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Key points
- New research challenges the notion that the time surrounding menopause is synonymous with poor mental health.
- Still, there are factors that make women vulnerable to clinical depression during menopause transition.
- Left unchecked, stress and poor social support can contribute to mental health problems.
- It's vital that women access the support they need to manage their stress.
A recent review paper published in the British journal The Lancet pooled data from 12 studies investigating the relationship between clinical depression and the menopause transition—the time starting with the onset of menstrual changes and ending with the final menstrual period.
The researchers analyzed data from 600 women globally and “found no compelling evidence for a universal or uniform increased risk of depressive symptoms over the menopause transition.” Indeed, their analysis went further and studied other mental health conditions such as anxiety, bipolar, and psychosis and found no evidence that menopause universally elevates the risk of those mental health conditions either.
This study challenges the widely held notion that the time surrounding menopause is synonymous with poorer mental health.
A Vulnerable Subgroup at Risk for Depression
While these findings are encouraging, the study did identify some of the factors that did make women vulnerable to clinical depression during the menopause transition. There was a higher risk of depression in those who experienced:
- A longer menopause transition. (This period can last anywhere from 4-10 years)
- Sleep disruption e.g., frequent hot flashes at night that contribute to chronic insomnia.
- A prior history of clinical depression, which made them more vulnerable to experiencing a recurrence during the menopausal transition.
- Stressful life events and low social support
Stress and Social Support: Modifiable Risk Factors
I’d like to home in on these last factors that put menopausal women at risk for poorer mental health. When it comes to psychological stress, women, more than men, consistently report higher levels with each passing year. As a women’s health psychiatrist, I’ve witnessed how stress is ubiquitous and frequent in the daily lives of women and how this situation is further complicated by lives that have quickened and intensified in the digital era.
What’s more, the average age of menopause transition is 47—a time of life that is often associated with stressful events. For example, it’s not uncommon for women of this age to be dealing with other health conditions (e.g., heart disease or cancer) or the loss of loved ones such as parents, siblings, or close friends. They may be going through many transitions, such as facing an empty nest or changes in the workplace. Often, they are spending many hours in unpaid labor caring for elderly parents and dependent children.
To add insult to injury, we live in a culture that does not value women past a certain age, who may not meet a standard of youthful beauty and are no longer capable of reproduction. And in my experience, it is hit or miss if women get the support they need when dealing with stressful situations. This is unfortunate when considering the downstream consequences for their mental health.
The bad news, then, is that stressful life events appear to be an integral part of the stage of life that also coincides with the menopausal transition. Left unchecked, this can contribute to mental health problems.
The good news is that stress is a modifiable risk factor—meaning it can be managed—as is increasing your social support network. If women can get the support they need to manage their stress, its harmful impacts on their physical and mental health could be mitigated.
What Women Going Through Menopause Can Do
1. Be proactive about managing stress. Establish and practice a daily self-care routine. At a minimum, this should include exercise, eating healthfully, and allowing sufficient time for sleep. Now is also the time to think about cutting out unhealthy ways of coping with stress, such as excessive alcohol consumption or nicotine use.
2. Be proactive about building a social support network. Look at the people who make up your social support network. Who is there for you when you need them? Who do you feel you can trust? Who do you feel is invested in you and your well-being?
Now is a good time to re-evaluate the time and energy you give to one-sided or unhealthy relationships. If you’re someone who finds it hard to ask for help or verbalize when you’re overwhelmed, now is also a good time to start working on developing that skill.
3. Don’t assume that depression or poor mental health is part and parcel of menopause. In fact, if you’ve never had clinical depression before, then you’re unlikely to have it during menopause.
4. Seek professional evaluation if necessary. If you notice significant signs and symptoms of depression, it’s important that you don’t chalk it up to menopause and seek professional attention. Find a therapist near you in the Psychology Today Therapy Directory.
What Partners Can Do
People whose partners are going through menopause can be a key source of support. It’s important to:
5. Get educated. There are many good and reliable resources available on the internet from which to get educated about menopause. It is helpful to have knowledge about what menopause is, what common signs and symptoms are, and how they may change over the different stages of menopause.
6. Act rather than speak. If you know your spouse is overloaded or taking on a disproportionate burden of certain duties—including childcare, caregiving, and household tasks—say directly, “Tell me what I can do to help,” and then be ready to follow through.
7. Prioritize kindness, compassion, and outward displays of affection or affirmation. Anything that fosters optimism, a healthy self-image, and perceived control has been found to be protective of mental health across the menopause transition.
8. Get proactive about self-care. Mid-life is a time when consistent self-care is nonnegotiable for anyone. If you are not doing so already, now is the time to make basic self-care a priority; that includes exercise, healthy eating, and high-quality sleep. If you know your spouse is struggling in these areas, create a buddy system: Sync your calendars so you can exercise together, divvy up tasks (i.e., shopping, preparation, and clean up) associated with healthy home cooking, and set up a similar time for going to bed and waking up so you can keep each other accountable when it comes to sleep wellness.
9. Schedule regular communication or check-ins: The menopause transition is an ever-evolving situation that may take place over many years. Make sure you make time to stay connected on this issue. Keep this time free of distractions or interruptions.
10. Cultivate a “We’re in this together” philosophy: Viewing this as a “you problem” is inherently unhelpful and insensitive and can leave your spouse feeling isolated and lonely. Be a partner on this journey. Advocate for your spouse if they need help navigating or accessing the healthcare system. If you feel they are delaying getting help and putting the needs of others before their own, nudge them to prioritize their own health and well-being.
