perimenopause and mental health: it’s not just ‘in your head’
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during perimenopause, estrogen regulation takes a serious hit, rising to incredibly high levels before taking deep dives into severely low territory, making it just as unpredictable.
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perimenopause and menopause are physical changes that can cause many symptoms—hot flashes, night sweats, irregular periods, just to name a few. however, when the hormonal shifts occur, it affects a lot more than just physical health. there is a significant mental health aspect that goes along with the transitional period—an aspect that is long overdue for more widespread discussion.
“we’re actually learning more about the brain, more about the receptors, also related to hormones. so we do have estrogen, progesterone, receptors in our brains that are actually changing,” said linda franco, registered nurse and director of patient care at coral, a canadian virtual clinic offering services to women who are in midlife.
the mental health symptoms associated with perimenopause, such as increases in feelings of anxiety, depression, or even making people feel as if they don’t recognize themselves, have always been there, but “just now, people are realizing that it’s not in your head.”
“it’s not something made-up, and it’s not because of all the things that are going on in your life,” said franco. “there’s a true connection at work [between hormones and mental health].”
how hormones affect mental health during perimenopause
when women reach the stage of perimenopause, their hormones go a bit haywire. they’re up, they’re down, they’re all over the place in a way that’s not akin to what women are used to.
the two most notable hormones during this period are progesterone and estrogen, which are female reproductive hormones. progesterone is a steroid hormone produced in the ovaries, and in the brain, it is converted into allopregnanolone, a neurosteroid that promotes feelings of calm. every month during the ovulation period of a woman’s cycle, this hormone is converted in women with regulated hormones. but that changes in perimenopause.
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“when we hit perimenopause, it starts to fluctuate, and so ovulation becomes unpredictable and even then, we ovulate, and then another month we don’t ovulate, and so it becomes unreliable as well. this hormone conversion is not happening as it should,” said franco. “so, when that happens, it’s like we don’t get our natural prescription of anti-anxiety medication.”
that’s just one hormone. estrogen is also changing and shifting during perimenopause, too, fluctuating even more so than progesterone.
“estrogen is mostly related to the control centre of your emotions, how you’re able to control your emotions, but it also helps with memory, it helps with concentration and focus,” said franco.
during perimenopause, estrogen regulation takes a serious hit, rising to incredibly high levels before taking deep dives into severely low territory, making it just as unpredictable. during the menstrual cycle, your body is typically already equipped to cope with the changes, with both your body and brain helping stabilize your mood. but when perimenopause hits, the body has to find other ways to deal.
“it tries to compensate [for the loss of estrogen],” said franco. “so, it creates this other pathway to try and create other changes in your receptors to be able to cope with that mechanism, but it doesn’t work as well. it’s like if you have a thermostat in your house and it doesn’t read the temperature correctly. so, sometimes it works well, sometimes it doesn’t, and that’s why we hear a lot of patients going through perimenopause say, ‘it’s weird, because one week i feel great, i feel the most amazing, and then the next week i feel awful. i can’t get out of bed. i don’t recognize myself.’”
because it fluctuates so much, keeping up with those changes at a physiological level is a serious challenge.
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living with manageable changes without support
since women’s health issues have been understudied for centuries and women are often dismissed in health-care settings, many have learned that it’s just a part of life. you deal with it the best way you can and accept defeat.
the continued damaging rhetoric not only keeps providers on the sidelines of care, but also ensures women squelch their symptoms as normal and inevitable. women often attribute the changing symptoms to life events or stressors as well, completely unaware that there is something biological going on beneath the surface that can actually be addressed.
“they think, ‘oh, well. it’s normal. i haven’t slept a lot because i’ve been working on this project for work,’” said franco. “it’s self-normalizing basically, and the things that we hear from maybe friends or family or partners that can say, ‘well, you know, you’re not eating well. so, probably if you ate better, you wouldn’t experience all these symptoms.”
because it has become commonplace to dismiss the symptoms as normal or related to other aspects of life, whether by the health-care system or internally, the root cause is completely ignored.
“it’s like this wheel that doesn’t stop,” said franco. “so, we keep turning on who is going to sit down and really ask those root analysis questions … it’s easy to say i’m stressed or i’m anxious, but then going toward the root cause. when does this happen? can you relate it to an event? you start realizing that there’s no reason. your life hasn’t changed. your work hasn’t changed and it’s really related to the biological shift.”
managing mental health changes in perimenopause
while perimenopause is unavoidable, there are ways to manage it that allow women to improve their quality of life. and it’s “not just with meditating or going for a walk, which does help, but it is biologically a change.”
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the first is acknowledging that these changes are very real and breaking free from the conditioning that has made women second-guess themselves so easily.
“if i feel like i’m the one to blame because of my symptoms, i probably won’t talk about it with my partner, and if i don’t talk about it with my partner, my partner will probably attribute my behaviour to maybe you’re overworked, or maybe you’re not exercising enough, or you’re not eating well enough,” said franco. “we’re not looking for the solution inwards, and that’s where we find that the solution is really understanding what’s going on with our body.”
that all starts with education, says franco.
“you should see the light in the eyes [when people are finally told what’s going on with their hormones],” she said. “it’s like, ‘oh, okay. so, there is a change. it is valid. it is biological.”
but knowing what’s going on and seeking help are two entirely different things, because understanding the change is only as good as the care available.
“when you’re seeing a patient or when you’re going to see a mental health therapist,
you want a plan. you want to know exactly what is this providing for me? what are the next steps? if you come out of a consultation and you don’t know what the benefits were, you don’t understand where you stand, you don’t have a little bit more clarity on the symptoms that you’re experiencing. i think that’s the care that we don’t want to provide,” said franco.
you want a plan. you want to know exactly what is this providing for me? what are the next steps? if you come out of a consultation and you don’t know what the benefits were, you don’t understand where you stand, you don’t have a little bit more clarity on the symptoms that you’re experiencing. i think that’s the care that we don’t want to provide,” said franco.
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