Embracing Change: A Guide to Mental Wellbeing in Menopause

Menopause marks a significant life transition that extends far beyond the physical changes that you have heard about. While the end of menstruation often is the focus, the mental health impacts of this process often go unaddressed, leaving many feeling unprepared for the emotional and cognitive shifts that accompany changing hormone levels

Your Brain on Changing Hormones

The reality is that menopause affects far more than just your reproductive system. As estrogen and progesterone levels fluctuate and eventually decline, your brain chemistry shifts alongside these changes. This biological process can influence how you may feel about yourself, your relationships, and various aspects of your daily life, including your sex life. Very few people navigate menopause without experiencing some symptoms. Most experience mild-to-moderate symptoms, while some may face more serious ones. What is crucial to remember is that your experience is uniquely yours, both in terms of which symptoms you experience, how intense and duration. While hot flashes and night sweats (called vasomotor symptoms) are the most recognizable symptoms, often underrecognized are feelings of anxiety or depression that can be overlooked because they can have so many other causes and contributions, such as life stressors. These emotional changes can be one of the earliest signs of hormonal changes. While these symptoms can feel overwhelming, we’re here to help.

When Anxiety Becomes Your Uninvited Companion

What's happening to your body: Many people experience heightened anxiety during perimenopause and menopause, even if they've never struggled with it before. This isn't simply stress about aging or life changes — it's your brain responding to hormonal fluctuations affecting neurotransmitters like serotonin, GABA, dopamine, and others in the brain.

What you might notice:

• Heart racing over things that never bothered you before
• A persistent feeling of waiting for something bad to happen
• Panic attacks that seem to come out of nowhere
• Difficulty falling or staying asleep, or early morning awakenings (which can intensify other symptoms)

The mind-body connection in menopause is a feedback loop too - physical symptoms - like hot flashes, sleep problems, and body aches - can affect your mental health, and anxiety and depression can worsen physical symptoms. For example, poor sleep from night sweats can lead to stress, anxiety, or low mood creating a cycle that affects your overall well-being. Recognizing this connection can help us work together to find strategies that support both your physical wellbeing and emotional health during the menopause transition.

Navigating the Emotional Ups and Downs

Mood changes during menopause can make you feel like you’re on an emotional rollercoaster that you never chose to ride. These aren't simply "bad days"—they're intense emotional shifts that can happen rapidly and unpredictably. You might find yourself unexpectedly tearful over a commercial, feeling irritated by small things that normally wouldn’t bother you, or feeling waves of sadness or anger that seem to come out of nowhere..

These mood fluctuations stem from the same hormonal changes affecting anxiety. The unpredictable nature of these symptoms can be particularly distressing and challenging. One day you might feel completely balanced and in control, and the next you're overwhelmed by anxious thoughts and emotions that seem to come out of nowhere. Additionally, coping with other menopausal symptoms like hot flashes, sleep disruption, and physical discomfort can further challenge your emotional resilience.

Many people describe feeling like they're not themselves during this time, which can be frightening and isolating. We want to emphasize that these mood changes are a normal part of the menopausal transition, they do not reflect personal weakness or failing. The good news is, these symptoms are manageable with the right support, strategies, and comprehensive care.

When Thinking Feels Unclear: Understanding “Brain Fog”

One of the most frustrating aspects of menopause is cognitive fog—that persistent feeling of mental cloudiness that makes everyday tasks feel more difficult.

What's happening in your brain: We've learned that hormones like estrogen are important contributors to your brain health, supporting functions like memory formation, attention span, and processing speed. As these hormone levels change during perimenopause and menopause, your brain may feel like it is operating with less efficient fuel. As current research continues to explore the relationship with the brain during this transitional time, there is still much to learn about long-term impacts on brain health. .

What you might experience in daily life:

• Losing words mid-sentence
• Reading the same paragraph multiple times without retaining the information
• Walking into a room and forgetting why you went there
• Feeling like you're thinking through molasses

We understand that cognitive fog can be particularly challenging if you’re in a demanding career or managing complex family responsibilities. The worry that these changes might be permanent or progressive can create additional anxiety and stress, potentially intensifying both cognitive and emotional symptoms.

Finding Your Path to Balance: Treatment and Support Options

The good news is that the mental health challenges of menopause are highly treatable, and there are multiple approaches to finding relief and restoring balance and clarity.

Talk to your provider about menopause hormone therapy and other medication options. Try cognitive behavioral therapy (CBT) and acceptance and commitment Therapy (ACT). These therapies have proven particularly effective for menopausal anxiety, mood swings, and insomnia. Schedule a session with a mental health provider to explore these approaches.

Advocate for workplace accommodations-Talk to your employer about accommodations like flexible scheduling, temperature control, and scheduling breaks throughout the day. If you’re having trouble with concentration, noise-cancelling headphones can help minimize distractions.

Movement as medicine-Physical activity is an important component of supporting mental health during menopause. Engaging in enjoyable forms of physical activity—such as brisk walking, dancing, resistance training, or yoga—these activities provide substantial benefits to bother your mental and physical wellbeing.

Prioritize nutritional support- A brain-supporting diet rich in omega-3 fatty acids, whole grains, and phytoestrogens from foods like soy and flax can support brain health.

Sleep optimization- Menopause often disrupts sleep through hormonal changes, night sweats, and increased anxiety. Since poor sleep quality can directly impair concentration, memory, mental health, and overall cognitive function, addressing sleep issues becomes crucial for managing brain fog. Creating a cool, dark sleeping environment, maintaining consistent sleep schedules, and addressing night sweats or other sleep disruptors can significantly improve both sleep quality and daytime emotional stability.

Personalized Support Starts Here

Remember cognitive changes during menopause don’t define your capabilities or predict your future mental sharpness. With proper support and evidence-based interventions, most people can find significant improvement in their cognitive clarity and overall well-being. The One Medical team is here to work with you to develop a personalized plan that addresses your unique needs and supports you through this natural life transition.

To create your personalized plan, it’s time to assemble your medical team. The One Medical team can help wherever you are on your journey: book the peri/menopause visit for dedicated 1:1 time to discuss your plan with a menopause-trained provider.***If you are having feelings of self-harm you can get help 24/7 by texting or calling the 988 National Lifeline. It is free and confidential. One Medical is here if you are seeking mental health support.