Menopause and Mental Health (for Men to read too!)
Menopause is inevitable, but suffering is not. Often Women believe they are having mental health and identity concerns, and after working with them holistically, it is clear that menopause is playing a large role. Sometimes it is a huge relief to realise this is natural, but it often feels far from natural.
For the most part, Women have been suffering in silence and there is a hesitation to speak publicly about the effects of menopause. Perhaps this is because Women may already feel judged – whether you have children or not; breaks in career due to childbearing and caring; the stress from juggling multiple roles with multi generations all intersecting at once. The concern is that if ‘female issues’ are mentioned in workplaces, that may be another reason to not promote or provide equal pay. It is no wonder we don’t want to add to the narrative that menopause can be a challenging phase of life, and as a result, there is silence, misinformation and a lack of research into an inevitable issue that Women experience. I agree with Dr Mary Claire Haver when she points out how different it would be in regard to research and solutions, if at 51 men’s testicles shriveled up! (Haver, 2023). Shame and stigma around fertility status and aging, and silence about hormones over the generations must stop here.
The Facts
The average age for menopause is 51 (45-53 range). Menopause is defined when there has been no period for one year; perimenopause starts when estrogen levels start to drop and fluctuate and this can happen 7-10 years earlier (testosterone and progesterone and changes between the relationship between these three hormones also contributes). Medically induced menopause can occur at any stage. This can happen as a result of medical interventions and treatments like chemotherapy, radiation, or surgical removal of the ovaries (oophorectomy), often performed to treat cancers or other conditions affecting the reproductive system. It leads to a sudden onset of menopausal symptoms and can be immediate and more intense due to its rapid onset.
From a physiological perspective conditions that are related include frozen shoulder, carpel tunnel, hot flashes, fatigue, weight gain, aches and pains, loss of muscle mass, headache and migraine, skin changes, sleep changes, increased sweating, gut health, genital-urinary changes such as UTI, continence, vaginal tissue and lubrication changes, libido changes, chronic inflammation, insulin sensitivity (leading to weight gain, particularly belly fat and/or metabolic syndrome). If you have had Polycystic Ovarian Syndrome (PCOS), fibroids, heavy bleeding and/or clotting, or endometriosis, this could further increase symptoms.
From a cognitive and psychological perspective, a range of symptoms include mood swings, anger, depression, anxiety, panic attacks and specific phobias like agoraphobia and claustrophobia. Menopause can amplify the symptoms of grief and loss, Bipolar, ADHD, especially Premenstrual Dysphoric Disorder, Borderline Personality Disorder, Major Depressive Disorder and Generalised Anxiety Disorder. Cognitively, brain fog can feel dementia-like according to Dr Lisa Mosconi, a neuroscientist who studies the female brain pre, peri and post menopause (Mosconi,2023). It can feel like you are forgetful or ‘dropping the ball’ or not functioning like you’re used to. This in turn can amplify anxiety or depression and also lead to high fatigue and/or sense of wired hyper-vigilance because you’re aware that something is different. Aspects of identity can arise as a result of not feeling like yourself.
From a relational perspective (work, family and friends) often there is a strain or noticeable changes in demeanor such as higher levels of sensitivity or less tolerance or unwillingness to keep over-functioning in many arenas of life. Menopause affects divorce rates, career change and other life transitions, especially when it coincides with having adolescents, emptying of the nest and aging parents. Saying “NO”, putting boundaries in place, being unwilling or unable to perform at relentless levels and requiring more support to get the same amount of workload done tends to put a strain on marital, family and work systems. In Women’s defense, perhaps the systems needed re-adjusting anyway and menopause is the line in the sand that says “enough”.
That’s a LOT! What can help?
Given we are living longer, what medical, lifestyle, nutritional and ‘bio-hacking’ can we do to ease the transition?
I work from an integrative perspective looking at the bio, psycho, social and spiritual dimensions of self and work with a network of other practitioners across disciplines, so here is a comprehensive overview of considerations to explore in managing menopause.
