The Rage Is Real — Here’s How the Transition to Menopause Affects Mental Health

As much as you may feel like it, you’re not going crazy.

From a partner who’s not sharing the mental load to the latest frustration-inducing Mercury retrograde, triggers for anger, aggravation, even tearfulness abound in everyday life. If you happen to be in your 40s, you might also be dealing with juggling a career with raising children and/or caring for an aging parent. Living through perpetually “unprecedented” times certainly doesn’t exactly help matters. Oh, and neither does that superfun phase that pretty much no one looks forward to: perimenopause or menopause.

Generally kicking off with irregular menstrual cycles — and officially concluding once your period has been MIA for 12 months and can finally say you’re “in menopause” — the perimenopausal phase can last anywhere from four to 10 years, says certified menopause practitioner Sharon D. Malone, M.D., FACOG, Chief Medical Officer of Alloy, a telehealth company focused on menopause treatment. (She's also a friend of former First Lady Michelle Obama and has appeared on her podcast to discuss reproductive health and menopause.)

While most people have heard that the transition to menopause can lead to passing storms of irritability and mood swings, ongoing — and sometimes even debilitating — mental health challenges such as depression and anxiety may also be set off by perimenopausal hormonal flux, points out Dr. Malone. “They can affect not only the quality of life but also productivity, health, and personal and professional relationships as well,” she notes.

Here's what you need to know about mental health during perimenopause and menopause, according to experts and women who’ve been there.

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“Oh, my God, does nobody else feel this?”

There’s no doubt that mental health symptoms are pervasive among people going through this midlife transition. Depression affects about 18% of women in early perimenopause and 38% in late perimenopause. And a survey by women’s telemedicine start-up Evernow of 40,000 women in perimenopause and menopause found that nearly 60% reported severe anxiety or depression. Anyone who’s ever suffered from depression or anxiety is particularly susceptible during perimenopause or menopause, according to the experts interviewed.

And even though an estimated 1.3 million women in the U.S. enter menopause every year, the experience can feel incredibly isolating, which often serves to exacerbate mental health symptoms, as Vanessa McGrady, 54, can attest.

Describing herself as “solidly in perimenopause” after spotty periods followed by five months of no period, McGrady, who lives with her 11-year-old daughter and fiance, explains that she’s felt alone while battling symptoms. “I was getting hot flashes during [a recent] heatwave, and I remember sitting at the table crying because I was so hot, feeling like, ‘Oh, my God, does nobody else feel this?’” the Burbank, California-based journalist and communications expert recalls. “They were sympathetic, but I felt almost crazy. Like I was the one who was so hot and bothered.”

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Hot flashes were also at the crux of menopausal mental health struggles for Gina D’Amico, 42, of Lockport, Illinois, who went through early menopause at 38 due to various autoimmune conditions. “I definitely had a major increase in anxiety, because I couldn’t sleep through the night from hot flashes waking me every hour or two,” she remembers. “My mental health plummeted for a while until I got the help of an antidepressant. The mood swings were pretty out of control. It was far worse than any PMS symptoms I’d experienced before.”

D’Amico’s experience is an example of how symptoms of perimenopause and menopause can compound one another, leaving you feeling down — or downright enraged. For instance, if you’re suffering from hot flashes, night sweats, or just good old-fashioned insomnia, it can be pretty tough to get a restorative night’s sleep. And this can absolutely have a negative impact on your mood and mental health — not to mention quality of life, concentration, and work productivity, says psychologist Sheryl Kingsberg, Ph.D., Chief of the Division of Behavioral Medicine in the Department of OBGYN at University Hospitals Cleveland Medical Center and advisor to Alloy.

And as for the much-discussed rage? While it’s high time we did away with the problematic myth that transitioning to menopause automatically means being “out of control and bitchy,” some women do experience moods that are about as fiery as their hot flashes, says Dr. Kingsberg. They’re not as common as depressive episodes, anxiety, or longer spans of depression, but a small number of women report an out of control mood or irritability that comes out as explosive anger, Dr. Kingsberg explains.

