Can menopause affect your personality? Insights from medical professionals.

Quick show of hands: Who’s heard the term 'reverse puberty'? Anyone? It’s the nickname experts sometimes use to describe the process of perimenopause (the four- to 10-year transitional period leading into menopause). And, boy, is it an accurate description. Not only is your body phasing out of its reproductive years (menopause is marked by 12 consecutive months with no menstrual cycle), but your hormone levels can fluctuate wildly too. Remember how angsty and rage-filled you felt as a teenager during puberty? Well, welcome to reverse puberty as a mid-life woman.

In these years, many people experience a disconnection from their usual selves, which can present in various forms. You might notice that your patience is wearing thin, your libido has decreased, or your cognitive sharpness seems to be fading. Feelings of anxiety or depression may also arise. According to Dr. MargEva Morris Cole, an assistant professor of obstetrics and gynecology at Duke University School of Medicine, these symptoms are common side effects of the hormonal changes occurring during perimenopause, but they can also be influenced by the broader life circumstances that often accompany this transition.

"Midlife can be incredibly stressful, and often people overlook this while concentrating on hormonal changes," she explains. "During their 40s and 50s, individuals face numerous responsibilities, be it related to their careers or family. Additionally, they may grapple with the feeling of aging and increased fatigue while managing all these demands."

When you combine all these changes, it might feel like your whole personality has transformed in an instant. But is that really the case? And how can we address the intense emotions that arise during this period? Continue reading for professional insights on managing the emotional ups and downs of menopause.

Meet the experts: MargEva Morris Cole, MD, is an assistant professor of obstetrics and gynecology at Duke University School of Medicine and is a NAMS Certified Menopause Practitioner. Wendy Perello, MSW, LCSW, is a therapist licensed in Massachusetts, New Jersey, and New York.

The impact of perimenopause on the brain and mental well-being.

Indeed, hormones—especially the fluctuating levels of estrogen, progesterone, and testosterone—significantly influence your mood throughout perimenopause. Although each woman may experience these hormonal changes uniquely, Dr. Cole has observed some common patterns in her practice.

"When individuals are experiencing early perimenopause or are in their late reproductive stages, the issue isn't solely the decline in hormone levels," she explains. "Instead, it's the erratic spikes and drops. During ovulation, some may find their oestrogen levels soaring, only to plummet later in the cycle. This fluctuation often leads to severe mood swings and heightened irritability."

As a woman transitions into the later phases of perimenopause, there is a decline in oestrogen levels, which is frequently associated with a new range of symptoms.

"It differs from person to person, but many individuals begin to express concerns about brain fog, anxiety, and persistent low moods during this period," explains Dr. Cole. He notes that some patients have compared their feelings to having a cloud looming above them. "They might not articulate it as 'I feel sad,' 'I feel downcast,' or 'I feel less energetic,' yet they carry an unmistakable sense of heaviness."

However, hormones are just one aspect of the overall picture.

Common symptoms of perimenopause, including vasomotor issues like hot flashes and night sweats, can significantly impact your mental well-being. For example, if you frequently wake up at 3am due to night sweats, it’s likely that you’ll feel grumpy and fatigued the next day instead of refreshed. Similarly, experiencing sudden hot flashes during a crucial work presentation or a first date might leave you feeling self-conscious or anxious.

"Many women may not be aware that this could be affecting their emotional well-being."

"Many of the individuals I encounter aren't seeking help primarily due to menopause; instead, they're often dealing with anxiety or depression," explains therapist Wendy Perello, MSW, LCSW. "My role is to uncover the underlying causes of these feelings. When I work with women in this demographic, I make it a point to discuss perimenopause and menopause, as many women are unaware that these stages could be influencing their emotional well-being."

