Unraveling Menopause: Why you don't feel like yourself — and when to seek help

Menopause is a period of significant hormonal changes in women, marking the end of her reproductive years. According to the World Health Organization, natural menopause is deemed to have occurred after 12 consecutive months without menstruation and it happens, usually with age, as the ovaries gradually decrease production of the hormones estrogen and progesterone. 
Menopause is a crucial time for women and not only does her body undergoes changes, but even her mental health too. Many times, women say they are not feeling "themselves". This is not being dramatic or having exaggerated reaction. Experts point out that women undergo psychological changes and needs support in such situations.  

Menopause: Fluctuating hormones lead to mood changes

Priyanka Kapoor, psychologist, psychotherapist, NuHer, shares, "Estrogen and progesterone fluctuate wildly in perimenopause and menopause‚ and hormones affect the brain's neurochemistry‚ particularly serotonin and dopamine which influence mood‚ memory‚ and stress resilience․ It's not unusual for women to report in menopause that they 'don't feel like themselves' because they're not․ The hormones fluctuate‚ causing sudden anxiety‚ unexplainable brain fog‚ irritability‚ and bouts of depression without the woman having a history of mental health problems․ Night sweats disrupt sleep‚ making the nervous system more exhausted than usual․"

Yashika Somaiya, Clinical Psychologist, Holy Family Hospital, Bandra, agrees that women going through menopause may experience changes in their emotional well-being, such as increased anxiety, irritability, low mood, emotional sensitivity, sleep disturbances or a feeling of “not being themselves.” She adds, "Changes in reproductive hormones, particularly fluctuations and decline in estrogen during the menopausal transition, may influence brain systems involved in mood, cognition, sleep and emotional regulation. At the same time, hormonal changes do not act in isolation. Sleep disturbances, physical symptoms, metabolic changes and psychosocial factors such as work-related stress, caregiving responsibilities, relationship concerns and other life changes can also influence psychological well-being during this period."

Also Read: World Menopause Day: 10 Steps To Deal With Menopause - All You Need To Know

When to seek support

Kapoor points out that when your daily functioning is hampered and affected, and if you start having relationship issues with family and friends, you should seek for support immediately rather than waiting for the worst case scenario. "There's a difference between a natural transitional mood change and a psychiatric episode․ Seek treatment by a mental health professional for mood swings which disrupt your work‚ social life or daily tasks or when your symptoms of sadness and anxiety have lasted for more than two to three weeks․ Targeted hormonal therapy combined with cognitive behavioral therapy‚ sleep hygiene therapy and lifestyle changes restore cognitive function and emotional well-being․ You don't have to go through all the transitions of midlife white-knuckled․ Specialised and compassionate care can help you feel like yourself again․"

Somaiya says that from a clinical psychology perspective, comprehensive assessment is important when emotional or behavioural symptoms become persistent, distressing or begin interfering with daily functioning. "This helps differentiate psychological distress occurring during the menopausal transition from conditions such as major depressive disorder, anxiety disorders or other mental health concerns. It is equally important to consider and rule out co-existing medical conditions that may contribute to or present with similar symptoms," she adds.

Somaiya further asserts that women should consider seeking professional psychological or psychiatric support when they experience recurrent or severe panic attacks, persistent anxiety, sadness or hopelessness, emotional numbness, loss of interest in previously enjoyable activities, significant sleep disturbances, or when these symptoms begin affecting work, relationships, self-care or everyday functioning. Any thoughts of self-harm or suicide require immediate professional attention.

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"Evidence-based psychological interventions such as Cognitive Behaviour Therapy (CBT), Acceptance and Commitment Therapy (ACT), supportive psychotherapy and appropriate stress-management strategies can help women manage emotional and behavioural difficulties during this transition. When symptoms are moderate to severe or require medical management, psychiatric consultation and appropriate pharmacological treatment may also be considered. An individualised and multidisciplinary approach, whenever required, can help provide comprehensive support based on the woman's specific needs," Somaiya adds.

(This article features expert quotes provided for informational purposes only. It is not a substitute for professional medical advice. Always consult a qualified healthcare provider regarding any medical condition.)