Written by Menopause and Mental Health, Part 2
By Erin Tanner MSN, APRN, FNP-C, PHMNP-BC, PMH-C, Vetted Konenki Provider
The primary driver behind many menopause-related mental health symptoms is the fluctuation and eventual decline of hormones, especially estrogen and progesterone.
Estrogen, far more than just a reproductive hormone, significantly influences brain chemistry by impacting crucial neurotransmitters. As estrogen levels drop, so too can serotonin (affecting mood, sleep, and emotional well-being), dopamine (linked to motivation and pleasure), and norepinephrine (influencing energy and focus). This can lead to increased irritability, sadness, anxiety, and low energy (Mu et al., 2025).
Similarly, the decline in progesterone lessens its calming effect on GABA, a key neurotransmitter that helps reduce anxiety.
Estrogen receptors are present in vital brain areas like the hippocampus (memory) and amygdala (emotions), meaning its decline directly contributes to issues like brain fog, memory problems, and heightened emotional responses. Estrogen also offers neuroprotection, so its decrease can leave brain cells more vulnerable, further impacting cognitive and emotional health.
In summary, the mental health symptoms of menopause are a complex interplay of rapid and significant hormonal fluctuations affecting brain chemistry, exacerbated by sleep disturbances and the accumulated stressors of midlife. It’s a genuine biological and psychological phenomenon, not “just in your head” (Grace et al., 2025; Mu et al., 2025; Shrivastava et al., 2025).
Real Stories, Real Relief
Sarah, 48, started having panic attacks after decades without any anxiety. She thought she was losing her mind—until her doctor explained the connection to perimenopause.
“I wish someone had told me this was normal,” she said. “It would have saved me months of fear.”
Stories like Sarah’s are common. Understanding the biological roots of your experience can be the first step toward healing—not because it fixes everything, but because it gives you language, validation, and direction.
Stay tuned for Part 3: How to Support Your Body—Physical Strategies for Emotional Health.
Ready to Take the Next Step?
Find Support Near You: Visit our Find a Provider page to connect with a vetted menopause expert who understands what you’re going through.
Not Sure Where to Start? Schedule a free 20-minute call with our Wingwoman Concierge for personalized guidance—because you shouldn’t have to figure this out alone.
References
Grace, A. & Pandian, S. (2025). Mental health—an emotional roller coaster around menopause. National Journal of Community Medicine, 16(1), 94–101. https://doi.org/10.55489/njcm.1601202554670
Liu, H., Cai, K., Wang, J., & Zhang, H. (2023). The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis. Front Public Health. https://doi.org/10.3389/fpubh.2022.1045642
Maki, P., Panay, N., & Simon, J. (2024). Sleep disturbance associated with the menopause. Menopause, 31(8), 724–733. https://doi.org/10.1097/GME.0000000000002386
Mu, E., Chiu, L., & Kulkarni, J. (2025). Using estrogen and progesterone to treat premenstrual dysphoric disorder, postnatal depression and menopausal depression. Frontiers in Pharmacology, 16. https://doi.org/10.3389/fphar.2025.1528544
Shrivastava, G., Roshiya, K.D., Gohil, D.K., & Patadia, H. (2025). Menopause and Mental Health. Journal of Neonatal Surgery, 14(17S), 849–860. https://www.jneonatalsurg.com/index.php/jns/article/view/4678
Zeng, W., Xu, J., Yang, Y., Lv, M., & Chu, X. (2025). Factors influencing sleep disorders in perimenopausal women: a systematic review and meta-analysis. Frontiers in Neurology, 16. https://doi.org/10.3389/fneur.2025.1460613
