Menopause and Mental Wellbeing

You might be sleeping badly, snapping at people you love, forgetting words mid-sentence, or feeling anxious in a way you never did before. Many women wonder if they are losing themselves. Often, the answer is perimenopause, and this is common, and it helps to talk.

What is happening

Menopause is when your periods have stopped for 12 months in a row. For most women it happens somewhere between about 45 and 55. The years before it, called perimenopause, can start in your early to mid 40s and last several years. During this time, oestrogen and progesterone levels rise and fall unevenly.

These hormones affect the brain as well as the body. That is why perimenopause can bring anxiety, low mood, irritability, poor concentration and "brain fog", along with hot flushes, night sweats, joint aches, vaginal dryness and irregular periods. Night sweats break up sleep, and poor sleep makes mood and memory worse. Women who had low mood before, or with periods, may notice it more now.

In many South African families this stage lands at the same time as caring for teenagers and ageing parents, work pressure and money stress. It is often not talked about, so many women carry it alone.

Signs to notice

• Periods becoming irregular, heavier or lighter
• Hot flushes or night sweats that wake you
• New anxiety, panic or low mood without a clear reason
• Forgetting words or losing your train of thought
• Less interest in sex, or pain during sex
• Feeling unlike yourself for months

30-second self-check

Answer yes or no to each question.

• Are you over 40 and have your periods changed?
• Do hot flushes or night sweats disturb your day or sleep?
• Do you wake in the night and struggle to get back to sleep?
• Have you felt anxious, low or irritable most days for two weeks or more?
• Is your memory or focus worse than it used to be?
• Has this affected your work or relationships?
• Have you avoided talking to anyone about it?

0-1 yes: You may be early in this change. Keep an eye on patterns and look after sleep.
2-3 yes: Menopause may be affecting your wellbeing. A chat with a nurse or doctor is worthwhile.
4 or more yes: This is having a real impact. Book an appointment and ask about treatment options and emotional support.

What you can do next

• Today: Start noting your periods, flushes, sleep and mood for a few weeks. Patterns help your doctor.
• This week: Keep your bedroom cool, wear layers, and cut back on alcohol, caffeine and spicy food in the evening if they trigger flushes.
• This month: See a doctor or clinic nurse. Ask about hormone therapy and non-hormonal options, and whether it suits you.
• Move most days. Walking and strength exercises help mood, sleep, weight and bone strength, which drops after menopause.
• Tell someone: a partner, friend or manager. Small changes at work, like a fan or flexible start, can make a big difference.

Your tool

Sleep Habits Self-Check - a short private check of your sleep routine and habits that shows which changes are most likely to help you sleep better through this time.

When to get professional help

Get help if low mood, anxiety or poor sleep last more than two weeks or are affecting your life. See a doctor soon for any bleeding after your periods have stopped for a year, bleeding after sex, or very heavy bleeding. Go to emergency care or call 10177, or 112 from a mobile, for chest pain or stroke signs (FAST: Face drooping, Arm weakness, Speech slurred, Time to call). If you have thoughts of ending your life, call the Suicide Crisis Helpline on 0800 567 567 now. If you are in danger right now, call 10111.
Who can help: doctor, nurse, psychologist, counsellor, dietitian, biokineticist

Getting help in South Africa

Your public clinic or GP can assess symptoms and refer you if needed. Some private gynaecologists and GPs have a special interest in menopause. For emotional support, call the Cleared Mind 24-hour Careline on 0800 212 146 or SADAG on 011 234 4837.