Menopause & Your Mental Health

You already know menopause brings physical changes, from hot flashes to bone fragility to weight gain. But that’s not where it ends. Mental health issues can also arise, including mood swings, irritability, and even anxiety and depression.

We were thrilled to welcome Judith Joseph, M.D., M.B.A, to a recent webinar, hosted by Alloy’s Rachel Hughes. Dr. Joseph is a board-certified psychiatrist, chair of the Women in Medicine Initiative for Columbia University Vagelos College of Physicians & Surgeons, and a clinical assistant professor of child and adolescent psychiatry at NYU Langone Medical Center. She has conducted several clinical research studies in women’s mental health as the Principal Investigator of her research lab, Manhattan Behavioral Medicine. Dr. Judith developed the T.I.E.S. method to address mental health symptoms in Menopause. She is on the medical advisory board of Let’s Talk Menopause, a national non-profit organization.

We’re sharing some of Dr. Joseph’s conversation with Rachel Hughes below. To watch the entire webinar, head over to our YouTube!

Please note that this conversation has been edited for brevity and clarity, and that our webinars are for educational purposes only.

Rachel Hughes 

I have to say, we got a very large number of registrants ahead of this webinar. That tells me two things: People want to hear from you, and this is a topic that warrants a lot of attention. A lot of women are struggling with their mental health. I have shared that looking back, my first symptom was anxiety. It was not something that I put together at the time but it was disruptive to my life, and when I began to share my story, I heard a lot of it back from other women. 

So, to begin, if you would just explain the connection between hormonal changes during perimenopause and menopause and the onset or exacerbation of mental health symptoms like anxiety, depression, and mood swings.

Dr. Judith Joseph:

First of all, thank you so much for having me and for sharing your story. I think when we share it it decreases stigma and allows us to feel like we’re not alone.

Now, onto hormones. Women go through several periods of hormonal fluctuations and vulnerability throughout their lives. They go through puberty and they get their periods. And some studies suggest that as many as 80% of people who get their periods have experienced mood symptoms during PMS. And then there are some people who have more severe symptoms, like Premenstrual Dysphoric Disorder (PMD), where their mood symptoms may impact their functioning. So that’s the beginning. Then, for people who go through pregnancies, there’s the postpartum period where people feel different in terms of their mood, anxiety, irritability. And that actually starts in the third trimester. These drops in hormones can really impact your mood. And then there’s perimenopause and menopause.

So we need to identify what’s going on, understand it, and then find reasonable ways to cope. Now let’s talk about the mind-body connection. The mind-body connection exists, especially in women, related to hormones, because hormones travel throughout the entire body, including the brain. And so you may see symptoms like anxiety, depression, problems with sleep, and problems with thinking. And you might be wondering if you’re having a major depressive episode. 

So, when these things come up, I like to think about the three Ps. First, period changes. If you’re having period changes and mental health symptoms, you should talk to a provider about perimenopause and menopause, because period changes are not a symptom of a major depressive episode. The second P is physical changes. If you’re having physical changes like hot flashes, dry skin, changes in odor, or urination, those are more likely to be related to something hormonal than a major depressive episode. The last P is for past. If you have a past history of depression or trauma or other mental health issues, or if mental health issues run in your family, you are more likely to have a recurrence, or to experience mental health issues as a symptom of perimenopause and menopause. 

And not everyone wants to talk about these things, so not everyone knows their family history. But it’s important to talk about it, because talking about mental health gives us knowledge, and knowledge is power. 

Rachel Hughes

That’s so helpful. Thank you so much. When I invited people to submit questions for today, several people got back to me and were asking about their rage. That’s the word they used. A few of them also said they conflated rage with dissatisfaction in their marriages. And a few people expressed real concern with their ability to hang on to their relationships.

Dr. Judith Joseph Rage is interesting because it can come from lots of different places. So, for some people who have a lot of anxiety, and who like things just right, their anxiety can get worse during this vulnerable time, where their hormones are fluctuating, and it can manifest as rage. And that’s a rigid kind of rage. And then there are people who are irritable, or who have depression, and irritability and depression can also manifest as rage, which can look like not wanting to do things. And then there are others who have ADHD, and that can manifest as rage, and it’s more of an impulsive rage. The first thing that comes to mind, they’ll just do it. So we want to understand what that rage is about so we can better understand it.

