Mental Health Challenges During the Menopause Transition

As the ovarian hormones estrogen and progesterone decline, women may experience a decrease in resilience and the ability to cope with everyday stressors. This is due to the presence of estradiol receptors throughout the body, particularly in the brain. When estrogen levels drop, these receptors stop functioning properly, leading to neuro-inflammation and a reduction in the function of receptor sites for key neurotransmitters such as serotonin, dopamine, and norepinephrine. Consequently, women may experience new or increased anxiety, depression, panic attacks, ADHD symptoms, brain fog, and memory difficulties during this time. However, these changes are not permanent, and the receptors can be reactivated if estrogen is replaced.

Perimenopause can begin 7-10 years before menopause, which means that many women may experience these mental health issues well before they realize they are in perimenopause. As a result, the actual cause of these changes is often overlooked or misattributed to other factors. In addition, the menopausal transition is accompanied by physiological changes, such as sleep disruptions, weight fluctuations, and metabolic shifts, which can further exacerbate mental health symptoms.

While these changes can cause intense suffering and difficulty, there are things that can be done. The following strategies have been shown to be beneficial in improving mental health and life satisfaction. It may take multiple dietary and lifestyle changes to find a new balance, but it can get better. If you are in crisis please seek professional help. These struggles can be severe and should be addressed.

Minimize or Eliminate Processed Foods

Consumption of ultra processed foods has been associated with an increased risk for anxiety and depression. These foods are also low in nutrients which the body needs for production of hormones and neurotransmitters. Reduce or eliminate added sugars, refined grains, fried foods, and processed meats.

Try a Dietary Prescription

The Mediterranean, Japanese, and Norwegian diets have all been shown to be beneficial for mental health. These dietary patterns incorporate fruits, vegetables, legumes, nuts, seeds, whole-grains, and foods rich in omega-3 fatty acids. Processed foods and sweets are limited.

Eat More Fruits and Vegetables

Fruits and vegetables contain compounds that positively impact mental well-being. Research shows that consuming at least five servings each day can benefit mental health. Aim for a variety of colors. Buying frozen produce is a healthy way to expand your options throughout the seasons.

Try Eating More Fiber

Studies have found that diets higher in fiber result in less depressive symptoms. This could be due to the higher nutrient content in less processed foods and because fiber is beneficial for gut bacteria that help in the creation of neurotransmitters. Choose fruits, vegetables, whole-grains, legumes, nuts, and seeds. Aim for around 25 grams of fiber per day. If you aren't used to eating fiber, increase your intake slowly to avoid digestive distress.

Improve Your Gut Microbiome

Improving the gut microbiome can be useful in improving sleep quality.  An imbalance in the gut microbiome can negatively impact sleep, and poor sleep can further contribute to gut imbalance, creating a bidirectional, vicious cycle. The gut microbiome plays an important role in the production of compounds that influence sleep, wakefulness, stress, and anxiety, such as the neurotransmitters serotonin, dopamine, GABA, and the hormones cortisol, adrenaline, and melatonin. When the gut microbiome is not functioning optimally, the necessary compounds for quality sleep are not produced effectively, and poor sleep can create an environment where these compounds are not synthesized adequately. Improving gut health involves lifestyle modifications like exercise, stress reduction, and increasing fiber intake from diverse plant sources like fruits, vegetables, legumes, nuts, and seeds. The indigestible fibers in these foods travel to the colon, where they ferment and produce short-chain fatty acids, which have been shown to improve sleep quality and reduce the stress hormone cortisol while enhancing melatonin production. Consuming at least 30 different plant foods weekly can provide the beneficial gut bacteria with a diverse range of fibers for fermentation. Probiotics containing at least 40-50 billion colony-forming units (CFUs) and multiple species may also be useful in improving gut health. Incorporating fermented foods like unsweetened yogurt, kefir, kimchi, and refrigerated sauerkraut can further increase gut microbiome diversity.

Exercise Regularly

Physical activity can improve mood and help increase resilience to stress. Exercising with friends or in a class setting can be an additional mood booster because of the added benefits of social connection. If exercise is difficult or painful, start slow by incorporating short walks.

Reduce Inflammation

Inflammation in the body is associated with depression, anxiety, and poor cognition. Avoid processed foods, added sugars, smoking, and toxins. Address sources of chronic inflammation with your doctor. One common source of inflammation is gum disease. Be mindful of your oral hygiene.

Prioritize Sleep

Adequate sleep is crucial for maintaining mental well-being. Disrupted sleep is common in the menopause transition and the disruption often leads to poor mental health which can then lead to more disrupted sleep.  Implement good sleep hygiene practices and address any sleep disturbances. This one can be tricky and will probably take multiple interventions to get sorted out. Seek medical help if necessary.

Manage Stress

Chronic stress can significantly impact mental well-being and sleep quality, which become especially crucial during menopause when resilience may be lower. Managing stress levels is more important than ever during this time. Incorporating mindful practices such as meditation or yoga can improve mental health and help alleviate some menopausal symptoms. Additionally, positive social interactions can make a substantial difference in overall well-being.

Many women approaching menopause have endured high stress levels for years. The hormonal fluctuations during this transition can alter your ability to cope with stressors you've previously managed well. While reducing stress can be challenging amidst life's responsibilities, it's crucial to recognize that many menopausal symptoms are exacerbated by stress. Prioritizing stress management can greatly improve your symptoms and, consequently, your overall quality of life.

Consider Supplements

The following supplements may be helpful in supporting mental well-being. Getting lab work done can help diagnose vitamin and mineral deficiencies that may be contributing to mood struggles. Check with a doctor before adding supplements as they can interfere with the efficacy of medications.

