Menopause and Mental Health
Navigating the Transition with Strength and Support
Despite the fact that more than 10 million women in Canada are over the age of 40 and represent one quarter of the population, their needs related to menopause have been overlooked. In fact, the average Canadian woman will spend up to HALF OF HER LIFE in a menopausal state - perimenopause, menopause and postmenopause.
We know a lot about puberty and pregnancy, with education and care available. But when it comes to menopause – the years leading up to it in perimenopause and the years after it in postmenopause – the open talk, fact-based information and societal support disappear. Far too many women go through menopause without a good understanding of what is happening to their bodies and how changing hormone levels can contribute to longer-term health issues. Women are not prepared for this stage of life.
Menopausal symptoms like hot flashes, nights sweats and mood changes are casually trivialized rather than seen as major life disruptors. In fact, 3 out of 4 women experience menopausal symptoms that interfere with their DAILY LIVES. AND, 10% of women will stop working due to unmanaged symptoms of menopause with 1 in 4 women suffering with severe menopausal symptoms.
While menopause is a natural stage of life, the health problems associated with it are real and need our urgent attention. Women need to know that they should not suffer in silence and that there are a range of options to help them.
So, let’s start the conversation…
What is Menopause?
Menopause is a natural biological process that marks the end of a woman's reproductive years. Firstly, menopause typically occurs between the ages of 45 and 55, but the timing can vary widely among women. The transition into menopause, known as perimenopause, can last for several years and is characterized by irregular menstrual cycles and fluctuating hormone levels. Eventually, a woman reaches menopause when she has not had a menstrual period for 12 consecutive months.
What are the stages of menopause?
Menopause is divided into four stages:
Premenopause: The beginning of premenopause is defined as the first menstrual cycle. This stage starts when a woman enters her reproductive years.
Perimenopause: This is the transitional phase leading up to menopause. Hormone levels fluctuate, and menstrual cycles may become irregular. Perimenopause can last for several years.
Menopause: This is the point when a woman has not had a period for 12 consecutive months.
Postmenopause: After menopause, a woman enters the postmenopausal stage. Hormone levels stabilize, and some symptoms may improve, but women are still at risk for certain health conditions associated with aging.
How does menopause impact women physically?
Menopause brings about significant changes due to fluctuations and changing levels of estrogen, progesterone, and other hormones as a woman ages. Physical changes during menopause can increase a woman’s risk of heart disease, osteoporosis, and vaginal infections. While everyone’s experience of menopause is unique, some women experience severe and wide-ranging symptoms, while others may barely notice any change.
COMMON SYMPTOMS
Irregular periods
Hot flashes
Cold flashes
Night sweats
Feeling clammy
Heart palpitations
Trouble sleeping
Fatigue
Incontinence
Sore breasts
Vaginal dryness
Pain during sex
Itchy, crawly skin
Itchy ears
Achy joints / muscles
Tense muscles
Headaches
Migraines
Digestive issues
Heartburn
Bloating
Allergies worsen
Weight gain
Frequent urination
Hair loss / thinning
More facial hair
Less pubic hair
Dizziness
Vertigo
Changed body odor
Adult acne / dry skin / rosacea
Electric shock feelings
Tingling extremities
Bleeding gums
Burning tongue / roof of mouth
Chronic bad breath
Dry mouth
Blurred vision
Dry eyes
Weakened fingernails
Ringing ears (tinnitus)
Recurrent UTI’s
Slower muscle recovery
Increased muscle loss
How does menopause impact women emotionally and mentally?
Menopause can also have a profound impact on women's mental health. Menopause often coincides with other life stressors, such as career changes, children leaving home, and caring for aging parents, which already contribute to emotional challenges. Add fluctuating hormone levels and a wide range of physical symptoms including sleep disturbances and hot flashes, it’s not uncommon for women to find themselves in psychological distress.
COMMON SYMPTOMS:
Unpredictable mood swings
Lack of focus
Difficulty concentrating / brain fog
Faulty memory / forgetfulness
Irritability / rage
Low libido / decreased sexual desire
Anxiety
Depression
The Menopause Blues
What women should know about menopause and brain fog (International Menopause Society)
How is menopause diagnosed?
