Menopause mood changes: low mood, anxiety and irritability explained

The NHS describes mood changes as one of the main groups of symptoms of perimenopause and menopause: you may have mood swings, low mood or depression, and you may also notice problems with your memory or concentration. It adds that symptoms can have a big impact on daily life, relationships, social life, family life and work.

Mood changes can begin during perimenopause, when periods are becoming irregular, and may continue after periods have stopped. The NHS says symptoms usually last 7 to 9 years, sometimes longer, and that they can change, for example hot flushes may improve and be replaced by other symptoms such as low mood and anxiety.

The sources used here do not set out a single cause. They describe a network of linked symptoms. The NHS says sleep problems can make you feel irritable, stressed and anxious and may be worse if you also have night sweats. Hot flushes, palpitations and anxiety can themselves occur together, and the NHS notes that hot flushes can cause palpitations or anxiety.

Life circumstances also matter. Midlife can bring caring responsibilities, work pressures, changes in family life or bereavement, any of which can affect mood independently of the menopause. For that reason a GP will usually ask about the whole picture.

The NHS describes depression as more than simply feeling unhappy or fed up for a few days: you feel persistently sad for weeks or months. Symptoms range from lasting feelings of unhappiness and hopelessness to losing interest in things you used to enjoy and feeling very tearful, and many people also have symptoms of anxiety. There can be physical symptoms such as constant tiredness, sleeping badly, having no appetite or sex drive and various aches and pains.

The NHS says it is important to seek help from a GP if you think you may be depressed and that it is best not to delay. Depression is a real illness, not a sign of weakness, and with the right treatment and support most people with depression can make a full recovery.

• Low mood or tearfulness lasting weeks rather than days.

• Losing interest or enjoyment in things you normally like.

• Persistent anxiety, panic or feeling on edge.

• Feeling hopeless, or that life is not worth living, which needs urgent help.

The NHS menopause advice for easing mood changes is to get as much rest as you can, exercise regularly and do relaxing activities. More generally it suggests keeping to regular sleep routines, eating a healthy balanced diet, trying yoga, tai chi or meditation, and talking to other people going through the same thing such as family, friends or colleagues. It advises not smoking and keeping within alcohol limits, as alcohol may affect symptoms.

The NHS depression overview adds that many people benefit from lifestyle changes such as getting more exercise, cutting down on alcohol, giving up smoking and eating healthily, and from reading a self-help book or joining a support group.

The NHS says the type of HRT offered depends on whether you still have periods and whether you have had a hysterectomy, and that oestrogen is the main type of HRT and can help manage symptoms. For low mood, depression or anxiety caused by perimenopause or menopause, the NHS says you may be offered antidepressants, and that CBT is a type of talking therapy that can help.

The NHS depression overview explains how treatment is chosen by severity: for mild depression a doctor may suggest watchful waiting, exercise and guided self-help, with talking therapies such as CBT; for moderate to severe depression a combination of talking therapy and antidepressants is often recommended; and severe depression may need referral to a specialist mental health team.

NICE's menopause guideline says menopause-specific CBT can be considered as an option for vasomotor symptoms and for sleep problems, alongside or instead of HRT, and that professionals should discuss the treatment options and the benefits and risks of each with you.

Anyone who has thoughts of harming themselves or ending their life should get help straight away: contact a GP, call NHS 111, contact Samaritans, or call 999 or go to A&E if in immediate danger. These feelings can occur in depression at any age, and the NHS notes that severe depression can make you feel suicidal. They are treatable and asking for help is the right step.

The NHS also asks anyone with palpitations or a fast heartbeat to contact their GP, as these can occur in the menopause but should be checked.

GPs can assess mood, discuss HRT and refer to NHS Talking Therapies, which in England can be accessed through self-referral. NICE advises that healthcare professionals identify menopause as early as possible and discuss all the treatment options.

Some people choose private menopause clinics or private therapy for quicker access or longer appointments. The principles of treatment are the same, and it helps to keep your GP informed so that medicines are coordinated.