Symptoms are frequently put down to other things, with women being prescribed antidepressants when hormone replacement therapy (HRT) may be more appropriate.

“Symptoms go far beyond hot flushes, and include things like ‘flat affect’, mood changes, withdrawal and exhaustion,” says psychologist and author Dr Audrey Tang.

“The problem is, this often affects women when they are established and growing in their careers, or may have young families, and it’s often put down to stress, so help isn’t sought.”

“Menopause symptoms may be confused with other medical conditions, so do get it checked – and ask for a second opinion if you are worried. Endometriosis, adenomyosis and even cancer can share some symptoms.”

In perimenopause

“Many women experience anxiety and depression due to the change in hormonal balance in perimenopause,” says Dr Shirin Lakhani, intimate women’s health expert and menopause specialist.

“Low mood, depressive symptoms and anxiety are often the first symptoms of perimenopause,” she explains.

“Many women also experience relationship difficulties due to the perimenopause, and whole family dynamics can change, as partners and family members do not know how to support women.”

Body changes may prove challenging, too.

“Women may also feel a loss of self-esteem as their bodies change, and concerns about ageing can develop. Perimenopause can also cause problems with sleeping, and tiredness can make symptoms such as being able to concentrate and anxiety much worse,” Lakhani explains.

“A lot of women I speak to have no idea what’s going on and feel they are going completely crazy. Even if it’s just having someone to listen to and acknowledge something is going on is very helpful. Often, once they are on hormones (HRT), they feel like they have themselves back again.”

It is upsetting to hear that women’s enjoyment of life often slips.

“Women may also experience a loss of interest in activities they previously enjoyed, as well as an increase or decrease in appetite and weight, and even thoughts of suicide. Sadly, we recently heard about the tragic case of Frances Wellburn, who took her own life in 2020. The link between menopause and poor mental health must be reviewed,” she states.

“If you already have a pre-existing mental health condition, it is also possible that the symptoms of menopause will cause a relapse or change to your mental health, so people need to be aware of this.”

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In menopause

“For the menopause itself, which is when you have not had a period for a year, women can experience similar mental health challenges to perimenopause, but things should get better as hormones start to settle down,” notes Lakhani.

This can provide some relief, but may continue to pose challenges for many people. Changing hormone levels can still cause mood swings, low mood and anxiety.

“Typically, the mood fluctuations as a result of hormonal changes won’t last and will ease. A lot of women are really scared they will need to take antidepressants for the rest of their life, but this isn’t the case. It should be temporary.”

Lakhani says menopausal women do need to be aware of a link between estrogen and brain functionality.

She says that “as estrogen levels dip in the menopause, many women experience feelings of memory loss and brain fog”.

So, if you are struggling, it is still worth getting support, even if your hormones are settling down.

What to do about it

Recognising the symptoms is one thing, but taking the next step can often be tricky. Dr Sohère Roked, GP, functional medicine and hormone doctor, advises taking a holistic approach, to see if any lifestyle changes can improve your situation.

“It may be HRT is recommended to help ease and balance your symptoms, but unless you also address lifestyle factors, it could exaggerate your symptoms, or you may not see all of the benefits. Lifestyle factors include drinking, smoking, high-stress levels in your everyday life, and a lack of exercise.”

Try giving up or cutting back on bad habits, take up a fitness class or start walking with a friend, and try to tune in to when you might be feeling stressed and do something about it – whether that’s mindfulness, exercise or just talking.

If you’ve not felt like yourself for a while, feel unwell or are struggling in any way, Roked also suggests speaking to your GP, or seeking a trained mental health or medical professional to guide you.