It's important to note that menopause is typically diagnosed retrospectively, meaning that a woman is considered to have reached menopause after she has gone 12 consecutive months without a menstrual period. However, perimenopause—the transitional phase leading up to menopause—can last for several years, during which menstrual irregularity and other symptoms may occur. Therefore, diagnosis and management of perimenopause and menopause often involves ongoing monitoring and evaluation of symptoms over time.
It’s also important to note that in some cases, menopause may start early as a result of: chemotherapy, gender-affirming hormone therapy, pelvic injury, radiation therapy or surgery. So, if you’re experiencing unusual symptoms and aren’t sure if they are related to perimenopause, it’s important to make an appointment with a healthcare professional.
Perimenopause and menopause is typically diagnosed based on a woman's symptoms and medical history. There isn't a single test that definitively diagnoses menopause, but healthcare providers may use a combination of methods to make an assessment.
Here are some common approaches:
Medical history and physical examination: Be sure to advocate for yourself and let your doctor know about any symptoms you may be experiencing, such as hot flashes, night sweats, vaginal dryness, and mood changes. A physical examination should be also be performed to assess overall health and rule out other potential causes of symptoms. Your doctor will ask about your menstrual history, including the regularity of your periods and any changes you have noticed in your menstrual cycle.
Blood tests: Blood tests can measure hormone levels, including follicle-stimulating hormone (FSH) and estrogen levels. In menopausal women, FSH levels are typically elevated, and estrogen levels are decreased. However, hormone levels can fluctuate, so a single blood test may not provide a definitive diagnosis. Blood tests may also be used to rule out other conditions that can cause similar symptoms, such as thyroid disorders.
Other tests: In some cases, healthcare providers may order additional tests or imaging studies to evaluate specific symptoms or rule out other medical conditions. For example, this can include tests for: cholesterol, estradiol, human chorionic gonadotropin (hCG), kidney function, liver function, progesterone, prolactin, testosterone and thyroid function.
What treatments are available for women going through menopause?
There are several treatment options available to help manage symptoms of menopause:
Lifestyle modifications: Eating a balanced diet, getting regular exercise, practicing relaxation techniques, and avoiding triggers like caffeine and alcohol can help alleviate symptoms.
Natural vitamins and supplements: Consult with your doctor about adding supplements to your routine. Based on your blood tests, they may recommend Calcium, vitamin D, vitamin B12, and magnesium.
Hormone Replacement Therapy (HRT): This involves taking estrogen or estrogen combined with progesterone to replace the hormones that the body no longer produces in adequate amounts.
Non-hormonal medications: Certain medications, such as antidepressants or anti-seizure drugs, may help relieve symptoms like hot flashes and mood swings.
Vaginal moisturizer / lubricant: To help relieve dryness and discomfort during sex.
Topical creams and medications: To help relieve skin dryness, itchy / blurred vision, acne and skin issues, etc.
Therapy: Cognitive-behavioral therapy (CBT) and other forms of counseling can provide support and coping strategies for managing psychological symptoms.
A simple approach to Menopause: The Menopause Quick Six (International Menopause Society)
Little BIG Talk: Menopause and Hormone Therapy
How do I prepare for perimenopause and menopause?
Who wouldn’t want to feel healthier and thrive in the prime of their lives? Untreated menopausal symptoms leads to poor health outcomes and a poor quality of life. To have control over your symptoms and to have a successful conversation with health care providers, it’s important to have a plan. Based on expert guidance from the Menopause Foundation of Canada, here is their three-step plan below:
STEP 1: TRACK YOUR SYMPTOMS
To make the most of your appointment, you need to come prepared with information to provide your health care provider with a clear picture of your experience. Tracking symptoms that could be related to hormonal change is an important first step. Your health care will need to rule out any other issues. Here are some tools to help you track your symptoms:
The Menopause Quick 6 Patient Assessment Tool
STEP 2: LEARN
If your family physician or other health care providers lack the confidence or knowledge to provide you with support, we encourage you to learn about the latest evidence-based information on menopause symptom management. Sharing credible, research-backed materials to your doctor will ensure your discussion is based on the most up-to-date and effective approaches to managing menopause symptoms. Here are some key resources to explore:
Pocket Guide: Menopause Management
A Pragmatic Approach to the Management of Menopause
STEP 3: PREPARE
Like any important conversation about your health, it’s a good idea to think through what key messages you want to get across to your doctor and how best to phrase them. Here are some ways to have an informed and productive conversation with your healthcare provider about receiving the guidance and care you need.
