The hormonal changes involved in the menopause transition can contribute to mood swings and other psychological changes, including new or worsening irritability, anxiety, or depression.

Studies suggest that women in perimenopause are 40 percent to 60 percent more likely to experience symptoms of depression than before perimenopause. Women with a history of major depressive disorder have a higher risk of experiencing a major depressive episode during the menopause transition.

Help is available if mental health symptoms are affecting you. Psychotherapists and other mental health professionals can support you during the menopause transition.

Why Might Menopause Affect Your Mental Health?

Several factors may contribute to mood changes and mental health challenges during menopause, including hormonal fluctuations.

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Yes, I started psychotherapy because of perimenopause or menopause.

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During perimenopause, estrogen levels fluctuate, while progesterone levels generally decline as ovulation becomes less frequent. After menopause, levels of both hormones are lower. Changes in hormones can affect brain chemicals, which may affect mood, mental health, and cognitive functioning (thinking and memory).

Psychological and cognitive symptoms of menopause-related hormone shifts may include:

• Mood swings
• Anxiety
• Panic attacks
• Memory and concentration issues
• Tearfulness
• Low motivation or confidence
• Anger and rage

Your mood and cognitive function may also be affected by menopause symptoms such as hot flashes and poor sleep. For some women, symptoms of hot flashes can feel like those of a panic attack. Poor sleep is also associated with mood changes and problems with thinking and memory.

Life stress during midlife can add to these changes. For example, some women may have many responsibilities and little time to care for themselves. The physical and emotional impacts of menopause can affect self-esteem, making mood issues harder to manage.

What Types of Therapy Might You Consider?

Mental health counseling (sometimes called talk therapy) for menopause can help you develop healthy ways to manage symptoms and other sources of stress. Depending on the type of therapy, you might learn relaxation techniques, breathing exercises, or ways to communicate with a partner or family members.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) has been shown to help with some menopause symptoms. This type of talk therapy focuses on recognizing unhelpful patterns of thinking and behavior and learning healthier ways to respond to them. Research suggests that CBT may help:

• Reduce anxiety
• Reduce symptoms of depression
• Improve sleep
• Reduce the severity of hot flashes and night sweats (vasomotor symptoms)

For example, believing that menopause symptoms are shameful or uncontrollable may make you feel worse. CBT can help you replace these thoughts and develop more helpful ways of thinking and coping.

Other Therapies

CBT has been widely studied, but it’s not the only type of psychotherapy that may help improve menopause symptoms. More generally, talk therapy may help improve sleep, memory, concentration, and quality of life. Other types of psychotherapy that might be helpful, depending on your needs, include:

• Interpersonal therapy — Focuses on relationship challenges and improving communication with others
• Psychodynamic therapy — Explores how past experiences may influence current thoughts, feelings, and behavior
• Mindfulness-based cognitive therapy — Combines CBT approaches with mindfulness practices
• Eye movement desensitization and reprocessing (EMDR) — Can help people process traumatic experiences
• Support groups or other forms of group therapy — Can provide support and connection with other people

Family or Couples Therapy

Menopause and perimenopause can put a strain on intimate relationships. Stress, disruptive sleep, and mood symptoms may add to existing relationship challenges or create new ones.

Some women may also feel misunderstood by their partners and family members during perimenopause or menopause. “I wish that every adult partner knew how women’s bodies work. I wish that they had more patience and more resources,” Tetenbaum said.

Learning to communicate better can help reduce relationship strain that may arise during perimenopause. “Something that I work on with women is communication skills related to self-assertion,” Tetenbaum said. “Women tend to be conditioned to not ask for things, even from their loved ones, so we work on direct communication and assertiveness skills.”

Family and couples therapy can help people navigate life changes and work through relationship challenges. It can also provide support, education, and guidance to help family members or partners strengthen their relationships and increase well-being.

When Should You Seek Professional Support?

You don’t have to reach a certain level of distress before seeking mental health support. If mood or mental health symptoms continue over time, and especially if they interfere with daily life or relationships with people close to you, consider reaching out for help. You may also find it useful to track your mood and look for patterns related to sleep, your menstrual cycle, and life stress.

You don’t need to have severe depression or be in crisis to benefit from mental health counseling. It’s OK to seek professional support whenever you feel you need it.

How Can You Find a Mental Health Professional?

Below are some ways to find a mental health professional who fits your needs during this phase of life:

• Referrals — Your healthcare provider may be able to refer you to local or telehealth mental health providers who have experience with menopause or midlife mental health. You can also ask friends or family members for recommendations if you feel comfortable doing so.
• Insurance company — Your insurance company may provide a list of providers who accept your insurance. You can also ask about coverage or reimbursement rates for any out-of-network care.
• Employee assistance program (EAP) — Some employers offer an EAP that can connect you with a licensed mental health professional. Your benefits may include a certain number of sessions for free or a reduced fee.
• The Menopause Society — This organization provides a directory of certified menopause practitioners from different healthcare specialties, including mental health. You can look for credentials such as LCSW, LMFT, Ph.D., Psy.D., or a medical degree in psychiatry.
• Psychology Today — This platform allows you to search participating therapists by location, insurance, specialty (including menopause), type of therapy, and other factors.

Not all mental health providers are trained in menopause-related mental health. Before scheduling a session, it’s a good idea to ask about a potential therapist’s experience in supporting people during perimenopause and menopause. It’s also important to find someone you feel comfortable talking with.

Consider making a list of questions and symptoms you want to discuss at your first meeting. Finding the right fit may take more than one try, and it’s OK to meet with another mental health professional if the first one doesn’t feel right.