Nutritional Support
Nutrition is important, not only from a physiological perspective to manage overall health, but also from a psychological perspective because ‘mood foods’ and ‘nootrients’ are important for our gut microbiome. Scientific research is emerging to understand the brain-gut axis in more depth.
Some general guidelines include:
- eating good fats from avocado, nuts, seeds and omega 3s from oily fish and avoiding trans fats and overly processed fats such as hydrogenated plant oils like palm oil;
- eating the full colour spectrum of vegetables (2 cups a day consisting of 5 vegies and 2 fruits) and around 30 different plants over a week.
- eating both soluble and insoluble fibre. The gut microbiome needs fibre as a prebiotic to selectively stimulate the growth or activity of gut bacteria, which in turn interact with our neurotransmitter receptors (e.g serotonin and GABA). In other words, we can regulate neurotransmitters through nutrition. Aim for 25g+ of fibre from a wide variety of veggies, fruit and wholegrain foods. You can also supplement with a couple of tablespoons of psyllium husks in water or smoothies to increase fiber. Foods like hummus also are great for adding fibre and helping the gut microbiome.
- the mediterranean diet suits many people. Also consider higher protein (min 1.2 gram per 1 kg of body weight), low sugar and refined carbohydrate, managed caffeine, limit alcohol, quit smoking, at least 2 litres of water a day (with electrolytes if you sweat a lot).
- supplementation is often needed even if your diet is top notch. Extra targeted supplementation can include vitamin D, Iron bisgylcinate, Activated/Methylated B complex (this form is important for people with methylation issues), calcium, Omega 3’s and Evening Primrose oil. Magnesium glycinate and Melatonin can help with sleep disturbance.
- Studies show that women with methylation issues often experience imbalances in hormone metabolism, contributing to menopausal symptoms like mood swings, fatigue, and cardiovascular risks. Proper methylation, supported by activated B vitamins, helps regulate homocysteine levels and aids in the synthesis of hormones, including estrogen and progesterone, which are crucial during menopause. (Driftless Integrative Psychiatry, 2024; Rupa Health, n.d.; Today’s Practitioner, 2023)
- Inositol, particularly Myo-inositol, has shown significant benefits for insulin resistance, weight loss, mood regulation, and PCOS support in perimenopausal women (Monastra et al., 2022; Unfer et al., 2020 and (Mainini et al., 2024). Furthermore, it has been found to reduce anxiety and depression symptoms by regulating neurotransmitters like serotonin (Rupa Health, 2023).
Exercise
Many women try to exercise harder, especially if they notice more belly fat or ‘middle aged spread’. This can put your already stressed body under more stress and cause cortisol imbalance. Consistently highly elevated cortisol or cortisol surges at the wrong time of day and out of rhythm can signal the nervous system to go into protection mode because it thinks it’s in danger. This signals “reserve energy” (and possibly fat) and if you keep driving yourself it can be counter productive. Whilst there is good evidence for HIIT style workouts, if you’re already feeling a lot of fatigue, you might be better to do gentler cardio, yoga, Pilates, walking, and aqua exercise to manage cortisol. It’s important to listen to your body and not push yourself when it’s telling you it’s exhausted. Some movement is better than nothing – nourishing not punishing is the key. That said, weight training is especially important to maintain muscle mass which declines as we age, but you can approach this at a slow and strong steady pace. Ideally aim for at least two sessions a week and lighter movement on other days with at least one rest day. Consider supplementing creatine to assist with muscle maintenance and Berberine and/or inositol can assist some people with belly fat by assisting to address insulin resistance
Sleep, Rest and Calming
Sleep and calm are also important for overall health and cortisol lowering. This may require putting boundaries in place (like not being available all the time, saying No, stopping over-functioning…) and intentionally carving out time for self-care. High cortisol contributes to anxiety, panic attacks, chronic fatigue and brain fog. Interventions like mindfulness, guided meditation, breath work, and vagus nerve massage are not just trendy movements – there is scientific evidence. Read my three articles on mindfulness to get an overview
These interventions can assist to down-regulate your nervous system and manage cortisol levels.
