Menopause and Mental Health

Menopause is a time period we still whisper about eventhough it’s something many people with functioning ovaries will experience in their lives. A lot of stigma and misconceptions surround the topic, including reducing menopause to a caricatured experience of simply having “hot flashes” or overly medicalized views where it is framed as a deficiency or almost an illness.

Menopause brings many complex physical and emotional changes, and it often coincides with important events in our lives, including changing roles in our careers and families, which can make it feel a lot to handle. For many, menopause can also invite a sense of grief or loss, and some may find themselves thinking more deeply about their identity and the meaning of life and even experience a sense of shame. 

However, menopause is not necessarily a time we need to be afraid of. Learning more about this transition and connecting with support can help us feel more equipped and empowered to navigate it and can make it possible to reclaim menopause as a valuable and personally meaningful time in our lives, rather than viewing it through disempowered or overly medicalized perspectives.

What is menopause?

Menopause happens when menstrual periods come to an end due to changes in ovarian functioning. More specifically, menopause is considered to happen when someone’s menstrual periods have stopped for about 12 months. Many people experience this period around the ages of 45 to 55, while earlier or later onset is also possible. Menopausal changes are often best understood by referring to three stages: perimenopause, menopause, and post menopause.

Perimenopause refers to the time that comes before menstrual periods end for about 12 months. This is the transition to menopause, where people may start experiencing some changes in their menstrual cycles and also experience some of the menopausal symptoms, including hot flashes, decreased s-x drive, sleep changes, and mood and attention changes. Perimenopause can take around 4 to 5 years. During this time, hormone levels still fluctuate, but it can be possible to become pregnant. 

Menopause happens when someone’s menstrual periods have stopped for 12 months. During this time, many people experience changes such as hot flashes, changes in s-x drive, sleep changes, and also changes to their mood and attention. From this stage onward, due to changes in ovarian functioning and associated hormonal changes, becoming pregnant is typically no longer possible.

Postmenopause refers to the years after menopause, once menstrual periods have stopped for 12 months. The physical and emotional changes experienced due to changing ovarian functioning and hormone levels during perimenopause and menopause often ease during this stage. Many people may notice their symptoms have stopped altogether or become much less intense or frequent, to the point that they no longer significantly affect daily life. As certain hormones, such as estrogen, are produced at lower levels during these years, there may be some additional vulnerability to certain health conditions, such as weakened bones or changes in heart health. Healthcare professionals often recommend having regular checkups and making lifestyle changes that feel nourishing and supportive as we navigate these changes.

During perimenopause and menopause, many people may experience a combination of some of the symptoms below. These symptoms typically ease or become less intense and frequent during the postmenopausal years. Not everyone experiences these symptoms in the same way, and other life events or factors can also affect how manageable they may feel:

• Changes in menstrual periods before they stop, such as irregular or sometimes heavy periods
• Hot flashes (sudden feelings of heat, often around the neck or face), night sweats, and increased heartbeat, often collectively referred to as vasomotor symptoms
• V-ginal dryness or irritation
• Sleep changes, including difficulty falling asleep or staying asleep
• Feeling tired and experiencing body aches, including muscle and joint pain
• Changes in s-xual drive, including feeling less interested in s-xual activities or experiencing discomfort during s-xual activities
• Changes in attention and memory, including finding it more difficult to concentrate
• Mood changes, irritability, and agitation
• Changes in body weight, hair, and skin may also be noticeable

Menopause & mental health

Menopause can have a complex effect on our mental health. 

First of all, some of the changes experienced during perimenopause and menopause can mimic or overlap with symptoms of other mental health conditions. For example, changes in mood, sleep difficulties and fatigue, and difficulties in concentration are also common in depression, or feelings of irritability, or increased heart rate and sweating can also be present when someone experiences anxiety. If these changes get overlooked, it can be easy to misattribute those changes to menopause or another mental health condition, which can affect the care options we receive. 

Moreover, menopause may seem like a reproductive change, but it also involves neuroendocrine changes that can affect how our brains process emotions, cognition, and energy levels, including arousal. That’s why, while going through perimenopause and menopause, some people may experience additional vulnerability to mental health conditions such as depression, anxiety, or suicidal ideation. For example, hormones that fluctuate during perimenopause and menopause may have modulatory or even protective effects on the brain, including neurotransmitter systems such as serotonin and GABA, which support major emotional and cognitive processes (Bachkangi, 2026). Changes in these hormonal systems may therefore contribute to increased vulnerability to mental health difficulties during this transition or can exacerbate existing mental health conditions. 