• Omega-3 - 1-2 grams/day of EPA or and EPA/DHA combination

• Vitamin D - 1500-4000 IU/day

• Probiotics - 1-10 billion colony forming units/day

• Zinc - 25 milligrams/day

• Vitamin C - 1 gram/day

• Tryptophan - 1 gram/day or 50-200 milligrams 5-HTP (Check with doctor and do not take in conjunction with antidepressants.)

• St. John's Wort - 600-1800 mg/day (Check with a doctor to determine dosage needs and eligibility and do not take with antidepressants.)

• Lavender - 80-160 mg/day

• Ashwagandha - 300-600 mg/day

Sources:

1. Photo by micheile henderson on Unsplash

2. McAdam, Emmal. How Menopause Impacts Anxiety, Depression, and Panic Attacks. Therapy in a Nutshell. Available at: https://www.youtube.com/watch?v=TTIlai-6kD8. Published May 2, 2024. Accessed May 7, 2024. 

3. Lane MM, Gamage E, Travica N, Dissanayaka T, Ashtree DN, Gauci S, Lotfaliany M, O'Neil A, Jacka FN, Marx W. Ultra-Processed Food Consumption and Mental Health: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients. 2022 Jun 21;14(13):2568. doi: 10.3390/nu14132568. PMID: 35807749; PMCID: PMC9268228. Accessed May 8, 2024. 

4. Barrea L, Pugliese G, Laudisio D, Colao A, Savastano S, Muscogiuri G. Mediterranean diet as medical prescription in menopausal women with obesity: a practical guide for nutritionists. Crit Rev Food Sci Nutr. 2021;61(7):1201-1211. doi: 10.1080/10408398.2020.1755220. Epub 2020 Apr 24. PMID: 32329636. Accessed May 8, 2024. 

5. Selhub, Eva. Nutritional Psychiatry: Your Brain on Food. Harvard Health Publishing. Harvard Medical School. Available at: https://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626. Published September 18, 2022. Accessed May 8, 2024.

6. Opie RS, Itsiopoulos C, Parletta N, Sanchez-Villegas A, Akbaraly TN, Ruusunen A, Jacka FN. Dietary recommendations for the prevention of depression. Nutr Neurosci. 2017 Apr;20(3):161-171. doi: 10.1179/1476830515Y.0000000043. Epub 2016 Mar 2. PMID: 26317148. Accessed May 8, 2024. 

7. Głąbska D, Guzek D, Groele B, Gutkowska K. Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review. Nutrients. 2020 Jan 1;12(1):115. doi: 10.3390/nu12010115. PMID: 31906271; PMCID: PMC7019743. Accessed May 8, 2024. 

8. Xu H, Li S, Song X, Li Z, Zhang D. Exploration of the association between dietary fiber intake and depressive symptoms in adults. Nutrition. 2018 Oct;54:48-53. doi: 10.1016/j.nut.2018.03.009. Epub 2018 Mar 21. PMID: 29747090. Accessed May 8, 2024.

9. Nikolova VL, Smith MRB, Hall LJ, Cleare AJ, Stone JM, Young AH. Perturbations in Gut Microbiota Composition in Psychiatric Disorders: A Review and Meta-analysis. JAMA Psychiatry. 2021 Dec 1;78(12):1343-1354. doi: 10.1001/jamapsychiatry.2021.2573. Erratum in: JAMA Psychiatry. 2021 Nov 3;: Erratum in: JAMA Psychiatry. 2022 Dec 1;79(12):1241. PMID: 34524405; PMCID: PMC8444066. Accessed May 8, 2024. 

10. Deslandes A, Moraes H, Ferreira C, Veiga H, Silveira H, Mouta R, Pompeu FA, Coutinho ES, Laks J. Exercise and mental health: many reasons to move. Neuropsychobiology. 2009;59(4):191-8. doi: 10.1159/000223730. Epub 2009 Jun 10. PMID: 19521110. Accessed May 8, 2024. 

11. Harsanyi S, Kupcova I, Danisovic L, Klein M. Selected Biomarkers of Depression: What Are the Effects of Cytokines and Inflammation? Int J Mol Sci. 2022 Dec 29;24(1):578. doi: 10.3390/ijms24010578. PMID: 36614020; PMCID: PMC9820159. Accessed May 21, 2024. 

12. Brown GC. The endotoxin hypothesis of neurodegeneration. J Neuroinflammation. 2019 Sep 13;16(1):180. doi: 10.1186/s12974-019-1564-7. PMID: 31519175; PMCID: PMC6744684. Accessed May 8 2024. 

13. Sarris J, Ravindran A, Yatham LN, Marx W, Rucklidge JJ, McIntyre RS, Akhondzadeh S, Benedetti F, Caneo C, Cramer H, Cribb L, de Manincor M, Dean O, Deslandes AC, Freeman MP, Gangadhar B, Harvey BH, Kasper S, Lake J, Lopresti A, Lu L, Metri NJ, Mischoulon D, Ng CH, Nishi D, Rahimi R, Seedat S, Sinclair J, Su KP, Zhang ZJ, Berk M. Clinician guidelines for the treatment of psychiatric disorders with nutraceuticals and phytoceuticals: The World Federation of Societies of Biological Psychiatry (WFSBP) and Canadian Network for Mood and Anxiety Treatments (CANMAT) Taskforce. World J Biol Psychiatry. 2022 Jul;23(6):424-455. doi: 10.1080/15622975.2021.2013041. Epub 2022 Mar 21. PMID: 35311615. Accessed May 8, 2024.