Menopause Low Mood: What can help?

You're more anxious than you used to be. You feel tearful for no obvious reason, your confidence has disappeared and even the smallest things feel overwhelming.

You might find yourself thinking, Why am I struggling so much? This isn't like me.

We tend to associate menopause with hot flushes, night sweats and changes to our periods.

But the psychological and emotional symptoms can be just as disruptive, and sometimes much harder to recognise.

Low mood, anxiety, irritability, reduced confidence and changes in motivation can all happen during perimenopause and menopause.

I know how devastating menopause can be when it affects your ability to function, work, maintain relationships and feel like yourself.

There are reasons why your mood might be changing, and there are treatment and support options worth exploring.

In this article, I'll explain what may be contributing to your low mood in menopause, when to seek medical advice and what you can do to start feeling better.

Can menopause cause low mood?

Yes, low mood and depressive symptoms are recognised symptoms associated with perimenopause and menopause.

Changing hormone levels, particularly fluctuations in oestrogen during perimenopause, can contribute to changes in mood and emotional wellbeing. Hormones interact with the brain systems involved in regulating mood, sleep and other functions.

Hormones aren't necessarily the only explanation though.

Midlife can bring its own pressures, from caring responsibilities and relationship difficulties to changes at work, physical health concerns and the realisation that your needs may have been put last for years.

Poor sleep, anxiety and other menopause symptoms can add to the strain.

Sometimes several of these things happen together, making it difficult to work out where one problem ends and another begins.

You might feel unlike yourself without being able to explain exactly why.

And because a low mood isn't as visible as a hot flush, you may not immediately connect the two.

Why does menopause affect your mental health?

Changing hormones

Oestrogen influences several systems in the brain involved in mood regulation. During perimenopause, hormone levels can fluctuate considerably before oestrogen levels eventually settle at a lower level after menopause.

Some women appear to be particularly sensitive to these hormonal changes.

You might notice that you feel more anxious, irritable or emotionally vulnerable than you did previously. You may also experience reduced motivation, lower confidence or periods of tearfulness.

These symptoms deserve attention, particularly when they are affecting your everyday life.

Poor sleep and other menopause symptoms

Night sweats, hot flushes, joint pain and other symptoms can interfere with sleep.

When you're exhausted, it's much harder to manage stress, regulate your emotions and cope with everyday demands.

You might find yourself becoming more irritable, worrying more than usual or struggling with tasks that previously felt straightforward.

If sleep is a significant problem for you, it's worth addressing it as part of the wider picture rather than treating your low mood in isolation.

Your previous mental health history

Have you experienced premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postnatal depression or other mental health difficulties in the past?

Your history is worth discussing with your healthcare professional. Some women with previous hormone-related mood difficulties find that their symptoms change or return during perimenopause.

However, a previous experience doesn't mean that you will necessarily struggle again.

It simply provides useful information when considering what might be happening now and which treatments could help.

The pressures of midlife

Hormonal changes don't happen in a vacuum.

You may be supporting children or ageing parents, dealing with relationship problems, managing financial pressures or questioning whether your current working life is sustainable.

You might be trying to keep everything going while feeling increasingly exhausted yourself.

And if you've spent years being the person everyone else relies on, admitting that you're struggling can be particularly difficult.

It's worth considering both the physical and emotional factors contributing to how you feel.

You don't have to choose between acknowledging the impact of menopause and recognising the other challenges in your life.

Low mood in menopause or depression: what's the difference?

This is an important distinction.

Some women experience changes in mood around the time of menopause without meeting the diagnostic criteria for depression. Others develop clinical depression during perimenopause or menopause.

The symptoms can overlap, and it isn't always possible to tell the difference without a proper assessment.

Low mood might involve feeling sad, anxious, irritable or less confident than usual. 

Depression can involve persistent low mood or loss of interest and enjoyment, alongside other symptoms that affect daily functioning.

If your low mood lasts for two weeks or more, keeps returning, or is making it difficult to manage everyday life, contact your GP. 

You don't need to wait until things become unbearable to ask for help.

Other physical health conditions, mental health difficulties, medication effects and life circumstances can contribute to similar symptoms.

