Hormonal imbalances during menopause are classically associated with hot flashes, fatigue and weight gain – physical symptoms that the body is experiencing change. However, physical changes are not the only effects of menopause. Mood swings are another common symptom of menopause that compounds the discomfort of the experience and may lead to mental health distress for some women.
Dr. Anita Petruzzelli, Medical Director of BodyLogicMD of Hartford, Connecticut, shared in a phone interview that during menopause, women may have issues with sleep and mood changes such as increased anxiety, depression, irritability, and low confidence.
She believes that if there is a hormonal imbalance during menopause, those imbalances can lead to some mental health issues.
“I would say that menopause doesn’t per se cause anxiety or depression, but if there’s an imbalance, people may be more anxious or irritable or depressed,” Dr. Petruzzelli said.
While menopause is a state of hormonal fluctuation, it is not a state of imbalance. It is normal for people to experience hormonal transitions at certain points in their life like puberty and menopause. However, if your hormone balance has not been carefully managed with optimal nutrition, routine detoxification, quality sleep and other pillars of a healthy lifestyle, these hormonal transitions can become a state of imbalance and lead to the uncomfortable symptoms typically associated with menopause.
During menopause, fluctuating levels of progesterone, estrogen and testosterone may impact a woman’s mood and how she feels mentally. Bringing balance to these hormones can help relieve such symptoms.
“If people have an imbalance where they have too much estrogen, they can be anxious and irritable and maybe not sleep as well,” Dr. Petruzzelli said.
Progesterone, a hormone produced in the ovaries, can help even out this kind of hormone imbalance by improving sleep, irritability and anxiety issues, according to Dr. Petruzzelli.
If women have a decrease in testosterone, they may see unwanted changes in mood, ambition, focus, confidence and sex drive, she said.
Making lifestyle changes is one way to improve mental health distress related to hormone imbalance during menopause. Calming activities like meditation, yoga, tai chi, deep breathing, and relaxation can help with some symptoms. Consistent exercise, a healthy diet, and avoiding alcohol are also valuable habits for women experiencing menopause.
“A lot of times when people have a lot of stress, they have a harder time dealing with menopause,” Dr. Petruzzelli said. “Just having stress will make hot flashes [and] night sweats worse, so things like meditation can really help.”
Mental health distress related to hormonal imbalance is often relieved with hormone replacement therapy, when administered as part of a comprehensive treatment plan. However, Dr. Petruzzelli still believes it’s important for women to be evaluated by a psychiatrist and psychologist if they’re experiencing conditions like anxiety and depression.
Dr. Keith Wharton, Medical Director of BodyLogicMD of Pittsburgh, Pennsylvania, has been a board-certified OB/GYN for 30 years and has extensive experience helping patients find balance with hormone replacement therapy.
He has noticed that many of the women he treats during menopause also struggle with their mental health. Bioidentical hormone replacement therapy is often part of the treatment plan Dr. Wharton develops for these patients—and many are pleased to note the dramatic difference in their health and quality of life.
At the beginning of the treatment process, every patient completes diagnostic testing, then Dr. Wharton assesses the lab results, patient medical history and current symptoms to best determine which therapy will be suit each patient’s needs.
For women who are candidates for BHRT, Dr. Wharton generally begins treatment of menopausal symptoms with estrogen and progesterone. In many cases, adding testosterone is also beneficial for addressing mood swings, fat gain and sexual dysfunction. Dr. Wharton recommends pellet therapy as the delivery method for testosterone, as it minimizes side effects and mimics the body’s natural release of the hormone over the course of three to six months.
“Clinically I’ve seen [mood swings] in patients who I’ve treated into menopause with estrogen and progesterone, and they would see a partial improvement, but never saw a complete resolution of their symptoms until more recently I’ve started adding testosterone,” Wharton said in a phone interview. “I’ve seen just some dramatic effects.”
He then tracks symptom improvements with a menopause rating scale (MRS).
“It’s a scale where the higher the symptoms are, the worse they’re feeling,” Wharton said. “I usually joke with my patients – I’ll tell them it’s the misery scale. The higher it is, the worse they’re feeling.”
Wharton has many success stories of women finding relief from mental health-related symptoms after starting BHRT.
For example, he had one patient who was on five antidepressants initially, and after her second visit with him, was off of all antidepressants due to the positive effects of BHRT on her symptoms, Wharton said.
“If a woman absolutely doesn’t want to take [hormones], then, sure, there’s things we can do,” he said. “We can look at optimizing the vitamin D, making sure she has the best diet ... also exercise is very important. I think the key things that you can do are hormonal balance, nutrition and exercise.”
Have you had any mental health issues during menopause? How did you find relief from these symptoms? Please share in the comments below.
Petruzzelli, Anita. Phone interview. May 31, 2015. http://www.bodylogicmd.com/physicians/dr-anita-petruzzelli
Wharton, Keith. Phone interview. June 14, 2015. http://www.bodylogicmd.com/physicians/dr-keith-wharton
About My Practice http://www.drkeithwharton.com/practice
Reviewed June 19, 2015
by Michele Blacksberg RN
Edited by Jody Smith