Article written by Dr Emma Ginns and Dr Mari Walling, British Menopause Society Registered Specialists and BSLM Lifestyle Medicine Physicians, Co-founders of Lemala Health. November 2026
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
In this guide, we explore why perimenopause and menopause can affect mental health and psychological wellbeing, the symptoms women may experience, and the treatments and support that can help, including HRT, lifestyle changes and psychological therapies.
We also look at the particular challenges of POI, surgical menopause and menopause following cancer treatment.
Changes in mood and emotional wellbeing are common during perimenopause and menopause.
You may notice relatively mild changes, or experience anxiety, low mood or other psychological symptoms that have a significant impact on your work, relationships and everyday life.
These changes sometimes occur alongside more familiar menopause symptoms, such as hot flushes, night sweats, changing periods or poor sleep. For some, however, changes in mood or mental health may be the first, or most troublesome, sign that something has changed.
What psychological symptoms can occur during menopause?
Women can experience a wide range of symptoms, including:
anxiety or a sense of unease
low mood
irritability or anger
tearfulness
feeling overwhelmed
loss of confidence
reduced motivation
mood swings
difficulty concentrating or making decisions
feeling less able to cope with everyday stresses
a sense of not feeling like yourself
Sleep disturbance is also very common during menopause and can have a significant effect on mood, anxiety, concentration and our ability to cope.
Some women describe a loss of their previous emotional resilience, and situations they would once have taken in their stride suddenly feel much harder.
Why can menopause affect mental health?
The relationship between hormones and our brains is complex.
Changes and fluctuations in hormones, particularly oestrogen, during perimenopause can influence brain systems involved in mood and emotional wellbeing.
Some women appear to be particularly sensitive to hormonal changes. A history of significant premenstrual mood symptoms or PMDD, or previous episodes of depression associated with hormonal changes such as the postnatal period, may be relevant when considering symptoms during perimenopause and menopause.
Poor sleep, physical symptoms, work pressures, caring responsibilities, relationships, physical health, alcohol and other stresses can all, in addition to changing hormones, affect how we feel.
Sometimes several factors may be contributing at the same time.
Is it menopause or a mental health condition?
It isn't always possible, or helpful, to put symptoms neatly into one category.
Anxiety and depression can develop independently of menopause. Equally, psychological symptoms associated with hormonal change can sometimes be overlooked or attributed simply to stress.
Understanding when symptoms began, whether they fluctuate, what other menopause symptoms are present, previous mental health and menstrual history, sleep and what else is happening in someone's life can all help build a clearer picture.
Sometimes investigations may also be appropriate. Depending on the symptoms and individual circumstances, this might include blood tests for conditions such as thyroid dysfunction, anaemia, iron deficiency or vitamin B12 deficiency.
Can HRT help psychological symptoms?
For some women, yes. HRT can be helpful for depressive symptoms that begin around the same time as other menopause symptoms.
HRT may also improve other menopause symptoms such as hot flushes, night sweats and sleep disturbance, which can in turn improve psychological wellbeing.
Of course, HRT isn't a treatment for every mental health problem. A history of significant anxiety, depression or another mental health condition, requires appropriate assessment and treatment in its own right. HRT and mental health treatment are not mutually exclusive, and sometimes both may be appropriate, and required.
What else can help?
Treatment should be individualised according to the symptoms and what appears to be contributing to them.
This may include:
improving sleep
regular physical activity
reducing excess alcohol
eating well
maintaining social connection
addressing significant sources of stress where possible
psychological therapies, including cognitive behavioural therapy (CBT)
appropriate treatment for anxiety, depression or other mental health conditions
Menopause-specific CBT can also be helpful for some women experiencing menopause-related depressive symptoms, sleep problems and hot flushes.
Often there isn't one single solution.
What about antidepressants?
Antidepressants can sometimes be helpful if you're experiencing depression or anxiety, particularly if you've had difficulties with your mental health before.
Experiencing menopause symptoms doesn't mean that treatments for existing mental health conditions should be stopped or avoided.
