Mental Health and Cognition in Menopause

Does Menopause Impact Cognition & Mood?

Changing hormones can trigger mood swings that turn things that used to not bother us into things we cannot tolerate. The percentage of women who experience mood swings and depressive symptoms during perimenopause and following menopause varies depending on the source however, this has a major impact on quality of life and should be monitored.  The hormonal drops that occur during menopause can set off depressive episodes. For women who have experienced depression in the past, they are more vulnerable to depression during menopause but even women who have never had depressive symptoms can find themselves facing this in perimenopause. 

Some of the key mood challenges associated with menopause include:

• Anxiety and/or feeling overwhelmed

• Irritability

• Loss of patience or coping

• Sadness

• Emotional flatness

• Troubles with motivation

• More frequent crying sometimes more intensely and unexpectantly

It can be exacerbated by having hot flashes and issues creating sleep deprivation such as night sweats and insomnia, associated with menopause. 

The positive news are mood swings and emotional changes are treatable but can have a major impact on work life and personal relationships. It is important to see a health care provider. Treatments include hormone therapy, and/or antidepressants, cognitive behavioral therapy and other therapy modalities, healthy lifestyle habits such as exercise and nutrition.  

What you can do:

Be proactive and log your moods, journaling can be a great way to track your mood

If you are noticing changes, you are on the right path by being a part of this community!

Reach out to friends, family, and support systems

1. Hormone Therapy (HT)

Bioidentical Hormone Therapy (BHT):

• May improve mood and reduce depression, particularly for women experiencing severe symptoms, though evidence is mixed. 
• A Systematic Review and Meta-Analysis (2024): A comprehensive analysis of 34 RCTs involving 14,914 participants examined the effects of menopausal hormone therapy on cognitive function. While the primary focus was cognition, the study also explored mood-related outcomes. Findings suggested that HT may have beneficial effects on mood, particularly when initiated during the perimenopausal period. However, results varied based on the type of hormone formulation and timing of administration. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1350318/full?utm

The relationship between hormone therapy and mood during menopause is complex. While some studies suggest potential benefits of HT on mood, others indicate an increased risk of depression, particularly with systemic administration in younger postmenopausal women. 

2.  Non-Hormonal Medications

• Antidepressants (SSRIs, SNRIs): Medications like fluoxetine, sertraline, or venlafaxine can help regulate mood and reduce anxiety.
• Gabapentin & Pregabalin: Can help with mood disturbances and hot flashes.

• Escitalopram for Hot Flashes (2011): An RCT assessed the efficacy of escitalopram, a selective serotonin reuptake inhibitor (SSRI), in reducing hot flashes among menopausal women. While primarily targeting vasomotor symptoms, the study observed improvements in mood among participants, indicating that non-hormonal treatments like SSRIs can also address mood disturbances during menopause. jamanetwork.com

 3. Lifestyle & Natural Approaches

• Exercise: Regular movement, particularly strength training and cardio, supports mood regulation.
• Dietary Changes: A Mediterranean diet rich in omega-3s, lean protein, and whole foods can reduce inflammation and stabilize mood.
• Mindfulness & Stress Reduction: Meditation, yoga, and deep breathing techniques can help manage anxiety and mood swings.

4. Supplements & Alternative Therapies

• Magnesium & B Vitamins: Support nervous system function and mood stability.
• Direct evidence from RCTs specifically targeting magnesium and vitamin B6 supplementation for mood disturbances during menopause is limited. Menopausal mood changes are influenced by complex hormonal shifts,  RCTs support the use of magnesium and vitamin B6 among individuals with low magnesium feeling stressed and for anxiety and mood swings associated with premenstrual syndrome (PMS), it may be considered an option during menopause. It is important to consult a health care professional to ensure safety. 
•  
• Adaptogens (Ashwagandha, Rhodiola): May help balance stress responses.
• Ashwagandha

• A notable RCT investigated the impact of ashwagandha root extract on perimenopausal women experiencing climacteric symptoms. In this double-blind, placebo-controlled study, participants received 300 mg of ashwagandha extract twice daily for eight weeks. The results demonstrated significant improvements in various menopausal symptoms, including mood disturbances, compared to the placebo group.

  lifeextension.com
• Another RCT focused on adults with stress and anxiety, administering 240 mg of ashwagandha extract daily. The study reported reductions in anxiety scores and decreased morning cortisol levels, indicating improved stress resilience. While the sample included both men and women, and menopausal status wasn't specified, the findings suggest potential benefits for mood regulation. thenourishedmenopause.com
•  

• Rhodiola

• Research on rhodiola's effects on mood during menopause is less extensive. However, a systematic review of RCTs examined rhodiola's efficacy in treating depression, anxiety, and mood disorders. The review identified 39 RCTs, with 17 focusing on mood-related outcomes. The findings suggest that rhodiola may have a positive impact on mood regulation, though specific effects on menopausal women require further investigation.
  drtorihudson.com
   

• In summary, while ashwagandha has demonstrated potential in improving mood-related symptoms during menopause, evidence for rhodiola is less conclusive. Further research is needed to establish the efficacy of these adaptogens specifically for menopausal mood disturbances.
   
   St. John's Wort is a herbal remedy traditionally used for treating mild to moderate depression. Several studies have explored its potential benefits for menopausal women experiencing mood-related symptoms:

• Monotherapy for Depression: Another randomized controlled trial assessed the impact of St. John's Wort on postmenopausal women with mild to moderate depression. The results indicated that participants receiving St. John's Wort experienced significant improvements in depressive symptoms compared to those receiving a placebo.
  drtorihudson.com

• While these studies suggest potential benefits of St. John's Wort for mood disturbances during menopause, it's essential to consult with a healthcare provider before starting any new supplement. St. John's Wort can interact with various medications and may not be suitable for everyone.
   
  Acupuncture & Herbal Medicine: Some women find relief through traditional Chinese medicine.

• Efficacy of Standardized Acupuncture: A Danish study involving 70 women with moderate-to-severe menopausal symptoms found that standardized acupuncture significantly reduced emotional symptoms, including mood swings and depressive moods, after 6 weeks of treatment.

  bmjopen.bmj.com

   

• Acupuncture for Depression and Insomnia: A feasibility study explored the effects of acupuncture on perimenopausal women experiencing both depression and insomnia. The results suggested that acupuncture might be a promising treatment for these comorbid conditions, though further large-scale studies are needed.

  frontiersin.org

• While these studies indicate potential benefits of acupuncture for mood-related symptoms during menopause, further research is necessary to establish definitive conclusions.