And the impact can be significant: menopause has been linked to anxiety and depression, according to a 2023 systematic review in Australasian Psychiatry, which found that menopause 'increases vulnerability to depression and anxiety.' While the review authors theorised this could be due to fluctuating hormones, they also didn’t discount the possibility of vasomotor symptoms and other menopausal symptoms having an effect. (More research is needed on that front!) The review also found that women with a history of a major depressive disorder are more likely to have a recurrence during the menopausal transition.

As you experience the transformations of perimenopause, your emotional state may also fluctuate, leading to reactions that are out of character for you. This could manifest as snapping at your partner for minor issues, like how they loaded the dishwasher, or finding yourself in tears at work after receiving a performance review that isn’t as positive as you hoped.

Will these changes in personality last forever?

While any significant life events, such as menopause, could leave their mark, both of the experts WH spoke with agreed that this transitional period does not fundamentally change who you are as a person. And the good news is that symptoms may lessen or even go away once you’re fully postmenopausal.

Dr. Cole explains, "Typically, the brain and mood-related symptoms begin to stabilize within a few years following the last menstrual period. Issues such as brain fog or difficulties with multitasking can arise, but the brain's plasticity allows it to adapt and reorganize. People often find that they can return to their previous levels of work and cognitive efficiency, albeit in potentially new and different ways, as they develop new strategies for coping."

As for whether depression symptoms specifically lessen after menopause, the Australasian Psychiatry systematic review found mixed results: Some quoted studies found an elevated risk for depression after menopause, while others found the opposite. (Another area that could potentially benefit from further study!)

Strategies for effectively navigating and leveraging this transformative phase

Dr. Cole suggests that if you're experiencing mood swings during this transition, there are various strategies to help manage them. "In perimenopause and menopause, we don't rely on a single approach to tackle the issue," she clarifies.

Your doctor will probably suggest starting with some lifestyle modifications.

"According to Dr. Cole, 'This is the perfect moment to implement changes that can enhance your overall health and wellness in the long run. Consider how you can adjust your stressors, set boundaries with loved ones, and prioritize personal time. Are you following a nutritious diet that supports your well-being? Are you incorporating exercise into your routine? It's essential to find what methods are most effective for you in regulating your mood.'"

For numerous individuals, achieving that goal might also involve therapy, where your therapist can assist you in discovering potential positive paths for transformation.

'I think it’s important to identify the things that you think are making you feel this way,' Perello says. 'If it's anxiety, do you meditate? Do you use box breathing? Do you use a journal? Acknowledge that it's also part of your life and it's something that you can't necessarily control, but you do have ways to manage it, like hormone therapy.'

Hormone therapy is another one of those therapeutic hammers Dr Cole was referencing. Depending on your unique concerns, your doc may prescribe you any combination of oestrogen, progesterone, and/or testosterone to help regulate your levels, which could, in turn, help stabilise your mood. In addition to – or in lieu of – hormones, your doc could also prescribe a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) to help manage symptoms. And not just the mood ones! Even when a patient isn’t on hormone therapy, SSRIs and SNRIs have been shown to help with hot flashes.

Menopause can signal the beginning of a transformative journey of self-exploration and personal wellness in your life.

Although it’s tempting to dwell on the challenges that come with this period of transition, it’s important to acknowledge the numerous benefits associated with menopause. For those who have worried about unplanned pregnancies (goodbye, daily birth control routines!) or dealt with painful and heavy menstruation, those concerns are now in the past.

Since this period frequently aligns with significant life transitions, like children becoming more independent or leaving home, menopause may signify the beginning of a new chapter focused on self-exploration and personal well-being.

Perello expresses, "I believe this can be an incredibly freeing period as you concentrate on your own needs. It prompts questions like, 'How can I nurture myself during this phase of life? What actions can I take for my physical well-being?' You may find yourself more attuned to your emotions, having been compelled to notice the importance of sleep, nutrition, and exercise, which ideally has been beneficial."

It's important to remember that you're not facing this alone. Countless women have experienced, and continue to experience, the same challenges you are facing at this moment.

"Let's approach it with a positive mindset if we can," Perello suggests.