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Menopause and Mental Health

Contributor Hadine Joffe, MD
8 minute read
Two older women laughing and hugging each other.

Many people are familiar with the infamous hot flashes associated with menopause. Perhaps you’ve also heard that menopausal women often experience difficulty sleeping, dry skin, decreased sex drive, or other symptoms. Now new research has shown that hormonal changes during menopause also can affect mood and mental health.

“Menopause and mental health can be intertwined in many ways, and mild mood disturbances are a common symptom of the menopause transition,” says Hadine Joffe, MD, a Mass General Brigham psychiatrist and women’s mental health specialist. Dr. Joffe is interim chair of the Department of Psychiatry at Brigham and Women’s Hospital and executive director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology. “But other symptoms that occur in menopause can appear to be mental health symptoms. So it can be hard to tell if something you’re experiencing is related to menopause or to a mental health episode such as anxiety or depression,” she adds.

Dr. Joffe wants women to understand that mood-related symptoms during menopause aren’t guaranteed. If you do have them, they’ll likely be mild. Along with your healthcare providers, you can take steps to manage them.

“Women should be more attentive and vigilant about taking care of themselves at this critical stage of life,” says Dr. Joffe. “We want women to feel like they have the knowledge and information to do the things they need to do to care for themselves and navigate this life transition without feeling like it’s overwhelming. They will get through it.”

Menopause and mood disturbances

Dr. Joffe treats women experiencing menopausal symptoms and conducts research into the relationships between menopause and mental health. In 2019, she published a study in the Journal of Clinical Endocrinology & Metabolism that linked increased mood disturbances during perimenopause with hormone fluctuations. These symptoms may include:

  • Feelings of anxiousness

  • Forgetfulness, low concentration, or “brain fog”

  • Irritability

  • Loss of confidence or self-esteem

  • Low energy levels

  • Sadness or moodiness

In 2024, she published a study in Lancet examining hormonal imbalance and depression. The research showed that certain characteristics can make women more vulnerable to mood-related symptoms during menopause:

  • Longer perimenopause (the period of transition from menstruation to menopause, which can last several months to many years)

  • Sleep disturbances, which may be related to night sweats

  • Stressful life events

  • Vasomotor symptoms, otherwise known as hot flashes or night sweats

“Sometimes the physical symptoms of menopause can lead to stress and fatigue, and those feelings can intensify emotions and affect mood,” Dr. Joffe explains. “For example, somebody may have a hot flash and feel stressed and physically uncomfortable. That can feel like an anxious spell. In addition, sleep problems, which are common in the menopause transition, can be connected to mood or anxiety problems.”

It’s very unusual for a person to have their first ever episode of depression when they hit midlife and perimenopause. For women who experience major depression, there’s almost always a history of mental health problems, such as a history of anxiety or depression or a lot of sleep disturbances.

Hadine Joffe, MD
Psychiatrist and Women’s Mental Health Specialist
Mass General Brigham

Menopause and major depression

Dr. Joffe emphasizes that most women don’t experience an episode of major depression during menopause. Those who do usually had depressive episodes in the past.

“It’s very unusual for a person to have their first ever episode of depression when they hit midlife and perimenopause,” Dr. Joffe explains. “For women who experience major depression, there’s almost always a history of mental health problems, such as a history of anxiety or depression or a lot of sleep disturbances.”

Signs and symptoms of clinical depression may include:

  • Being irritable or sad most of the time, or crying a lot

  • Feeling hopeless, worthless, empty, helpless, or numb

  • Feeling aches or pains with no clear cause

  • Having trouble making decisions

  • Losing interest in things you used to enjoy

  • Losing your appetite or losing weight for no apparent reason

  • Not wanting to live any longer or thinking about suicide

You may consider taking a menopausal depression test, such as the Patient Health Questionnaire (also called the PHQ-8), a survey that assesses depressive symptoms.

If you’re in the United States and experiencing signs of major depression, contact your doctor or the Suicide and Crisis Lifeline at 988 (call or text). You can also call 911 or visit the nearest emergency department.

Menopause and anxiety

A direct connection between menopause and anxiety is less clear. Some research shows that women are more likely to experience anxiety or panic attacks during menopause. However, Dr. Joffe points out that hot flashes and panic attacks have several common symptoms:

Hot flashes do not cause a shortness of breath. Trouble breathing is linked with panic attacks, but not hot flashes.

Importantly, perimenopause and menopause occur during a time in a woman’s life that can be stressful for many other reasons. Women are often working at high-pressure jobs with substantial responsibilities, raising kids, sending older children to college, and caring for aging parents. This can make it seem like menopause and anxiety attacks are related.

“The responsibilities in midlife are substantial. There are a lot of expectations. It’s a pleasure and a privilege to have people in your life who depend on you. But it also takes a toll,” Dr. Joffe says. “Women need to find ways to spread responsibilities out wherever they can, and they should make sure they have a network of people to depend on and talk to. Because if you’re not strong and stable, then you’re not in as robust a place to take care of everything on your plate.”

How to take care of yourself during menopause

Dr. Joffe encourages women to be proactive about menopause and mental health with the following strategies:

  • Manage stress: Activities that might help include connecting with others, meditating, practicing yoga, listening to and playing music, writing in a journal, or getting a massage.

  • Monitor your own mood: Take notes on mood changes and anything that may have affected your mood, such as sleep or stress. Ask people close to you whether they’ve noticed changes in your mood, because you may not be able to tell.

  • Pay attention to lifestyle habits: Certain lifestyle factors can improve or worsen mood. Eat a healthy diet, get regular exercise, and quit smoking.

  • Practice good sleep hygiene: For better sleep, go to bed at the same time each night and wake up at the same time every morning. Make sure your bedroom is quiet, dark, and relaxing. Avoid caffeine, large meals, and screens before bedtime. Be sure to get enough sleep and try to minimize awakening in the middle of the night.

  • Reach out to others: You don’t have to go through this alone. Talk to friends, family members, people in the community, religious or other community supports, or online forums. Delegate responsibility when you can.

  • Seek medical or mental health attention: If symptoms are interfering with your daily life, talk to a health care provider or mental health specialist. There are medications and behavioral interventions that can help.

“A lot of women just accept that menopause symptoms are a part of life — feeling poorly, not sleeping, never being refreshed. But you don’t have to accept that you have to suffer. You wouldn’t want to hop around in pain all day long. And you wouldn’t want other people in your life to endure really distressing thoughts, emotions, or sleep habits,” Dr. Joffe says. “So talk to people, take good care of yourself, and seek treatment when you need it. You really deserve it. And other people in your life would say the same thing.”

Hadine Joffe, MD


Psychiatrist and Women’s Health Specialist