Anxiety, sleep issues, inner restlessness, and even depressive symptoms can accompany menopause. Mental health deserves far more attention during this phase of life.

Every year on October 10th, World Mental Health Day draws attention to a topic that is still talked about too little:mental well-being. For women in midlife, taking a closer look at menopause is highly worthwhile. This stage can involve far more than hot flashes, night sweats, and irregular cycles. Mood, sleep, and emotional health can shift significantly as well.

When Everything Suddenly Feels Different

Perhaps you know the feeling: overall, your life is going fine. Career, family, relationships, daily routines. You function as usual. Yet, at some point, you realize that something feels off.

You become irritable more quickly. Your thoughts race. You sleep poorly and feel exhausted the next day. Activities that used to bring you joy suddenly feel overwhelming. Perhaps an inexplicable sense of anxiety creeps in.

And eventually, you ask yourself: What is actually wrong with me?

Because these changes often begin subtly, they are not always linked to perimenopause. However, the hormonal shifts during this time can directly impact the brain and psychological health.

This does not mean that every mood swing is purely hormonal. Depression, anxiety disorders, and other mental health conditions can occur independently of menopause. Nonetheless, accounting for this hormonal transition is essential when considering the whole picture.

How Hormones Interact with the Brain

Estrogen and progesterone do not only act on the reproductive organs. Estrogen influences brain processes tied to mood regulation, stress response, sleep, and cognitive function.

During perimenopause, hormone levels do not simply decrease gradually. Their concentrations can fluctuate wildly. For many women, this hormonal unpredictability manifests as changes in mood, sleep quality, and emotional resilience.

At the same time, perimenopause often coincides with a demanding life stage: career responsibilities, growing or departing children, caring for aging parents, evolving relationships, and a daily grind where personal needs are frequently pushed to the background.

Therefore, midlife mental health can rarely be attributed to a single cause. Hormones play a role, as do sleep quality,stress levels, life circumstances, and individual psychological history.

A New Study Highlights a Blind Spot

The extent of emotional strain women experiencing menopausal symptoms face was highlighted in a 2026 study published in the British Journal of Psychiatry International. Researchers evaluated 957 women attending a specialized menopause clinic in the UK. At baseline, 16.6% of participants—about one in six women in this clinical cohort—reported suicidal ideation. Over 70% exhibited moderate to severe depressive or emotional distress.

These findings must be interpreted within the context of the study population. The participants were not a representative sample of all menopausal women, but rather individuals seeking help at a specialized clinic due to severe symptoms. Thus, the 16.6% figure cannot be generalized to the broader population.

Over the course of two to six months, the participants' psychological symptoms improved significantly. Treatment included individualized hormone replacement therapy (HRT) with estradiol, progesterone, and in some cases testosterone. Even among women who reported suicidal ideation at the start, scores on depression questionnaires decreased.

However, this does not imply that HRT is a general treatment for depression or suicidal thoughts. The study was observational and lacked an untreated control group, meaning a direct cause-and-effect relationship cannot be definitively established.

What the study ultimately underscores is that mental health symptoms during perimenopause deserve serious attention and should never be dismissed as something women simply have to "tough out."

When Sleep and Stress Add Pressure

Sleep is a key area where physical and psychological changes intersect. Many women experience a sudden decline in sleep quality during perimenopause. Hot flashes and night sweats play a role, as do the hormonal fluctuations themselves.

Sleep deprivation, in turn, directly compromises emotional resilience. Prolonged poor sleep increases sensitivity to stress, irritability, brain fog, and emotional vulnerability—compounded by the relentless demands of daily life.

This can easily turn into a vicious cycle: Hormonal fluctuations → poorer sleep → increased fatigue → lowered stress resilience → worse mood → further impaired sleep. This cycle illustrates why different symptoms during this life phase frequently reinforce one another.

Red Flags You Should Take Seriously

Not every bad day is a cause for concern. We all experience times when life feels overwhelming. However, if psychological shifts persist or mark a clear departure from your usual baseline, it is important to pay closer attention.

Take note if you experience:

• Persistent feelings of sadness, numbness, or emptiness.

• A significant increase in anxiety or internal restlessness.

• Ongoing, chronic sleep disruption.

• Loss of interest or joy in activities you normally enjoy.

• Growing feelings of being overwhelmed or hopeless.

• Feeling like you no longer recognize yourself emotionally.

• Thoughts of death or wishing you were no longer alive.

If you experience thoughts of self-harm or suicide, please do not go through it alone. Reach out to a trusted person, or seek professional support from your gynecologist, a psychotherapist, or a psychiatrist.

Self-Care Is More Than a Bubble Bath

"Self-care" often sounds like a wellness marketing phrase. In the context of perimenopause, however, it means something far more foundational: tuning back into your body's signals and emotional state.

• How am I truly feeling right now?

• How much quality sleep am I getting?

• What daily demands are draining my energy the most?

• Where am I holding chronic tension?

• What do I actually need right now?

Women who have spent decades prioritizing others often push these questions aside. Perimenopause can serve as a vital cue to bring your own needs back to the forefront.

Prioritize Sleep

If you suffer from long-term sleep disruption, do not accept it as an inevitable part of aging. A consistent sleep routine, natural daylight exposure, regular movement, and targeted supplementation can help. If problems persist, consult a doctor. Be sure to discuss sleep issues and mood changes with your gynecologist alongside physical symptoms.

Find Joy in Movement

Regular physical activity supports mood regulation, sleep quality, and stress relief. It doesn't require intense daily workouts—walking, cycling, yoga, dancing, or swimming all work well. Choose movement that brings you joy rather than adding another chore to your task list.

Nourish Your Body Regularly

Nutrition plays a crucial role in maintaining energy, overall physical well-being, and mental resilience. The goal during perimenopause is not dietary perfection, but consistently supplying your body with energy and nutrients. The gut microbiome is particularly relevant here: via the gut-brain axis, the gut communicates closely with the brain. A diverse, plant-rich diet supplies a variety of fibers that nourish beneficial gut bacteria.

Re-evaluate Stress

Many women have spent decades managing high stress—balancing careers, family care, household management, and endless obligations. Ask yourself: What can I do less of? Cancel unnecessary appointments. Stop responding to every message immediately. Delegate tasks. Take real breaks. Set boundaries. This, too, is essential preventive health care.

You Don't Have to Suffer Through Menopause Alone

Perimenopause brings many shifts. Some are immediately physical, while others manifest in sleep, mood, or stress tolerance.

That is precisely why looking beyond physical symptoms matters. How do you feel overall? Are you sleeping well? Do you have enough energy? Do you feel balanced, or do you notice a shift?

World Mental Health Day (October 10) and World Menopause Day (October 18) highlight two topics that are deeply interconnected. Midlife health is about far more than managing symptoms or tracking numbers on a scale—it is about how you feel, how you experience daily life, and your overall quality of life.

Knowledge is power. The more we understand about the changes occurring during perimenopause, the better we can make sense of our experiences and seek the right support.

About the Author:

Mag. Carmen CREPAZ, MSc.
Nutritionist and Functional Health Coach
Master's in Nutrition and Sports
www.carmencrepaz.com/blog