Equally, if anxiety or low mood develops alongside other menopause symptoms, it's important to consider whether hormonal changes may be contributing, rather than automatically turning to antidepressants.
For some, treating menopause symptoms can make a significant difference. For others, specific mental health treatment may be needed, and sometimes a combination of both is the best approach.
PMS, PMDD and perimenopause
If you've previously experienced premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD), you may find that symptoms become more troublesome during perimenopause, when hormone levels fluctuate.
PMS and PMDD can cause significant changes in mood, anxiety and irritability, often following a cyclical pattern. As periods become less regular during perimenopause, this pattern may become harder to recognise.
Treatment needs to be individualised, particularly if you've previously experienced difficulties with hormonal contraception or progesterone and progestogens in HRT.
For some women with severe PMDD that hasn't responded to other treatments, surgical removal of the ovaries may have been considered. Hormone treatment following surgery may require specialist menopause support, particularly where there has been previous sensitivity to hormonal changes or progestogens.
POI, early and surgical menopause
The circumstances in which you experience menopause can also have an important impact on your emotional wellbeing.
If you experience premature ovarian insufficiency (POI), when your ovaries stop functioning normally before the age of 40, the diagnosis can be difficult to come to terms with, particularly because of the implications for fertility and future health.
Early menopause, before the age of 45, can also happen at a time when menopause is something you weren't expecting to face.
If you've had both ovaries removed surgically, the sudden fall in hormone levels can cause abrupt menopause symptoms. You may also be recovering from surgery and coming to terms with the reasons it was needed.
Alongside the effects of hormonal changes, you may experience grief, changes in body image or sexual function, concerns about fertility or relationships, or a sense of losing a stage of life earlier than expected.
Recognising and supporting your emotional wellbeing is an important part of care following POI, early or surgical menopause.
Menopause following cancer treatment
Cancer treatment can sometimes cause menopause, whether through chemotherapy, radiotherapy, surgery or treatments that suppress ovarian function.
If you've experienced menopause as a result of cancer treatment, you may be managing menopause symptoms alongside the physical and emotional impact of your diagnosis and treatment. Changes to your body, difficulties with sexual function, or worries about recurrence and future health can all affect your psychological wellbeing.
You may also have been advised that HRT isn't suitable for you, or feel uncertain about whether it would be safe.
This doesn't mean you have to simply put up with menopause symptoms or their impact on your wellbeing.
There are treatment options available, including non-hormonal treatments for menopause symptoms, support with sleep, vaginal and sexual symptoms, and psychological therapies.
Depending on the type of cancer and your individual circumstances, HRT may still be an option following a careful assessment of the benefits and risks.
When getting help has been difficult
You may have spent months or even years trying to understand why you feel different, without finding the answers or support you need.
Perhaps your symptoms have been attributed to stress or anxiety without hormonal changes being considered. Equally, you may have been told that everything is related to menopause, when an underlying mental health condition also needs attention.
If you've experienced POI, surgical menopause or menopause following cancer treatment, you may have found yourself navigating care between different healthcare teams.
Feeling unheard or struggling to access appropriate support can make an already difficult experience harder.
Having the time to explain your symptoms and experiences, and feeling listened to, can make a real difference.
When to seek help
If you're experiencing anxiety, low mood or other psychological symptoms that are persistent, getting worse or affecting your everyday life, it's important to seek medical advice.
If you're experiencing severe depression, thoughts of suicide or self-harm, or feel unable to keep yourself safe, please seek urgent medical help.
Your mental health matters, and symptoms should never simply be dismissed as "just menopause".
Looking at the whole picture
Mental health and menopause don't sit in separate boxes. Hormonal changes, sleep, physical health, relationships and the pressures of everyday life can all influence how you feel.
Understanding your symptoms, your experiences and what else is happening in your life is an important part of finding the right support.
Further support and information
Royal College of Psychiatrists: Position Statement - Menopause and mental health
Menopause after breast cancer: symptoms, treatment and support
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