Sleep is particularly difficult when there are night sweats, insomnia or the dreaded 3am wake up due to ‘cortisol dumping’ linked to estrogen fluctuation. There are a number of tweaks you can do to manage sleep and a really good ‘tool kit’ has been developed by Dr Andrew Huberman. You can find it here.
Supplements such as melatonin, valerian, passionflower, magnesium and l-theanine may assist (L Theanine can cause vivid dreaming in some people). If you take progesterone, it is helpful for sleep at night too.
On a spiritual level, if you have a faith-based system of belief, making the shift midlife from a human doing to a human being is the invitation for the second part of life. This involves intentionality in finding your worth and identity in faith, beliefs, values and deeper meaning rather than output and achievement. Your spirituality can help reframe your expectations and sense of worth. Perhaps explore your collective wisdom and all that you are and have learned, and not your churn rate and ‘works based’ doctrine. I love the book ‘Falling Upwards’ by Richard Rohr if you’re into spiritual existential exploration.
A word on Hormone Replacement Therapy and pathology…
Beyond all of these lifestyle changes, if you’re still struggling, you can then consider Hormone Replacement Therapy (HRT) or Bioidentical Hormone Replacement Therapy (BHRT). But wait…. Wasn’t there a study that indicated that HRT causes Breast Cancer…..?
Let’s take a look at this. The Women’s Health Initiative (WHI) study in the late 1990s (Writing Group for the Women’s Health Initiative Investigators, 2002) initially reported that hormone replacement therapy (HRT) increased risks of breast cancer, heart disease, and stroke, causing widespread fear among women considering HRT for menopause. However, the study had key flaws: it included older women who had been postmenopausal for many years and may already have had these health issues; used specific hormone types not representative of all HRT options; and did not account for the benefits observed, like reduced fractures and prevention of some conditions. Subsequent analyses have shown that the risks and benefits of HRT vary depending on a woman’s age and health status as is the case with any medication or supplement. (Manson & Kaunitz, 2016).
For women considering HRT, it’s important to consult a healthcare provider to weigh personalized benefits and risks, rather than relying solely on the initial WHI findings.
HRT can include creams, pills, troches and patches and varying amounts of different types of estrogen, progesterone, testosterone and sometimes DHEA in forms that are tailored for you. In a recent interview with Dr Lisa Masconi, she instills hope showing that estrogen plays a critical role in maintaining cognitive function, protecting the brain against neurodegenerative diseases like Alzheimer’s, and supporting mental well-being (Masconi, 2023).
Dr Mary Claire Haver advocates HRT and lifestyle changes. Advocacy and conversation focusses on prevention of diabetes, cardiovascular disease, dementia, bone density and more, as well as increase the psychological wellbeing of Women. It is clear prevention is better than cure and it is pointing to starting this in perimenopause rather than waiting too long after menopause.
It is a good idea to get blood work in your 30’s and 40’s to establish benchmarks (preferably day 2 of your period and with the same pathology lab over the years). It is also good to get pathology on the full thyroid panel (many of the same symptoms and can be concurrent), and nutrients such as iron, calcium, Vitamin D, cholesterol. From a sex hormone perspective you’ll be wanting E1, E2, progesterone, testosterone, SGBH, perhaps DHEA. From a mental health perspective and to get a read on methylation status, it can be advisable to test histamine and homocysteine, B12 and Active B12, Active B6 and active Folate. Methylation plays a role in mental health and hormone regulation.
I refer to GPs and naturopaths who are willing to work together with my client and myself (if consent provided) to offer a ’wrap around’ approach. Whilst my area is mental health, I do professional development, networking, and my own research to understand wider biological and physiological drivers that may be impacting someone’s mental state and wellbeing.
