Lifting the Mask on Menopause and Mental Health
By M. Jeanette Quiroga, MD
They called it “the change of life.” My mother and her sisters whispered about it while fanning themselves with dish towels and magazines. They joked about the hot flashes, the forgetfulness, and the exhaustion, and as a teenager in the nineties, that was, in truth, the extent of my education on menopause.
Even as a physician, with years of training in anatomy, physiology, and behavioral health, I had only gathered a few extra pieces of the puzzle. It wasn’t until my passion for women’s mental health deepened that I recognized the glaring gap in our understanding of women’s well-being: menopause.
The Overlooked Mind-Body Connection
For decades, conversations about menopause have focused on hot flashes and reproductive changes, while its profound impact on mental health has been largely ignored. Anxiety, depression, irritability, and changes in cognition can be just as disruptive as the physical symptoms— if not more.
The years before menopause, known as perimenopause, can begin as early as the mid-thirties and may last anywhere from a few months to a decade. Hormonal shifts in estrogen and progesterone during this time have a significant impact on neurotransmitters such as serotonin, dopamine, and GABA, the very chemicals that regulate mood, energy, and anxiety.
Estrogen receptors are also concentrated in areas of the brain tied to memory, decision-making, and cognition. As estrogen levels fluctuate, many women begin to experience a mental cloudiness often described as “brain fog.” This cognitive slowing can feel especially distressing when layered on top of the daily demands of raising children, managing a household, and advancing a career— and can fuel feelings of anxiety and depression.
Hormonal fluctuations also contribute to night sweats and hot flashes, which, combined with shortened REM cycles, restless legs, and heightened anxiety, can lead to sleep deprivation. Over time, the lack of restorative rest takes a toll—worsening fatigue, mood changes, and cognition.
Intimacy in Transition
Menopause doesn’t just mark the end of menstrual cycles—it can also reshape how women experience their bodies, relationships, and intimacy. For some, desire fades as testosterone declines, and fluctuations in estrogen can lead to physical changes that can make intimacy uncomfortable or even painful. These changes, along with the distress of night sweats, fatigue, mood swings, and disrupted sleep, leave many women with little energy or desire for intimacy.
Body-image changes, such as weight redistribution, thinning hair, and skin changes, can also affect confidence, sometimes leaving women feeling less attractive. Relationship dynamics come into sharper focus during this time: couples with strong communication and emotional connection may navigate these shifts with resilience, while relationships already under strain may experience further disconnect.
Still, menopause doesn’t have to mean the loss of intimacy. With open dialogue, medical support, and a willingness to redefine closeness, couples can adapt together. Menopause can become less about loss and more about transition.
Reframing Menopause and Mental Health
While the symptoms of menopause can be disruptive, they don’t have to define this stage of life. Women deserve space to talk openly about their experiences, share insights, and seek support without shame.
Treatment is not one-size-fits-all. For some, self-guided strategies such as exercise, mindfulness, and improved sleep hygiene may bring meaningful relief. For others, expert-led therapy can be invaluable— offering tools to navigate mood changes, identity shifts, and the stress of balancing life’s demands. Working with a therapist who understands the psychological impact of menopause can provide validation, practical strategies, and emotional support.
Medical options are also emerging, from treatments that ease hot flashes and sleep disturbances to those that address mood, anxiety, and cognitive issues. Together, therapy and medical guidance can address both the psychological and physical dimensions of menopause.
Above all, menopause should not be a silent struggle. By prioritizing mental health, acknowledging the very real emotional impact, and fostering open conversations, we can transform this stage from whispers and punchlines into a season of growth, resilience, and empowerment.
Dr. Jeanette Quiroga is the Medical Director of ECT and Neurostimulation at Laurel Ridge Treatment Center. She is also the founder of Ascend Psychiatric Specialty Services, where she specializes in the treatment of mood disorders, depression, and ADHD with a focus on women’s mental health. She can be reached at (210) 980-9885.
This article is provided for educational and informational purposes only and does not constitute providing professional services or medical advice. Those seeking medical advice should consult with a licensed physician or medical provider.
