I love being a woman. I tell my sons this often because I genuinely enjoy so many of the fun things that come with it, the clothes, purses, shoes, makeup, hairstyles, and all the little things that make us happy.
But being a woman also means experiencing hormonal changes throughout our lives. We spend our younger years waiting for our first period and eventually reach a point where we’re ready for those monthly cycles to end. Unfortunately, what comes next isn’t always quite as exciting: menopause.
We hear plenty about hot flashes and irregular periods, but menopause can involve much more. Anxiety, depression, weight gain, sleep problems, brain fog, and joint pain can also appear during the menopausal transition.
As a psychiatric mental health nurse practitioner, I see women confused by changes in their mood and wondering why they suddenly don’t feel like themselves. Anxiety and depression may need treatment, but there’s another question worth asking:
Could peri-menopause or menopause also be contributing?
Let’s look at how “The Change” can affect both a woman’s body and her mental health—and what we can do about it.
What Happens to Women’s Hormones During Perimenopause and Menopause?
We know menopause as “The Change.” We’ve heard about it, we know it’s coming, but how do we actually know when it has started?
The menopausal transition can be thought of in three stages: Perimenopause, menopause, and postmenopause. During this transition, the ovaries gradually change the way they produce reproductive hormones, specifically estrogen and progesterone. These hormones have been working behind the scenes throughout our reproductive years, affecting much more than our menstrual cycles.
Estrogen
Think of estrogen as one of the great multitaskers of the female body.
- It plays a role in the reproductive system
- bone health
- body-temperature regulation
- skin and other tissues
- brain function.
- Estrogen also interacts with systems involved in mood and cognition, which becomes particularly important when we’re talking about women’s mental health.
Progesterone
Progesterone is another important reproductive hormone.
- It helps prepare and maintain the uterine lining for pregnancy and
- plays a role in the menstrual cycle.
Aside from our reproductive system, Progesterone and some of its metabolites also interact with brain systems involved in:
- sleep,
- anxiety,
- our response to stress.
Perimenopause: When Things Start Changing
Perimenopause is the transitional period leading up to menopause. This is when hormone production begins becoming less predictable.
Ovulation may occur less consistently, which can lead to lower or more erratic progesterone exposure. Estrogen can also fluctuate significantly, sometimes rising and sometimes falling rather than simply declining in a straight line.
And this is often when women begin noticing that something feels different.
- Periods may become irregular.
- Sleep can change.
- You may suddenly feel hotter than everyone else in the room.
- Anxiety may appear or worsen.
- Mood can become less predictable.
Some women experience changes in concentration, energy, or other symptoms without immediately realizing that hormones could be playing a role.
This is also where serotonin and dopamine enter the conversation. Estrogen interacts with several neurotransmitter systems in the brain, including serotonin and dopamine, which are involved in mood, motivation, reward, cognition, and emotional regulation. As estrogen levels fluctuate during the menopausal transition, these brain systems may also be affected. Hormones aren’t the only explanation for mood changes, but they can be an important piece of the puzzle.
Menopause: When Estrogen Declines
Eventually, ovarian estrogen production declines more substantially. Menopause is officially reached after a woman has gone 12 consecutive months without a menstrual period, assuming another medical reason isn’t responsible.
Around this transition, women may experience symptoms such as:
- hot flashes,
- night sweats,
- sleep disturbances,
- brain fog, mood changes,
- vaginal and urinary symptoms,
- joint or muscle discomfort.
After menopause, lower estrogen levels also become increasingly important when we think about bone health and long-term physical health.
This is why “The Change” is about much more than losing your period. Hormonal changes can affect the way you feel physically, think cognitively, and function emotionally and sometimes all at the same time.
Menopause, Anxiety and Depression: The Mental Health Connection
Menopausal women may struggle to understand who they are becoming. They may suddenly experience anxiety or depression for the first time in their lives. I often sit across from women in tears asking me, “What is wrong with me?”