Conclusion
It’s important not to make drastic decisions while feeling menopausal dysregulation. Many relationships have ended; jobs or businesses have been thrown in and major life decisions made due to this time of upheaval. Sometimes that is a good thing, but sometimes it can cause things to seem worse than they are and the fall-out creates more negative consequences. Having someone objective to weigh things up and taking into account all things, is important. Menopausal transition can be an opportunity to work through issues that have been suppressed over a lifetime but can no longer be contained, providing an invitation to process and manage the upheaval and turn it around for good. It is a ‘change of life’ but maybe a life freed from over-functioning, just existing or surviving. As hormones catapult you into an undeniable time to have to deal with things, you can build the capacity to face things and look at things from other perspectives. This change can be a long-term gift that can make the path for the future very different.
Here are some great episodes on the Diary of CEO and I encourage you to watch these to educate yourself. I want to encourage you to embrace this ‘rite of passage’, but not just struggle through or invalidate it as something you have to just get through. Empower yourself with information, self-advocacy, self-care and seek the help from the range of specialists who will come alongside with tailored biological and psychological interventions and be on your team!
Episodes
The No.1 Menopause Doctor: They’re Lying To You About Menopause! Mary Claire Haver
The Menopause Doctor: This Diet Delays Menopause! Menopause Is Shrinking Your Brain! Dr Lisa Mosconi
Disclaimer
I am not a medical or nutritional professional. The above information is from my own research and what works for me and members of my family; client self-reports and discussions with other allied health professionals. As individuals, each person requires a tailored protocol. You are encouraged to do your own research to draw your own conclusions. It is also recommended that you seek specialised medical advice from a GP and /or clinical nutritionist or naturopath who specialises in female hormones and mood biochemistry. Even under direct guidance from healthcare professionals, individual requirements need to be tailored and responses are not guaranteed and should be monitored.
References
Haver, M. C. (2023, May 18). The No. 1 menopause doctor: They’re lying to you about menopause! [Video]. YouTube. In Diary of a CEO.
Mosconi, L. (2023, July 3). The Menopause Doctor: This Diet Delays Menopause! Menopause Is Shrinking Your Brain! [Video]. YouTube. In Diary of a CEO. https://www.youtube.com/watch?v=Cgo2mD4Pc54
https://www.youtube.com/watch?v=oQqcnYcKx68
Driftless Integrative Psychiatry. (2024). Regular vs. methylated B complex: A practical guide. Driftless Integrative Psychiatry. https://www.driftlessintegrativepsychiatry.com/post/regular-vs-methylated-b-complex-a-practical-guide
Rupa Health. (n.d.). The role of B vitamins in methylation processes: Clinical applications and dosage guidelines. Rupa Health. https://www.rupahealth.com/post/the-role-of-b-vitamins-in-methylation-processes-clinical-applications-and-dosage-guidelines
Today’s Practitioner. (2023). Demystifying methylation: Patterns, processes, and the pivotal role of B vitamins. Today’s Practitioner. https://todayspractitioner.com/nutritional-medicine/demystifying-methylation-patterns-processes-and-the-pivotal-role-of-b-vitamins/
Unfer, V., Facchinetti, F., Orru, B., Giordani, B., & Nestler, J. (2020). Myo-inositol effects in women with PCOS: A meta-analysis of randomized controlled trials. Journal of Clinical Endocrinology & Metabolism, 105(12), 01-07. https://doi.org/10.1210/clinem/dgaa610
Mainini, G., Ercolano, S., De Simone, R., Iavarone, I., Lizza, R., & Passaro, M. (2024). Dietary supplementation of myo-inositol, cocoa polyphenols, and soy isoflavones improves vasomotor symptoms and metabolic profile in menopausal women with metabolic syndrome: A retrospective clinical study. Medicina, 60(4), 598. https://doi.org/10.3390/medicina60040598
Rupa Health. (2023). Do you know about inositol? Learn the 6 evidence-based uses for this powerful nutrient. Rupa Health. Retrieved from https://www.rupahealth.com
Writing Group for the Women’s Health Initiative Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. JAMA, 288(3), 321-333. https://doi.org/10.1001/jama.288.3.321
Manson, J. E., & Kaunitz, A. M. (2016). Menopause management—getting clinical care back on track. New England Journal of Medicine, 374(9), 803-806. https://doi.org/10.1056/NEJMp1508967
