Navigating the Menopause Journey

By Susanne Steinberg, MD

Menopause is a natural phase in every woman’s life, marking the end of the reproductive years.

And while much of the focus on menopause centers on physical symptoms, the transition can trigger mental health challenges as well.

Fortunately, safe and effective treatment is available to manage the symptoms of menopause, so women do not have to suffer their way through the journey.

The Women’s Program at Penn Medicine Princeton House Behavioral Health uses evidence-based practices to address the special needs of women facing acute behavioral health crises involving trauma, addictions and life transitions, including, more recently, menopause. 

Understanding Menopause

Menopause is a natural biological process associated with the decline of reproductive hormones. Menopause occurs in three stages: 

• Perimenopause. The years leading up to menopause, often characterized by irregular periods and symptoms like hot flashes, night sweats and mood swings. 

• Menopause. The point when menstruation has ceased for 12 months. 

• Postmenopause. The years after menopause, when symptoms may persist but often lessen over time. 

Though every woman is different, the average age for the onset of perimenopause is 47. Menopause typically occurs between the ages of 51 and 52.

More than one million women in the United States experience menopause each year, according to the National Institute on Aging.

Physical and Mental Health Symptoms

Symptoms of menopause vary greatly from person to person. Some women may have minimal symptoms, while others may find the transition extremely difficult.  Physical symptoms can include:

• Hot flashes and night sweats.
• Vaginal dryness and discomfort with intimacy.
• Slower metabolism and weight gain.
• Thinning hair and skin.
• Decreased bone density.

Mental health symptoms can include:  

• Mood swings. Sudden feelings of joy, sadness, or anger that may appear without clear triggers. 

• Anxiety. Increased feelings of worry or nervousness, even in situations previously handled with ease.

• Depression. A persistent sense of sadness or hopelessness.

• Brain fog. Memory lapses, difficulty concentrating, trouble with word retrieval, decreased ability to multitask. 

In addition, night sweats and insomnia can result in sleep deprivation, which can have a profound effect on mental health. Lack of restorative sleep may increase irritability, lower concentration, and amplify feelings of stress or anxiety. 

For women with a history of mental health conditions or postpartum depression, menopause can exacerbate these symptoms. 

Moreover, menopause often coincides with significant life events — children leaving home, aging parents requiring care, or career transitions. These changes can challenge self-esteem and identity, compounding emotional strain. 

Treatments

One of the most important things a woman can do while navigating menopause is to seek advice from a trusted health professional with experience in menopause care.

Treatment for menopausal symptoms ranges from self-care practices to antidepressant medication and hormone therapy.

It is the position of the North American Menopause Society that hormone therapy is a safe option for the treatment of menopause symptoms in women under 60 or who are within 10 years of the onset of their menopause.  

Systemic hormone therapy delivers hormones throughout the body via pills, patches, sprays, gels, or a vaginal ring and can be effective in relieving both the physical and mental health symptoms of menopause.

Local hormone therapy delivers estrogen directly to the vaginal area through creams, rings or tablets. This type of therapy is primarily used to treat vaginal dryness and discomfort without affecting the rest of the body.

Not all women are candidates for hormone therapy. It may not be recommended for women with their own history of breast, uterine or ovarian cancer; blood clots or stroke; uncontrolled high blood pressure, and liver disease.

Self-Care

Self-care is important at any stage in life and can help ease the menopause transition. Self-care measures include:

• Get regular exercise to manage weight, strengthen bones, and improve mood.

• Adopt a meal plan, rich in fruits, vegetables, and lean proteins that is consistent with your tastes and that you can sustain and enjoy.

• Practice sleep hygiene. Have a fan by your bed and dress in layers to mitigate night sweats. Maintain a regular sleep schedule, avoid excessive alcohol use and power down your devices early.

• Adopt mindfulness practices to help reduce stress and improve focus.

• Stay socially engaged. At least one study has shown that women who have a social network are found to be more positive about menopause and less depressed.

• Stay informed. Recent research is taking the “fear factor” out of menopause treatment, as reported in the Women’s Health Initiative Review in May this year. Science has also uncovered an estradiol receptor site in the brain that may be a future target for treatment.

Menopause, while challenging, offers an opportunity for growth and self-discovery. Rather than think of this time as the end of something, think of it as a new beginning.

For more information about Penn Medicine Princeton House Behavioral Health visit www.princetonhouse.org. Princeton House admissions clinicians can be reached at (888) 437-1610.

Susanne Steinberg, MD, is board certified in psychiatry and neurology. She is Medical Director of the Women’s Program at Penn Medicine Princeton House Behavioral Health and Medical Director of Princeton House’s Moorestown site.