That said, some of these changes may be temporary and also ease out in the postmenopause period. For example, cognitive changes due to hormonal changes during the menopausal period, such as difficulty concentrating or experiencing confusion and forgetfulness, are not always directly linked to long-term cognitive decline, and many people may report finding relief from these symptoms during the post-menopause years. Still, it can be confusing and overwhelming to experience these symptoms in the first place, and their secondary effects on relationships or our sense of self can be more persistent if we do not have access to an adequate level of support.

Effects of menopause can also be more nuanced. Experiencing such significant changes in our bodies can also affect how we feel about ourselves, our relationships, or even life itself. This isn’t necessarily because hormone changes make us feel this way, but because living with these changes isn’t easy. For some people, physical symptoms of menopause can be more intense and frequent, and being in a constant state of managing physical discomfort can start becoming emotionally and mentally taxing, bringing about feelings of being out of control and helplessness. Similarly, having changes in one’s body, such as weight, hair, and skin, can also create additional stress and affect one’s body image and confidence.

Menopausal changes can also affect relationships and other activities because we might be feeling reduced levels of energy and fatigue from managing menopausal symptoms and can’t find the energy and motivation to connect with others or activities we used to love. Due to some of the symptoms that directly affect s-xual activities such as increased v-aginal discomfort and decreased s-xual drive, some people may feel as if their sense of intimacy or connection to their partner has been affected. Similarly, reproductive changes and the inability to conceive after menopause can bring a sense of grief or loss for people who may have had different hopes or goals around family and caregiving. Many people may also experience a greater sense of loneliness within their relationships if they feel that the changes they are going through are not fully understood or supported by those around them.

However, for many people, menopause is also a time when some of the changes can feel positive for some people. For example, some people may find it liberating to not experience menstruation. Similarly, while there might be increased vulnerability, some people may also feel better equipped to navigate these challenges because they feel more experienced in life overall.

Navigating disempowerment and systemic barriers during menopause

Menopause is often framed around loss, fertility, aging, and a stereotypical “aging woman” concept. However, menopause is not experienced in the same way by everyone, and these limiting narratives can create barriers in connecting with support and care.

Facing and sometimes also internalizing social expectations around youth and how one should look can bring a lot of shame or a sense of loss during menopausal changes, eventhough those perspectives are rather limiting and do not reflect our genuine capacity.  For example, research shows that across social media platforms, aging individuals are almost symbolically “annihilated” or underrepresented. Many people’s social media feeds are filled with vlogs and experiences from younger adults, which can make the physical and emotional experiences of later life feel less visible or “valid.” For someone going through menopause, this lack of representation may make it harder to see their experiences reflected. Similarly, the strong narratives on “being young”, looking a certain way, and maintaining a certain body image can add to the pressure some people feel about menopausal changes. 

Moreover, standard definitions and guidelines often describe cisgender women (and do so in a very narrow way, assuming they are cisgender, heterosexual, non-disabled, and more) and may not fully reflect the experiences of transgender, non-binary, and gender-diverse people. This can make it extremely challenging for some people to find adequate information or healthcare professionals who understand their experiences and needs. For example, in a study (Toze & Westwood, 2024), participants who identify as trans, gender non-conforming, and non-binary (TGNB) expressed that menopausal changes had certain effects on their identity experiences. Some reported that their understanding of their identities and their connection to their bodies had been affected, including how they express their identities. Significantly, many participants reported difficulty connecting with inclusive resources and health care options that would support their needs, and some have even refrained from seeking support altogether, believing it would add stress and challenges rather than help.

That is why support across the menopause transition should not only include temporary symptom management but also should include clear, evidence-based information about what to expect and challenge overly negative assumptions about menopause, gender, and aging to provide adequate and empowering care to people and support their overall wellbeing. 

How can therapy help?

Therapy can offer valuable support for changes that come with perimenopause and menopause. It can help us understand and build compassionate coping skills for more uncomfortable symptoms such as mood changes, irritability, anxiety, or feeling overwhelmed. It can help us challenge unhelpful thoughts around low self-esteem, body image, and uncertainty about identity. Support can also include cultivating meaning and compassion and developing appropriate adjustments to life changes. It can also help when relationships or intimacy change, or when increased stress leaves you feeling less emotionally resilient than before.