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"It's in your brain, not your head."

Still, how every person going through perimenopause and menopause might feel, mentally and emotionally, is completely individual, emphasizes Dr. Malone. “Every woman’s brain is uniquely wired not only by their physiology but by their life experiences as well,” she notes.

Of course, there’s a hormonal explanation for these mental health challenges. “Perimenopause is characterized by the erratic production of estrogen, progesterone, and testosterone,” explains Dr. Malone. And after menopause, your levels of these hormones — which Dr. Malone points out have a “relative calming effect on the brain” — are consistently low.

“People are most symptomatic during the mid- to late perimenopause while the hormones are most unpredictable,” notes Dr. Malone.

That’s because there are millions of estrogen receptors in the brain — most notably in the hippocampus, hypothalamus, and amygdala, which are important for memory, regulation of  menstrual cycles, temperature regulation, sleep, and mood, she says. And when the delicate balance of your reproductive hormones is thrown off by this completely normal but thoroughly disruptive phase, there are sure to be, as Dr. Malone puts it, “global implications for brain function.”

In other words? Don't be hard on yourself if you lose your cool over something that you intellectually realize is irrational, Dr. Malone says. "That's how it is. We say, 'It's not in your head, but it's in your brain.' There really is something going on there."

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Managing the “Inevitable March to Menopause”

Given just how darn long, “the inevitable march to menopause,” as Dr. Malone calls perimenopause, and menopause itself are, you might feel like you have to resign yourself to dealing with nonstop angst for years and years. But there are ways to manage your mental health during this transition.

Find a practitioner who gets it.

Finding a health care provider who makes you feel heard is often challenging, period. It’s even more frustrating when you’re dealing with anxiety, depression, or a slew of other mental health concerns during perimenopause or menopause.

McGrady learned this firsthand when she saw her general practitioner about her symptoms. “I told her, ‘I'm gaining weight, I feel like I'm not metabolizing, I can't regulate my temperature, my hair's falling out,’ and I started crying,’” she recalls. “And she was like, ‘Why are you crying?’ And I said, ‘Because I feel broken.’ And she just seemed like, ‘Why are you even telling me this?’ It made me feel completely gaslit.”

The incident led her to seek out care from a different, integrative practitioner who she says has given her validation and is working with her on a holistic treatment protocol.

“Only about 20% of medical residency programs are providing any menopause training. So you have people going to what they think is an authoritative source, asking for help — they feel like they're drowning, and they want to be thrown a life raft — and instead, they're thrown the weight of ignorance right back at them.”

Mache Seibel, M.D., member of the Harvard Medical School faculty and author of Working Through Menopause: The Impact on Women, Businesses, and the Bottom Line, points out, “Only about 20% of medical residency programs are providing any menopause training. So you have people going to what they think is an authoritative source, asking for help — they feel like they're drowning, and they want to be thrown a life raft — and instead, they're thrown the weight of ignorance right back at them.” For that reason, “you generally do have to be your own advocate.”

Don’t accept depression as ‘normal.'

If you feel like you could be struggling with depression, regardless of whether it’s related to midlife hormonal imbalance, Dr. Malone emphasizes the importance of seeking treatment and getting screened.

“Depression is depression,” she says. “It doesn't matter why you have it — if you have it, it should be treated as the serious illness that it is and not ignored or attributed to simply being a normal menopausal event.”

Dr. Kingsberg notes that there is strong evidence that cognitive behavioral therapy (CBT) can even help reduce vasomotor symptoms (aka hot flashes and night sweats).

Connect with others going through the same thing.

Not surprisingly, experts say mind-body practices like acupuncture and good, old meditation and yoga can all help regain your sense of calm. However, of all the mood-boosting techniques out there, both McGrady and D’Amico say that talking to other women has been the most uplifting.

For instance, D’Amico has found that in Facebook Groups, she can trade notes with other women on emotional well-being and how they’ve gotten through the worst of it or explained to their partners what they’re going through. “It often is just women reassuring each other that what we are experiencing isn’t us going crazy — that the symptoms and emotions are normal.”

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