Taking Care of Your Mental Health in Menopause

For many women, their peak earning years —the career phase when they’re most likely to take on senior roles and make the most money—occur in their 40s and 50s. This, coincidentally, is also the age they’re likely to experience menopause. So, it’s hardly surprising that a 2021 survey conducted by the U.K. government found that almost one million British women had left their jobs because of menopause. The resulting workforce shortage prompted parliament to launch a menopause task force to promote access to support and treatment and combat stigmas in the workplace.

While change is happening on the ground in the U.K., the ripple effects are already being felt around the globe. This includes in the U.S., where the conversation around menopause is not only shifting in the public domain but also behind closed doors with mental health professionals.

“This movement would not be happening had it not been for what happened in the U.K.,” says New York City-based psychiatrist and media consultant Dr. Judith Joseph, who also credits the stateside shift in the conversation around menopause to the wealth of information at our fingertips.

As a result of her research in the areas of postpartum depression and high-functioning depression, coupled with the work she does with patients, Dr. Joseph is interested in the connection between women’s mental health and hormones. Menopause can manifest in the form of both physical and emotional changes. Dr. Joseph often helps patients determine whether menopause symptoms such as depression, anxiety, poor concentration, and loss of identity are mental health issues or side effects of fluctuating hormones.

To help determine whether your anxiety or depression is a psychological issue or a symptom of menopause, Dr. Joseph suggests using her Three Ps formula. “I tell patients, look at those three things—physical changes, period changes, and your past history—and then bring that to your doctor,” she says.

Physical changes:

None of the criteria used to define major depressive disorder include physical changes. If you’re experiencing depression accompanied by dry skin and hot flashes, for example, you may want to consider the role menopause might be playing in your symptoms.

Period changes:

Has the frequency, duration, or amount of your menstrual flow changed? “It never ceases to surprise me how often women are like, I forgot that I stopped getting my period,” says Dr. Joseph. “And lo and behold, it coincides along the time when the memory problems were starting years before where they were having patchy periods, and they were having this gradual issues with forgetfulness and not functioning in their capacity.”

Past history:

If you have a family or personal history of depression or anxiety, then you’re more likely to have major depressive disorder in midlife. “But if this is your first depression and it’s in midlife, then you really need to be thinking about hormone fluctuations,” says Dr. Joseph, while also noting the genetic component of menopause. “I usually tell my patients that it’s helpful to draw a family tree when you come to a doctor’s office, have your family tree ready as much as possible—these are things that my family experienced—because you’re likely to experience things that your people who are genetically linked to you did. I also ask my patients to bring their own past histories with them to doctor’s offices. Because if you have a history of trauma, you’re likely to have worsened symptoms in menopause.”

Once it’s been determined that your symptom is connected to menopause, Dr. Joseph recommends coming up with a treatment plan with your gynecologist, who may suggest hormone therapy. In the case of mental health issues, patients who may not want to pursue this approach often turn to Dr. Joseph for a plan B. Here, Dr. Joseph taps into her T.I.E.S method (Thinking. Identity. Emotions. Sleep.). This tackles the cognitive and psychological issues associated with perimenopause and menopause.

T.I.E.S. draws upon therapeutic modalities like dialectical behavioral therapy, which she explains as “a specific type of cognitive behavioral therapy that helps with distress tolerance and mood regulation.” It involves organizational skills therapy and cognitive behavioral therapy, which helps people with anxiety and depression. It has also been proven effective in addressing emotional dysregulation within perimenopausal mood changes.

Many women are often in denial when it comes to menopause. Dr. Joseph has always been a proponent of preparing patients for a healthy start to the second part of their lives. “Just like you would plan a nest egg for retirement, start planning for your ovaries’ retirement. It doesn’t mean that you retire, but you want to live a long, healthy life where you’re not getting your bones broken, and you’re not having balance issues,” says Dr. Joseph.

She cites your 30s and 40s as a time to start eating a lot of protein, lifting weights to build muscle mass, getting rid of toxic habits like smoking and drinking heavily, taking vitamins, learning how to manage your stress, and implementing mindfulness strategies. “We spend so much time investing in our education and in our finances, but not in our long-term physical and mental health. And what’s the point of having all that money in the bank if you don’t have your health?”