Towards Better Mental Health in Midlife

Some women are vulnerable to mental health issues in midlife, but there are strategies that can help women get faster, targeted relief and thrive.

Hadine Joffe, MD, MSc

Disturbance of mood is common in midlife women across the menopause transition. While clinical depression is less prevalent, depressive symptoms, anxiety, and irritability affect a large proportion of women in perimenopause and early postmenopause. Women with a history of depression are more vulnerable to an episode of depression as hormones fluctuate during the menopause transition.

At the Translational Science Symposium on Midlife Wellbeing held in advance of the 2021 Annual Meeting of the North American Menopause Society, expert Dr. Hadine Joffe, Professor of Psychiatry, Women’s Health, at Brigham and Women’s Hospital, Harvard Medical School, shared with healthcare providers a framework for understanding mental health in midlife women and potential factors contributing to mental health changes. She also offered strategies for women to recognize mood issues and get the help they need more quickly.

The Link Between Perimenopause and Mental Health

If you’re experiencing your first episode of depression during perimenopause the underlying causes may be hormonal changes, hot flashes, and sleep disturbance. However, not all mental health symptoms that arise during the menopause transition are attributable to menopause. Perimenopause occurs at a time in life when life events and stressors may make women more vulnerable to mood disruption. 

When considering whether your depression is related to perimenopause or not, you and your health care provider will examine factors like:

• History of depression
• Menstrual cycle changes
• Presence of hot flashes and sleep disturbance
• Presence of other considerable life stressors

Towards Better Mental Health

Mental illness is the leading burden of illness in women, despite the fact that they are increasingly aware of the imperative for good mental health and wellbeing. Poor mental health in midlife erodes wellbeing at a time when women are at their most productive in the workplace, shoulder family responsibilities, and are adapting to changes in their physical health. Many women recognize the mind-body connection and seek to understand how changes in their body and in their environment might influence their mood state; they seek strategies to counter these pressures and bring balance to their lives. 

The intersections between midlife, the menopause transition, and mood are complex to disentangle. Strategies to protect mental health and manage any new distress and depression symptoms require an understanding of the causes in order to select the most specific treatment approach(es). To quickly get to the root cause and treatment for your mood issues, these are the most important steps you can take:

• Knowledge: Like in many areas of health, knowledge is power. Recognize that mood issues may become more prevalent in midlife. Self-awareness during this life stage can lead to faster diagnosis and treatment. 
• Data: The next step is to track menopause symptoms and life stressors. The more information you can give your healthcare provider about your menopause transition, history of prior mood issues, and life stress, the better. Keep a journal or use an app that tracks menopause symptoms.
• Self-Care: It may be tempting to sleep longer, avoid exercise, indulge in comfort food, or drink an extra glass of wine to manage mood. However, these are the very behaviors to avoid. It may be hard, but focus on daily exercise, healthy eating, limiting your alcohol, and connecting with supportive family and friends.

By tracking your mood you can help your healthcare provider assess your situation and ultimately, if needed, help you find the best treatment — whether behavioral or pharmacologic. Remember, mood issues are not something you have to suffer through in hopes they will eventually go away. Seek out help from a qualified healthcare provider. Your middle years can be the most rewarding of your life. Don’t let mood issues stand in the way of thriving in midlife.

This information was presented at the Translational Science Symposium “Charting the Path to Health in Midlife and Beyond: The Biology and Practice of Wellness” held in advance of the 2021 Annual Meeting of The North American Menopause Society in Washington, DC. Excerpts from the Translational Science Symposium are presented as part of the Live From #NAMS2021: The Latest Breakthroughs in Women’s Midlife Wellness series published by Women Living Better and Lisa Health with permission from NAMS. 

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