Menopause mental health symptoms: what changes, which phase carries the risk and what a hormone scan measures

In this article you can read what menopause mental health symptoms look like, which phase of the menopause carries the highest risk of depression, how long the symptoms last and when to make an appointment with your GP. That matters, because the low mood, the short fuse and the inner restlessness of these years are often read as a change in who you are, while cohorts that follow the same women through every phase find a pattern in the phase itself.

BioProfile’s hormone scan measures how much of these symptoms you notice and gives you an indication of where you stand today in this area, as one of the 11 health areas the full scan assesses. This is not a diagnosis. It is insight, to see where you stand today, and to help you make better choices in your food and your lifestyle. What this scan does not do: point to a cause. Naming an illness is work for a doctor.

What menopause mental health symptoms look like

Thuisarts lists anxiety, depression and other mental health symptoms with the menopause, and writes that the change can make you tired, low, sad or quick to anger.⁠⁴ The Dutch figures come from a survey of 4010 female workers aged 40 to 67, average age 53.1, held in November 2021 as a follow-up to the Nationale Enquête Arbeidsomstandigheden 2020. Of that group, 18.5% were in the perimenopause, and 80% of them had menopause symptoms, 27.5% often and 52.5% sometimes. On the psychological domain of the Greene Climacteric Scale, eleven symptoms with a score of 0 to 33, women in the perimenopause came out at 8.7 on average against 7.0 premenopausal and 6.4 postmenopausal, and 27.1% were emotionally exhausted against 17.5% and 17.9%.⁠²

In plain words: the mental load is modest on average, about one and a half points on a scale of 33, and the load is highest in the years when your period is still there and turns irregular.

Depression: the phase that carries the risk

A 2024 meta-analysis pooled 17 prospective cohort studies with 16,061 women, from a search of Medline, PsycInfo, Embase and Web of Science from inception to 12 July 2023. Women in the perimenopause had a significantly higher risk of depressive symptoms and of a depression established with a standardised interview than women in the premenopause: pooled odds ratio 1.40 (95% CI 1.21 to 1.61, p < .001) across 7 articles with 9141 participants. Women in the postmenopause showed no significantly raised risk compared with women in the premenopause.⁠¹ At the Pittsburgh site of SWAN, 221 women aged 42 to 52 who entered premenopausal had a structured clinical interview every year for 10 years. The same women had a major depressive episode two to four times as often during the perimenopause or the early postmenopause, and that held regardless of an earlier major depression, of major life events that were measured each year, of psychotropic medication, of hot flushes and night sweats, and of the level of and the changes in the sex hormones.⁠⁵

What that means for you: the risk lies in the phase rather than in a single hormone value, and on the other side of the menopause it drops again. Behind the word ‘menopausal depression’ sits the same depression, measured with the same standardised interview.⁠¹

Anxiety, inner restlessness and your character

In the SWAN cohort across several sites, 2956 women aged 42 to 52 at the start were examined every year for 10 years. Women with few anxiety symptoms before the menopause reported high anxiety symptoms more often in the early perimenopause, the late perimenopause or the postmenopause than in the premenopause, with odds ratios of 1.56 to 1.61, independently of major life events, money worries, health experienced as fair or poor, and hot flushes and night sweats. Women who already had high anxiety symptoms at the start kept those high figures for all 10 years, with odds ratios that did not differ by phase.⁠⁶

That is also the answer to the question about character. The restlessness of these years shows up mostly in people who had little of it before, and it follows the phase of the menopause. Who you are stays; the phase changes.

How long it lasts

Thuisarts puts the start between the ages of 40 and 60, the last menstrual period at 51 on average, and 1 in 100 women goes through the menopause before 40; eight in ten have hot flushes, and 5 years after the last menstrual period the symptoms usually ease.⁠⁴ Among 1,449 SWAN participants with frequent hot flushes or night sweats, enrolled from February 1996 through April 2013 with a median of 13 visits, the median total duration was 7.4 years, and in the 881 women whose last menstrual period could be established a median of 4.5 years ran on past that period. Women whose frequent symptoms began in premenopause or early perimenopause had the longest course, a median above 11.8 years in total, against a median of 3.4 years in women whose symptoms began after menopause.⁠⁷

The earlier the symptoms start, the longer the period lasts. Which symptoms belong to this period and how long each symptom lasts is set out in menopause symptoms: which ones belong to it and how long they last.

At work

RIVM surveyed more than 12 thousand working women between the ages of 40 and 66 in the Netherlands. More than 1 in 3 women going through the menopause say the symptoms limit how they function at work, and of that group fewer than half, 48%, talk about the symptoms at work. Sleep problems are among the most reported symptoms, alongside hot flushes and night sweats.⁠³ A short night and a heavy afternoon belong to the same picture, and most people around you never hear a word about it.

What was studied

A 2025 systematic review found 16 studies with a total of 910 women, covering research published from 1990 to December 2024, with randomised controlled trials, quasi-experimental and observational designs. The review looked at cognitive behavioural therapy in group form, individual form and self-help form for hot flushes, night sweats, anxiety, depression, sleep problems and quality of life: cognitive behavioural therapy in a group gave the greatest gain, and self-help forms showed moderate but meaningful improvements.⁠⁸ For you, that is something concrete to talk over with your GP.

When to make an appointment with your GP

Thuisarts gives these signs for the menopause: your period is very heavy, you have menopause symptoms and are younger than 40, you have not had a period for more than a year and blood is coming from the vagina, or hot flushes and other menopause symptoms are troubling you a lot.⁠⁴

For low mood, the page on low mood adds these: you want help with the sadness and the low feeling, you are taking medicines that have low mood or depression as a side effect, or you keep feeling low and no longer feel like doing anything at all. Low mood usually passes after a few weeks or months; if it has not passed after a few months, talk to your GP, and contact your GP straight away if you feel very low, anxious or confused, or if there are thoughts of suicide.⁠⁹

What a hormone scan measures

The hormone scan asks five questions about the past two weeks and converts your answers into a score from 0 to 100, with the reading band the score falls in. What you get is a picture of how much of these symptoms you carry today, and a starting value you can repeat in two weeks to see a direction instead of a memory.

A questionnaire cannot tell one cause from another. An underactive thyroid, short nights, a busy stretch at work and the perimenopause can look the same. The scan is not a diagnosis. Blood values and a conversation with a doctor are the layers that turn a picture of symptoms into an explained picture.

In summary

Mental health symptoms in the menopause belong to it just as much as hot flushes do: Thuisarts lists anxiety and depression among them,⁠⁴ and Dutch workers in the perimenopause score higher on the psychological domain and report more emotional exhaustion than their premenopausal and postmenopausal colleagues.⁠² The perimenopause is the phase with the higher risk of depression, pooled odds ratio 1.40, and after that the risk drops again.⁠¹ Anxiety rises above all in women who had little of it before.⁠⁶ The earlier the symptoms start, the longer the period lasts.⁠⁷ A hormone scan gives you a baseline in this area. It is not a diagnosis.