers, partners, or people. Identity work is often overlooked in this stage of life but can be powerful in restoring self-trust and emotional grounding.
Final Thoughts
Mental health care that ignores hormones is incomplete. And women deserve better.
Understanding the connection between menopause and mental health isn’t about minimising distress or waving away symptoms as “just hormonal.” It’s about expanding our lens to include the full picture — and responding with empathy, accuracy, and care.
Because when a woman says, “I don’t feel like myself,” we need to know how to help her find her way back.