For example, Acceptance and Commitment Therapy (ACT) or existential therapies can help you explore your values and how you connect with meaning and purpose in life. They can help you reflect on who you are and what matters to you. Approaches like Cognitive Behavioral Therapy (CBT) can help you notice and challenge unhelpful patterns of thinking that may be contributing to anxiety, low mood, irritability, or reduced self-worth and self-esteem. Dialectical Behavior Therapy (DBT), meanwhile, can offer practical tools and skill-building for managing intense emotions, stress, and overwhelm, as well as navigating difficulties in relationships.

At the same time, a holistic approach is important. Emotional and psychological symptoms during perimenopause and menopause don’t always have a single explanation. As we noted above, menopausal changes may mimic a mental health condition or overlap with existing ones, or they may contribute to symptoms that feel entirely new. Understanding our experience can therefore benefit from working collaboratively with a GP, gynecologist or menopause specialist alongside a therapist. 

Therapy can help us reclaim menopause as a personally meaningful time of life, rather than seeing it solely through an overmedicalized or disempowering lens. It can help us make sense of what we are going through without necessarily letting it define or overshadow our sense of who we are.

Takeaways:

• Menopause is a transition through perimenopause, menopause, and postmenopause that marks the end of the menstrual cycle, where people may experience symptoms.
• Menopause can invite complex physical, emotional, and life changes, and can involve grief, loss, identity questions, shame, and a sense of overwhelm.
• Menopause can affect mental health through hormonal and neuroendocrine changes, while physical symptoms, body changes, relationships, intimacy, and reproductive changes can also affect wellbeing.
• Social expectations that we get exposed to around youth, aging, gender, and body image can create additional shame, disempowerment, and barriers to inclusive information and adequate care.
• Therapy can support us in developing a compassionate way to connect with ourselves, challenge unhelpful thoughts, navigate relationships and life changes, and help reclaim menopause as a personally meaningful and empowering stage of life.

References & further reading: 

• Amaral, I., & Flores, A. M. M. (2023). Challenging gendered and ageing normative stereotypes on Instagram. Ageism and Digital Technologies, London: Routledge, 152-71.
• Bachkangi, P. (2026). Menopause and mental health: Clinical evidence and public discourse. Menopause Review/Przegląd Menopauzalny, 25(1), 36–44. https://doi.org/10.5114/pm.2026.162164
• Conde, D. M., Verdade, R. C., Valadares, A. L. R., Mella, L. F. B., Pedro, A. O., & Costa-Paiva, L. (2021). Menopause and cognitive impairment: A narrative review of current knowledge. World Journal of Psychiatry, 11(8), 412–428. https://doi.org/10.5498/wjp.v11.i8.412
• Crockett, C., Lichtveld, G., Macdonald, R., et al. (2026). Menopause and mental health. Advances in Therapy, 43, 98–108. https://doi.org/10.1007/s12325-025-03427-w
• Hendriks, O., McIntyre, J. C., Rose, A. K., et al. (2025). Menopause and suicide: A systematic review. Women’s Health, 21. https://doi.org/10.1177/17455057251360517
• Hickey, M., LaCroix, A., Doust, J., et al. (2024). An empowerment model for managing menopause. The Lancet, 403, 947–957.
• Kleiber, M., Klincewicz, J., Klincewicz, J., Niedziela, N., Denisewicz, N., Fornalski, E., & Kujawińska, M. (2026). The role of physical activity in managing menopausal symptoms: A narrative review. Quality in Sport, 70, 74707. https://doi.org/10.12775/QS.2026.70.74707
• Shaver, J., & Woods, N. (2015). Sleep and menopause: A narrative review. Menopause, 22(8), 899–915. https://doi.org/10.1097/GME.0000000000000499
• Toze, M., & Westwood, S. (2024). Experiences of menopause among non-binary and trans people. International Journal of Transgender Health, 26(2), 447–458. https://doi.org/10.1080/26895269.2024.2389924
• Vincent, C., Bodnaruc, A. M., Prud’homme, D., Olson, V., & Giroux, I. (2023). Associations between menopause and body image: A systematic review. Women’s Health, 19. https://doi.org/10.1177/17455057231209536
• Wood, K., McCarthy, S., Pitt, H., Randle, M., & Thomas, S. L. (2025). Women’s experiences and expectations during the menopause transition: A systematic qualitative narrative review. Health Promotion International, 40(1), daaf005. https://doi.org/10.1093/heapro/daaf005

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At Roamers Therapy, our psychotherapists are here to support you through anxiety, depression, trauma, and relationship issues, race-ethnicity issues, LGBTQIA+ issues, ADHD, Autism, or any challenges you encounter. Our psychotherapists are trained in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Acceptance and Commitment Therapy, Person-Centered Therapy, and Gottman Therapy. 

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