Menopause and Mood Changes
The drop in estrogen and progesterone levels that comes with menopause can affect your mental as well as physical health, similar to what some people experience during PMS or their period.
How menopause can affect mental health
Dropping estrogen and progesterone levels can affect how much serotonin your body produces. Serotonin is a chemical made by the body that carries messages between nerve cells in your brain and the rest of your body, telling the body how to work. Serotonin helps control memory, mood, body temperature, sleep, sex drive, and hunger. Low serotonin levels are thought to play a role in depression and anxiety.
At the same time, the physical symptoms of menopause, including vaginal changes, hot flashes and insomnia, also can cause mood changes, anxiety, stress, depression, and even grief.
Mood swings
Menopause, as well as some breast cancer treatments, can cause your emotions to change frequently and sometimes dramatically — like feeling happy one minute and sad the next. Let your care team know if you're having mood swingsso they can help you manage them.
Grief vs. depression
If you find yourself grieving during menopause, be assured it’s normal. But it may be difficult to determine whether you’re experiencing normal grieving or clinical depression.
Both can cause sadness, loss of interest in what used to be pleasurable activities, and problems sleeping and eating.
Grieving is more of a process. You have these feelings, but you move through them. Depression tends to last longer and causes more intense feelings that have more of an effect on your day-to-day functioning.
Dr. Alan Wolfelt, founding director of the Center for Loss and Life Transition in Colorado, created a checklist to help people distinguish between grief and depression.
You have normal grief if you:
respond to comfort and support
are often openly angry
relate your depressed feeling to the loss experience
can still experience moments of enjoyment in life
exhibit feelings of sadness and emptiness
may have physical complaints that don’t last
express guilt over some specific aspects of the loss
feel a temporary loss of self-esteem
You may be clinically depressed if you:
do not accept support
are irritable and complain, but do not directly express anger
do not relate your feelings of depression to a particular life event
have an overwhelming sense of doom
project a sense of hopelessness and chronic emptiness
have ongoing physical complaints
have generalized feelings of guilt
feel a deep and ongoing loss of self-esteem
Treatments for menopausal mood changes
If you have symptoms of grief or depression that last for weeks with no sign of improvement, it’s important to talk to your doctor.
If you’re in breast cancer treatment while you’re going through menopause (or if breast cancer treatment is causing early menopause), your care team can figure out if one of your medications could be causing your symptoms and see if switching to a different treatment is possible.
Your doctor can also recommend treatments for other menopausal symptoms (like hot flashes). Managing these symptoms may help ease depression and grief.
You also may want to ask your doctor to refer you to an accredited mental health professional who has experience working with people going through menopause.
If you’re diagnosed with depression, combining treatments, such as counseling and antidepressant medicines, can be effective.
Therapy
There are many different types of therapy, but in general, most therapy sessions focus on helping you lessen distress, solve problems constructively, turn around negative thoughts, deal with emotional issues, and get support from family and friends.
Cognitive behavioral therapy (CBT) is a specific type of therapy that helps you identify, understand, and then change the negative thoughts you’re having, which in turn can improve your emotional health and ability to function.
Medicine
Antidepressant medicines work by balancing brain chemicals called neurotransmitters, which affect mood and emotions. Examples of neurotransmitters include serotonin, norepinephrine, and dopamine.
A psychiatrist or your doctor can work with you to figure out which medicine relieves the symptoms of depression with the fewest side effects. Many people need to try a few different types of medicine before their symptoms improve.
If you’re starting a new medicine to treat depression, it can take two weeks or more to feel the effects.
Common types of antidepressant medicines include:
SSRIs (selective serotonin reuptake inhibitors), such as Lexapro (chemical name: escitalopram), Celexa (chemical name: citalopram), and Zoloft (chemical name: sertraline)
SNRIs (serotonin norepinephrine reuptake inhibitors), such as Cymbalta (chemical name: duloxetine), Effexor XR (chemical name: venlafaxine), and Pristiq (desvenlafaxine)
Bupropion (brand name: Wellbutrin)
If you’re taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take. Some antidepressants — including Paxil, Wellbutrin, Prozac, Cymbalta, and Zoloft — may interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. Learn more about medicines to avoid while taking tamoxifen.
Diet and exercise
What you eat plays a huge role in how you feel. In fact, diet is such an important part of mental health that there is a field of medicine called nutritional psychiatry. Your brain functions its best when you eat a high-quality, healthy, and balanced diet. Eating a lot of processed foods and refined sugar can cause inflammation. Studies suggest this can affect brain function and may make any symptoms of depression worse.
A 2017 study found that “A dietary pattern characterized by a high intakes of fruit, vegetables, whole grain, fish, olive oil, low-fat dairy, and antioxidants — and low intakes of animal foods — was apparently associated with a decreased risk of depression. A dietary pattern characterized by a high consumption of red and/or processed meat, refined grains, sweets, high-fat dairy products, butter, potatoes, and high-fat gravy, and low intakes of fruits and vegetables is associated with an increased risk of depression.”
Exercise can also help boost your mood. Exercising causes a chain of events in the body that offers a number of health benefits, including improving sleep and lowering blood pressure. Exercise also makes your body release proteins that make nerve cells grow and make new connections, including the nerve cells in your brain. These new nerve connections can help your brain function better, which makes you feel better.
As with most treatments for depression, it takes time for changes in your diet and your physical activity to help you feel better. Still, many doctors say if you exercise regularly and eat healthy, you should start to feel some improvement in a few weeks.
Dietary patterns and depression risk: A meta-analysis. Li, Y. Psychiatry Research. July 2017. Available at: https://doi.org/10.1016/j.psychres.2017.04.020
Smauthpongtorn, C., et al. Consumption of Ultraprocessed Food and Risk of Depression, JAMA Network Open, Sept. 20, 2023. Available at: https://jamanetwork.com/article.aspx?doi=10.1001/jamanetworkopen.2023.34770 or https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809727