You deserve an assessment that takes your symptoms seriously.

What should you do if you're experiencing low mood in menopause?

Start by speaking to your GP or healthcare professional.

Explain what you've been experiencing, when it began and how it is affecting your life. 

Mention any other menopause symptoms, changes to your sleep, previous mental health difficulties and any medication you're taking.

Depending on your symptoms and medical history, your GP may consider whether further assessment or investigations are appropriate.

For example, thyroid problems, anaemia and vitamin deficiencies can cause symptoms such as fatigue and difficulties with concentration that may overlap with menopause symptoms. 

Tests should be guided by your individual circumstances rather than assuming that everyone needs the same set of blood tests.

It can help to keep a brief record of your symptoms before your appointment, particularly if you find it difficult to explain everything when you're there.

You might note:

• When your low mood started and whether it fluctuates.

• Any changes to your periods or other menopause symptoms.

• How you're sleeping and how tired you feel.

• Whether you're struggling at work, at home or in your relationships.

• Any treatments or medication you're already using.

If you suspect menopause is contributing, say so. Your experience matters, and it's reasonable to ask about menopause-specific treatment options.

Treatment options for low mood in menopause

The right approach depends on the cause of your symptoms, their severity, your medical history and your preferences.

Here are some of the options worth discussing with your healthcare professional.

Hormone replacement therapy (HRT)

HRT can help with many menopause symptoms, and NICE recommends considering it for depressive symptoms that begin around the same time as other menopause symptoms when the person does not meet the criteria for depression.

Some women notice improvements in their mood as their menopause symptoms improve, particularly when sleep and other disruptive symptoms also get better.

However, HRT isn't a guaranteed treatment for low mood, and it isn't a substitute for appropriate assessment and treatment of depression.

If you're considering HRT, discuss the potential benefits, risks and different preparations with a suitably qualified prescriber. 

If you're already taking it but aren't feeling better, ask for a review rather than assuming you simply have to put up with your symptoms.

Cognitive behavioural therapy (CBT)

CBT is a talking therapy that helps people explore the connections between their thoughts, feelings and behaviours.

It can help with anxiety, low mood and unhelpful patterns of thinking. Menopause-specific CBT may also help with particular menopause-related difficulties, including sleep problems and coping with symptoms.

You don't have to wait until you've tried HRT to ask about psychological support.

Depending on your circumstances, CBT may be used alongside other treatments or as an alternative when other options aren't suitable or aren't your preference.

Antidepressants

If you have depression, your healthcare professional may recommend treatment in line with guidance for depression in adults. 

Depending on your circumstances, this may include antidepressant medication, psychological therapy or a combination of approaches.

Antidepressants may also be considered for some people experiencing anxiety or low mood associated with menopause.

The important point is that menopause-related symptoms and depression can overlap, and both need to be taken seriously.

Don't feel that you have to choose between addressing your hormones and looking after your mental health. Your treatment plan should take account of both.

Herbal remedies and supplements

You may see products marketed as natural solutions for menopause-related low mood.

Evidence for many herbal remedies is limited, product quality can vary, and some preparations interact with prescription medicines.

For example, St John's wort can interact with a range of medications, including some antidepressants and hormonal medicines.

I personally find Nu Mind Wellness Menopause Support helpful for the mood-related challenges I've experienced myself during menopause. It's a supplement I'd encourage you to look into if you're exploring ways to support your wellbeing.

(Disclaimer: I'm an affiliate partner for Nu Mind Wellness because I love this product! This means if you decide to purchase it through my links, I may receive a commission at no extra cost to you)

Supplements affect everyone differently, and my experience doesn't mean you'll necessarily notice the same benefits. They shouldn't replace appropriate medical advice or treatment if you're experiencing persistent low mood or depression.

Before trying any new supplement, check the ingredients and speak to your pharmacist or healthcare professional, particularly if you take medication or are considering HRT.

Complementary therapies

Some women find relaxation practices, massage, mindfulness or other complementary therapies helpful for managing stress and supporting their general wellbeing.

These may be useful additions to a wider treatment plan, depending on your needs and preferences.

However, they shouldn't replace medical assessment or evidence-based treatment when you're experiencing persistent or severe low mood.