Anxiety can feel like a loss of control. Everything suddenly seems overwhelming, and there may be a constant sense of worry about things that haven’t even happened. Hormonal fluctuations during perimenopause and menopause can affect brain systems involved in mood and our response to stress, making this an important factor to consider when anxiety suddenly appears or worsens.
Depression may look like hopelessness, low energy, loss of motivation, irritability, or no longer finding joy in things you once enjoyed. It can look different for every woman, but one important sign is recognizing a significant change from how you normally feel.
When I see these symptoms in women who may be experiencing the menopausal transition, I often encourage them to also speak with their OB-GYN. Menopausal hormone therapy may be appropriate for some women, depending on their symptoms and individual medical history. Mental health treatment may also be needed, including psychotherapy and medications such as SSRIs when appropriate.
The important thing is not to automatically assume “it’s just menopause” or, on the other hand, overlook hormonal changes completely. Sometimes both pieces need to be addressed.
Menopause Weight Gain, Joint Pain and Other Physical Changes
As estrogen levels decline, women may begin noticing physical changes in addition to changes in mood. One of the most common concerns is menopause weight gain, particularly an increase in fat around the abdomen. Hormonal changes can influence where the body stores fat, while aging, changes in muscle mass, activity levels, sleep, and metabolism can also contribute.
Women may also begin losing muscle and bone mass as they age, with bone loss accelerating around the menopausal transition. This is one reason strength training becomes increasingly important for women as we get older. Maintaining muscle and challenging our bones can help preserve strength, mobility, and long-term independence.
Joint pain is another complaint many menopausal women report. Estrogen has effects on inflammatory pathways and musculoskeletal tissues, so declining levels may contribute to increased joint and muscle discomfort in some women.
The changes don’t stop there. Women may notice differences in their skin, hair, cholesterol levels, and cardiovascular health as estrogen declines. Menopause is much more than the end of our menstrual cycle, it represents a transition that can affect health throughout the body.
Treating Menopause Symptoms: What Can Actually Help?
Learning about all the changes we may face during menopause can make the future sound a little discouraging. While we cannot stop the natural biological changes that come with aging, we can take steps to reduce their impact and protect our long-term health.
Strength training is one of the most important habits women can incorporate as we get older, particularly during our 40s and beyond. Resistance exercise helps preserve muscle, supports bone health, improves strength, and provides important mental health benefits. In my previous article, Strength Training for Women: Build Strength, Confidence & Better Mental Health, I discuss these benefits and how beginners can get started.
Nutrition matters too, especially protein. As we age, maintaining muscle becomes increasingly important, and adequate protein combined with resistance training helps support muscle maintenance and growth. Protein also contributes to bone health and satiety, which can be helpful as sleep, appetite, activity, and metabolic changes make weight management more challenging.
Don’t overlook sleep and mental health care either. Poor sleep can worsen mood, anxiety, energy, appetite, and concentration. Depression and anxiety during the menopausal transition also deserve proper evaluation and treatment rather than simply being dismissed as “hormones.”
Finally, menopausal hormone therapy (MHT) may be an appropriate treatment for certain menopause symptoms in some women. Whether it’s right for you depends on your symptoms, health history, age, timing, and individual risk factors. This is an important conversation to have with your OB-GYN or another healthcare professional experienced in menopause care.
Menopause may change our bodies, but it doesn’t mean we have to simply accept every symptom without asking what we can do about it.
Conclusion
Menopausal women can struggle with the many changes happening to their bodies and minds while trying to hold on to a sense of who they are. These changes are a natural part of life, but knowing what to expect and understanding how to manage the symptoms can make this transition a little easier to face.
Anxiety often grows from the fear of the unknown. Learning about your body, recognizing changes when they happen, and creating a lifestyle that supports your physical and mental health can help you feel more prepared for this next stage of life.
Menopause represents change, but change doesn’t have to mean losing yourself. This can also be a time to become more intentional about your health, advocate for what you need, and build habits that help you become a stronger and healthier version of yourself.
And remember, you don’t have to navigate this transition alone. Talk with your healthcare providers, ask questions, and seek support when you need it. Understanding what is happening to your body is one of the first steps toward taking care of it.