This is the time to tell your doctor about the symptoms you are experiencing and how it is impacting your life. Start by letting them know that you have some symptoms that you think are related to the menopausal transition and you would like help with them. Then share what symptoms you have tracked and explain how those symptoms make you feel, such as:
I have been waking up with night sweats once/twice/multiple times a night and they are making me tired because I can’t sleep through the night.
When I sneeze unexpectedly I pee a bit/a lot/some and this is making me uncomfortable and embarrassed.
My vagina feels like sandpaper. It hurts a lot and it would be very painful to have sex.
Remember, you deserve to feel healthy. Advocate for the care you need.
How can a therapist or social worker help a woman struggling with the transition of menopause?
Mental health is crucial during the transition of menopause because the hormonal changes and associated symptoms can significantly impact emotional well-being. Women may experience increased stress, anxiety, and depression during this time, which can have a negative impact on their overall quality of life. Addressing mental health concerns can help women navigate the challenges of menopause with resilience and adaptability.
A mental health professional can play a crucial role in helping a woman struggling with the transition of menopause in several ways:
Providing validation and support: Menopause can be a challenging time, and simply having someone who understands and validates your experiences can be incredibly comforting. A therapist can offer you a safe space to express your feelings, concerns, and struggles without judgement.
Education and psychoeducation: Many women may not fully understand what to expect during menopause or how it can impact their mental health. A therapist can provide education about the physical and emotional changes associated with menopause, as well as strategies for coping with symptoms and managing stress.
Coping strategies: Therapists can teach you coping skills and techniques to help manage symptoms of menopause, such as relaxation exercises, mindfulness meditation, and cognitive-behavioral techniques. These strategies can empower you to take control of your emotional well-being and navigate the challenges of menopause more effectively.
Addressing psychological symptoms: If a woman is experiencing anxiety, depression, or other mental health concerns during menopause, a therapist can provide evidence-based treatments such as cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), or psychodynamic therapy. These approaches can help you to explore underlying issues, challenge negative thought patterns, and develop healthier coping mechanisms.
Supporting lifestyle changes: Therapists can assist you in making positive lifestyle changes that can alleviate symptoms of menopause and improve overall well-being. This may include recommendations for diet and exercise, sleep hygiene, stress management techniques, and strategies for maintaining social connections and support networks.
Advocacy and empowerment: A therapist can advocate for your needs and rights during the menopausal transition, helping you to access appropriate medical care, support services, and resources. Additionally, therapy can empower you to assert yourself, set boundaries, and prioritize self-care during this challenging time.
Menopause is a significant life transition that can impact women physically, emotionally, and psychologically.
Unfortunately, there is still a stigma surrounding menopause and mental health issues. Many women may feel embarrassed or ashamed to discuss their symptoms openly, leading them to suffer in silence. Additionally, misconceptions about menopause and aging may lead to dismissive attitudes from healthcare providers or reluctance to seek treatment. This stigma can prevent women from getting the support and treatment they need to manage their symptoms effectively. But, it doesn’t have to be that way. Knowledge is power, and breaking the stigma around menopause is the first step toward empowering women to navigate this phase of life with confidence and grace. By talking openly about menopause, we can dispel myths, share experiences, and provide support to one another.
So let's start the conversation. Whether you're in the thick of it or just curious, by addressing mental health concerns and seeking support and treatment when needed, women can navigate this journey with strength, resilience, and dignity. Let's come together to learn, share, and uplift each other. Because when we break the silence around menopause, we pave the way for a smoother journey for women everywhere.
Whatever it is, we’re here for you.
Life is uncertain. Jobs are stressful. Parenting is hard. Relationships take work. Families can be dysfunctional. And sometimes, love hurts. When you’re confronted by feelings, events, or issues that are making your life challenging, it’s okay to ask for some help.
