The Myths of Menopause: It’s Not Just Hot Flashes

Perimenopause and menopause present a hormonal roller coaster, with mental-health impacts that are only now being understood and discussed.


Menopause, the time in a woman’s life when her periods stop permanently, is often associated with hot flashes and night sweats. But what many women don’t realize is that menopause can also have a significant impact on mental health. Why is there a lesser-known connection between menopause and mental health? Let’s discuss.

The hormonal roller coaster of perimenopause

Perimenopause is the period leading up to menopause, which typically begins eight years before a woman’s last period. During this time, a woman’s body experiences fluctuating hormone levels, most notably estrogen.

Dr. Alison Shea, an OB-GYN and menopause expert at McMaster University, compares this hormonal flux to a “roller coaster”. She explains that the brain is intricately linked to estrogen levels, and these fluctuations can disrupt the production of neurotransmitters like serotonin, which plays a role in mood regulation.

Many women experiencing symptoms of depression, anxiety, and mood swings during perimenopause don’t connect these changes to their hormonal shifts. Janet Ko, president and co-founder of the Menopause Foundation of Canada, highlights this knowledge gap.

She states to the Toronto Star, “It’s a myth that it’s just about hot flashes. It is a profound hormonal change that will impact your entire body, and when you don’t understand that mental health can be part of that, you may be experiencing these challenges and not connecting the dots on the why.”

This lack of awareness can lead to feelings of self-blame and isolation. Ko emphasizes, “This can lead to women being very negative on themselves, having feelings of self-blame, feeling like they’ve lost themselves.”

Why healthcare professionals need to be aware

Unfortunately, some healthcare professionals may not be equipped to recognize the mental health aspects of menopause. Ko points out that some women are prescribed antidepressants as a first-line treatment, without exploring the possibility of hormonal changes.

The hormonal fluctuations are most erratic during perimenopause, which can lead to unpredictable mood swings. Shea explains to the Star, “You might feel really well for a few days, then really off for a few days.” She identifies the period from when periods become irregular to a few years after the final period as the “most vulnerable” time for mood changes.

These emotional shifts can have a ripple effect on a woman’s life. Shea describes how these hormonal changes can manifest in behaviour, stating, “People will say that they’re yelling at their kids, they’re getting in more arguments with their partner. They’ll say, ‘I’ve gotten in trouble at work because I just spoke my mind but I probably should have had more of a filter.'”

Treatment options for mental health during menopause

There is some good news, though. There are steps that can be taken to manage the mental health effects of perimenopause and menopause. Shea recommends a holistic approach that includes lifestyle changes such as regular exercise, a healthy diet, and prioritizing sleep.

Hormone replacement therapy (HRT) is another option. While Shea acknowledges that HRT is not a cure-all, she describes it as a way to smooth out the bigger bumps. She explains that HRT works by providing a steady level of hormones, which can help to regulate neurotransmitters and improve mood.

If you are experiencing emotional distress during perimenopause or menopause, it is important to remember that you are not alone. You’re not crazy, and there is support available.

Resources like the Menopause Foundation of Canada can provide information and connect women with healthcare professionals who are knowledgeable about menopause. If you are struggling, talking to your doctor is the first step towards finding relief and regaining control of your mental and emotional well-being.

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Adam is a passionate advocate for women's and infants' health. With a Master of Science and a current Ph.D. from the University of Toronto's Department of Physiology, he has dedicated his academic and professional career to understanding and improving health outcomes for women and newborns. Adam's research is driven by a deep commitment to empowering women through education and by promoting the incredible advances in women's health care. As a proud Canadian, he is eager to shine a light on the contributions and progress made in his home country, aiming to inspire and contribute to a healthier future for all women and their families.