How can menopause impact your mental wellbeing?

Clinical neuropsychologist Dr Nicola Gates explains the brain-hormone connection, and how to feel better during menopause.

Written by Dr Nicola Gates

When I was writing my first book, A Brain for Life, which is about dementia prevention, many women around menopause age asked me to help them with their menopause brain fog. Others reported changes to their emotional equilibrium and psychological health.

It struck me that there was not enough information available about all the changes women undergo through menopause. There is information about the common physical symptoms like hot flushes and disturbed sleep, but in contrast very little on the brain and mind changes – especially how the reduction of oestrogen impacts cognitive function and psychological wellbeing.

Once I had embarked on writing my new book, The Feel Good Guide to Menopause, my life took a random turn. I was plunged into medical menopause, first with pharmacological treatment and then through surgery due to diagnosis of oestrogen driven cancer. All my research and suggested management strategies became personally very relevant.

What is the 'brain-hormone connection'?

We have a lot of hormones, and people often correctly identify the sex hormones and understand how they impact upon puberty, sexual reproduction and fertility. However, they do not necessarily understand that hormones also impact the brain, emotions and behaviour.

The brain communicates with the body (and vice versa) through hormones, which allows us to function and behave as necessary for survival. A simple example is how women can become ‘clucky’ when they are fertile or begin ‘nesting’ prior to the birth of their baby – hormones are influencing their behaviour.

The menopause transition takes women from being fertile for sexual reproduction to being non-fertile. It is the opposite of puberty, so the sex hormones oestrogen, progesterone and testosterone all decline. It is important for women to understand what is happening, as their body, brain, behaviour and emotions adjust to a different, less potent form of oestrogen than that produced by the ovaries.

Some changes mean women develop increased risks for cardiovascular disease like stroke and cardiac arrest, or osteoporosis. Other changes include collagen loss, increased wrinkles, dry skin, hair loss and weight gain, and other changes that impact emotions, connectedness to others and the brain.

How can menopause can impact the brain and mental wellbeing?

Oestrogen is a crucial hormone for many body systems and processes – that is why men have some oestrogen too. Menopause results in a decline in available oestrogen in the brain, and this has a direct impact on memory formation.

It also impacts other neurotransmitters and hormones, which can influence our stress levels, sleep, motivation, sense of trust and bonding and mood. Progesterone loss during menopause also impacts our emotions and mood, as it has had a calming effect.

For some women, menopause is also very challenging emotionally. They may have beliefs about menopause that are unhelpful to them, which usually revolve around age and becoming an older woman. This is not entirely surprising given the historical portrayal of older women in society, but as a result menopause can mess with women’s self-view and confidence in a very unsupportive way.

What can women do to manage the effects of menopause?

The best suggestion I have after decades of working with people is to encourage women to make themselves a priority, to quieten down any negative self-criticism or judgement, and become accepting.

What we think can have a huge impact on our experience. Studies demonstrate that women who hold critical and negative beliefs about menopause have a poorer menopause experience than women who think about menopause in a neutral or positive way. Accepting menopause as a natural process that ends is a good start.

Menopause is a great point to take stock of general health and lifestyle. Making necessary changes to be fit and healthy may help decrease menopause symptoms, and will also support health going forwards into late life.

Other strategies are to address each menopause symptom that has a negative impact. If sleep is an issue, for example, address this by developing good sleep hygiene, reducing stimulants like caffeine and alcohol, exercising to make the body tired and trying meditation to calm the mind.

If hot flushes are a problem, consider the clothes you wear so you can peel off layers, or wear clothes without waistbands and belts, control the environmental temperature, try to manage stress, reduce stimulants that raise body temperature, and eat a healthy, nutritious diet. Perhaps consider meditation to relax and ride through hot flushes rather than tensing or stressing.

MORE: What can help with menopause symptoms?

In your book you write: "Menopause will liberate you from cycling sex hormones and herald the start of your third life." Can you expand on this idea?

Menopause signifies the end of fertility and reproduction, which means the daily changes in hormones that have supported the monthly menstrual cycle have gone. Women then develop a stable base of hormones and are no longer under the influence of those changing hormones.

I use the term third life because the average age of menopause is 51, which is considered midlife. The reproductive years are over. The hormones that make many women compulsive carers – of children, pets, parents and others – have diminished. This gives women the time and space to care for themselves, to chart their own course. They can grow again as individuals or redirect their energy and passion into new areas of life and living.

The Feel Good Guide to Menopause by Dr Nicola Gates is published by ABC Books and is available now, RRP $32.99.

Written by Dr Nicola Gates

Dr Nicola Gates is a leading clinical neuropsychologist. She is the author of the popular book A Brain for Life and the new release, The Feel Good Guide to Menopause.

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