Lifestyle changes that may support your mood

Lifestyle changes aren't a cure for every cause of low mood, and they won't necessarily be enough on their own.

But looking after your basic needs can support your mental and physical wellbeing, particularly alongside appropriate treatment.

The trick is to focus on manageable changes rather than giving yourself another long list of things you feel you ought to be doing.

Start with one area that feels achievable.

Related reading: 5 foundations of menopause health

Sleep support

If you're waking repeatedly during the night, feeling exhausted during the day or struggling to switch off, look at what might be affecting your sleep.

Addressing night sweats and other menopause symptoms may help. A consistent bedtime routine and a relaxing wind-down period can also be useful.

If sleep problems persist, discuss them with your healthcare professional.

Related reading: How to sleep in menopause

Eat regularly and aim for a balanced diet

When you're feeling low, planning meals and eating regularly can become difficult.

Try simple meals containing a source of protein, fibre-rich carbohydrates, fruit or vegetables.

These can help you meet your nutritional needs without creating another demanding task.

You don't need a perfect diet to look after yourself.

Related reading: Free Menopause Recipes

Find movement that works for you

Physical activity can support mental wellbeing, but it doesn't have to mean joining a gym or following an ambitious exercise programme.

A short walk, some gentle stretching, dancing in your kitchen or another activity you enjoy can be a useful starting point.

Choose something that fits your current energy levels and physical abilities.

Reduce the pressure where you can

If you're already overwhelmed, adding more tasks to your to-do list isn't going to help.

Consider whether there is one responsibility you could postpone, share with someone else or approach differently.

You may also benefit from taking a closer look at your working arrangements, caring responsibilities or other sources of ongoing stress.

Looking after yourself sometimes means doing less, not trying harder.

Don't underestimate the importance of support

When you're struggling with low mood, it can be tempting to withdraw from other people.

You might feel embarrassed about how you're coping, worry that nobody will understand or simply lack the energy to explain what is happening.

You may also be so used to looking after everyone else that asking for help feels uncomfortable.

But you don't have to manage everything alone.

Support might mean talking honestly to someone you trust, seeking professional help or finding a community where you can discuss menopause with people who understand its impact.

It could also mean asking for practical help with shopping, meals, childcare or other everyday responsibilities while you're struggling.

When low mood needs urgent help

If you're experiencing persistent low mood, worsening symptoms or difficulty functioning, seek professional support rather than trying to manage everything yourself.

If you're in a mental health crisis and need urgent help in England, you can call NHS 111 and select the mental health option. If you or someone else is in immediate danger, call 999 or go to A&E.

How menopause coaching may help

Sometimes, understanding the available options is only part of the problem. You may also be trying to work out which information is relevant to you, how to make changes when you're exhausted, or how to put advice into practice when life already feels overwhelming.

That's where menopause coaching may be helpful.

As a certified Menopause Wellness Practitioner and Women's Health Coach, I offer personalised, evidence-informed support to help women make sense of their symptoms, explore lifestyle changes and identify practical steps that fit their individual circumstances.

Coaching doesn't replace medical care, diagnose mental health conditions or prescribe treatment but it can complement the support you're receiving from your healthcare professionals.

And if low mood in menopause is affecting your ability to work, you may be able to access  fully funded support through the UK government’s WorkWell scheme.

WorkWell helps eligible people with health conditions and/or disabilities to manage barriers to work, remain in employment or explore a return to work.

Depending on your circumstances and local provision, support may include personalised guidance, help to identify workplace adjustments and connections to relevant services.

I have experience delivering menopause wellbeing support through these funded referral pathways. Ask your GP or employer for more information.

You deserve to feel heard, supported and equipped to make informed decisions about your health.

For further guidance on menopause treatment, see the NICE menopause guideline and the NHS menopause treatment advice.

Menopause expert Dr Louise Newson has a great podcast episode 'Mental Health issues and hormones' where she is joined by psychiatrist, Dr Louisa James.

And I have a FREE Menopause Health Guide for you to download:

DISCLAIMER: This page does not provide medical advice; it is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek professional medical advice on any of the topics or products covered on this page.