Self-care is important at any stage of life, but it’s particularly so during times of change, like perimenopause. And just as you would take care of symptoms like hot flushes and night sweats, you need to look after your mental health too. Vhi Clinical Psychologist, Dr Ruth McIntyre, provides tried and tested techniques for looking after your mental health and delves into an area a lot of us struggle with - saying no! 

In what ways can women’s mental health be impacted during perimenopause?

There are many ways in which a woman’s mental health can be impacted during perimenopause. Symptoms such as low mood, anxiety, irritability, difficulty concentrating, memory problems, low energy and poor sleep may all occur at this time. Experiencing a time of such big change, which involves very real physiological changes, can be stressful. How a woman interprets this change and how much the symptoms she is experiencing interfere with her life can have a significant impact on her wellbeing. Although many women will experience some emotional symptoms of perimenopause, Dr McIntyre highlights that the experience is different for every woman and while it may be challenging, the majority of women will cope just fine with the transition.

What causes these effects on mental health during perimenopause?

There are hormonal and non-hormonal causes for the changes to women’s emotions and mental health during perimenopause. On the hormonal side of things, you have oestrogen and progesterone, which are responsible in different ways for regulating mood; both are affected by perimenopause. The hormonal changes that occur impact the brain, and as the brain adapts to these hormonal fluctuations, its emotional regulation and control centres are impacted. Sleep, along with thinking skills, including concentration and memory, can also be affected.

When it comes to the non-hormonal factors that can impact mental health during perimenopause, it’s mostly environmental and social influences; things that naturally happen at this stage of life when perimenopause usually takes place. This can include a high-stress or demanding job, care responsibilities within the family, including hormonal teenage kids, concerns about aging parents, relationship issues or lack of support from those around us.

Will all women in perimenopause experience changes to their mental health?

Not necessarily. Dr McIntyre says that similar to the onset of menstruation and the hormonal fluctuations that women are already familiar with, some women might find that they are affected by emotional symptoms while others won’t have issues with them.  

What are common emotions that women experience during this life stage?

Regulating emotions in general can be tricky for some women during perimenopause due to fluctuating hormone levels. Feeling overwhelmed or anxious about things that might not have made you feel that way previously is also quite common. Irritability and anger can also occur, which can have a negative impact on relationships. Some women can feel a sense of sadness during this time, maybe in regard to feelings of losing their youth or fertility. Dr McIntyre says that it’s completely understandable to feel a range of emotions and suggests speaking to your healthcare provider if the emotions are interfering with your day-to-day life or feel like too much for you to cope with alone.

Are there ways women can safeguard their mental health during perimenopause?

First and foremost, you should prioritise sleep, eating well and being physically active. Mindfulness can also be useful because it helps develop awareness of your internal state, including thoughts, emotions and bodily sensations. This allows women to feel better equipped to handle the changes they experience with perimenopause. Connecting with others and drawing on the supports available to you is also important, like friends, family or online perimenopause and menopause groups. If these measures don’t help in the way you’d hoped, speak to your healthcare provider about the various treatments that are available to alleviate your symptoms. Some other things that may help safeguard your mental health during perimenopause include:

• Meditation
• Yoga
• Workshops or events about perimenopause and menopause 
• Podcasts focused on coping with perimenopause and tips from other women
• Journaling
• Gratitude practice
• Stress management. Different things work for everyone, such as exercise, breathing exercises, therapy, massage, and connecting with others or simply allocating time to do the things you enjoy
• Complementary and alternative therapies such as acupuncture, aromatherapy and herbal remedies
• Self-compassion

What about women that already live with mental health challenges or diagnoses?

If you’ve struggled with your mental health in the past or still do, Dr McIntyre says that this does not mean you’ll struggle again or more during perimenopause, however, it can make it a little more likely. It’s good to “loosely” prepare, but don’t overwhelm yourself with assumptions that you’ll have a difficult time coping mentally. It’s possible you already have the tools and coping strategies that you know are effective in helping your mental health, and Dr McIntyre advises drawing on them again during perimenopause. Educate yourself about perimenopause and consider what you can do to support your body and mind in the best way you can. Always speak to your healthcare provider if you’re struggling.  

What are some behaviours and habits women should avoid during perimenopause to safeguard their mental health?

It’s wise to avoid unhealthy behaviours that are a bad idea during any stage of life. Things like smoking, excessive alcohol consumption, and eating food that isn’t nourishing should be avoided. Aside from these, if certain contexts or settings tend to exacerbate your symptoms, you may want to try changing things up, for example, choosing restaurants you know have air conditioning when planning a meal out so that you feel more comfortable.

Dr McIntyre says learning to say no is valuable and will help you to avoid taking on too much and becoming overwhelmed. For many of us, saying no can make our skin crawl! Dr McIntyre recommends exploring your fear around saying no; is it from previous experience of people’s reactions? Are you just assuming there will be a bad reaction? It’s important to acknowledge your needs and feelings and give yourself permission to say no if that is what feels right for you. Remember that you have the right to say no and deserve the self-respect of saying no when you need to, and in fact, most times people will completely accept your answer. Respectfully saying no both at home and in the workplace can be beneficial for everyone involved―you can function better and give your best when you don’t have too much on your plate.

As for the things that absolutely must be done but cause you stress, try to give yourself more time and space to do them throughout perimenopause.

At what point should a woman see a healthcare professional if experiencing changes to their mental health during perimenopause?

If you don’t feel like you’re coping during perimenopause, or you’ve tried healthy lifestyle behaviours like those discussed above and are still struggling, speak to your healthcare provider for guidance. It’s important for women to remember that they aren’t alone, and there is no need to deal with their symptoms without professional help.  

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately. 

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