It is normal to feel emotional about physical changes like getting older, the impact of poor sleep and the loss of fertility, role changes like children leaving home, looking after ageing parents or other relatives, or facing the loss of parents. Menopause can signal a time to take stock of life and focus on the next stage.

Shifts in the levels of female hormones can cause temporary mood changes, including symptoms of depression.

The hormone changes at menopause can contribute to depressed mood and anxious feelings, and you may find your emotions swing from joy to frustration and annoyance in the blink of an eye. Whether menopause causes depression continues to be debated, but there are many things you can do to help with both depression and anxiety if you experience these at the same time as menopause.

Hormonal changes may be a small part of the causes of the depressed mood and anxious feelings women often experience around perimenopause.

Symptoms that may overlap with depression include: sleep issues, sexual problems, appetite changes, low energy and poor concentration.

A number of studies have identified that menopause significantly impacts mood and mental health, including higher stress levels and depression. Anxiety and panic attacks are also reported during menopause with hormonal changes and physical symptoms especially for women with Bipolar illness. Women with schizophrenia may be at increased risk of an episode as their production of oestrogen decreases, and some antipsychotic medications like Sulpiride and Risperidone may cause periods to stop which can be mis-diagnosed as menopause.

Depression and depressed mood around the time of expected menopause is more likely to occur because of factors other than menopause, including: prior episodes of depression, a significant stress in your life, a negative attitude to things happening in your life, dissatisfaction with your relationships, low self-esteem, poor body image, a poor lifestyle such as little exercise or a high intake of alcohol.

Research suggests women who have a surgical menopause and/or an early menopause are more likely to experience a clinical depression than women who have menopause at the expected age. This seems to be influenced by the more sudden drop in hormones that comes with a surgical menopause, and it might also be related to the illness that caused the surgery in the first place, such as a cancer diagnosis.

Although the biological changes are the same in all women, the socio-cultural experience of menopause will differ between women. For some women, menopause will be a freedom from the risk of pregnancy; for others it will be a sadness if they have not had children.

Anxiety, depression and sleep are interlinked as anxiety and depression can trigger sleep problems and sleeplessness can make anxiety and depression worse. Lack of sleep can affect mental wellbeing, cognitive function and cardiac health. Sleep disturbances are common throughout the peri-menopause, menopause and post-menopause. 

There are techniques that can be successful in helping to deal with depression, anxiety, stress and poor body image such as Cognitive Behavioural Therapy and Mindfulness.

It is important that women maintain a healthy diet and regular exercise after the menopause to minimise health problems and promote self-esteem and wellbeing.