That said, there is a practice called mindfulness, which helps with all types of rage. And you want to learn mindfulness when you’re in a peaceful state, and you can sit, and practice it. Mindfulness allows you to pick and choose which thoughts you want to put on a pedestal, and which ones you want to shelve. With my patients, I typically suggest they practice in the mornings, because mornings tend to be peaceful, and they pick a part of the morning to just sit still and be present. It could be a very simple practice, where you’re just sipping your coffee, or sipping your water. And what you do is, you stay grounded in that moment. You focus on the five senses, and you sip on the water, and describe how it feels. It’s cool; it’s wet. We’re going to listen to the sounds our nails make as they tap the glass. We’ll look at the colors. We’ll stay in the moment. And the more you do that, the more you practice it, the more you’re able to be mindful when you’re hit with emotions. And that’s a practice you can have for the rest of your life. It gives you the ability to choose how you want to react to things, and what you want to do. Do you want to shelve the feeling for now, or deal with it?

Rachel Hughes 

Awesome. Thank you. Another thing we know, but research also indicates, is that Black and native women’s experiences are marginalized. And these women often face unique challenges during perimenopause and menopause, including more severe symptoms, earlier onset of symptoms, and less access to healthcare. Could you elaborate on this and talk about the specific ways in which systemic racism and perhaps socioeconomic factors may impact this group of women and their experiences?

Dr. Judith Joseph

Yes, and I think people are surprised to learn that the highest rates of PTSD occur in African American communities. They're surprised, because when you hear PTSD, you think about combat. But in Black communities, there is systemic racism, there’s generational trauma, and there’s discrimination and microaggressions that wear on us every day. Black people walk around knowing that they’re Black and they think about being Black all the time. I don’t think that many people understand what that’s like. And the stress wears on you. And there are studies that show that. And I think that can be very validating. It sounds like it could be depressing and daunting, but in reality it’s quite validating.

So I tell that to my patients. I tell them that there’s a reason you’re going through this sooner and there’s a reason your symptoms are more severe. And it helps when women learn they’re not alone. Studies show that when a group goes through something together, it sort of lessens the blow. It doesn’t eradicate it, but it’s helpful. 

We also need to challenge any misconceptions we have about Black people. A doctor may not look at a Black woman in her late thirties or mid forties and say, “Oh, I should be screening her for perimenopause.” But it actually does happen earlier for Black women. And we have to educate ourselves, and arm ourselves with knowledge. 

Many doctors only get one class on menopause after they graduate medical school. But women spend about half of their lives postmenopausal, because we’re living longer these days. 

Rachel Hughes

Can we talk about alcohol in midlife?

Dr. Judith Joseph

Yes. And this is a hard one for people because for some people, a glass of wine at the end of the day is something they really look forward to. But we can’t drink like we’re in our twenties anymore. Our bodies are not the same. And the thing is that alcohol is not healthy for you. There’s no amount of alcohol that’s safe. I know that you want to enjoy life, and that’s understandable, but you just need to know the risks, and understand that it’s not something that is healthy for you.

Rachel Hughes What about exercise?

Dr. Judith Joseph Exercise is something I talk about regularly. In our twenties we do a lot of cardio, especially women. But you want to start lifting weights and building muscle mass because as you get older, the cardio you did in your twenties won’t be as helpful. You need to lift weights. You need to shift things. 

I think there’s a form of denial that we are all guilty of. We want to keep doing what we’ve always done. But things change, and we have to change with them.

Rachel Hughes

Can you talk about the T.I.E.S. method?

Dr. Judith Joseph

I coined the T.I.E.S. method to help people understand symptoms to look for. So the T is thinking. It’s brain fog, it’s having words on the tip of your tongue and losing what you’re going to say, being forgetful, problems with calculation and memory, etc. The I is identity issues. I don’t know who I am anymore, I feel like I don’t know who I am. The E is emotions, which encompasses anxiety, depression. And S is sleep. Sleep ties all of it together. T.I.E.S. helps you identify the symptoms. Then, you can address them.

Rachel Hughes Thank you so much for your time. I hope we get to speak again soon. This part of the perimenopausal and menopausal midlife journey can’t get enough attention. 

Dr. Judith Joseph

Thank you for having me, and thank you for your advocacy work. It’s important and needed. Sharing your experience helps so many people. We don’t heal in silos, we heal in communities.

To watch the whole interview, go to YouTube! To find out about upcoming webinars, follow us on Instagram at @myalloy.