The journey through perimenopause and menopause is often associated with well-known physical symptoms like hot flashes and night sweats. Yet, the profound hormonal changes during this natural stage of life also have a major impact on mental health—an aspect that is often underestimated or dismissed.
Perimenopause is the transitional phase leading up to menopause. It can begin several years before menstrual periods stop completely. Menopause itself is defined as going twelve consecutive months without a period.
During perimenopause, the ovaries start producing estrogen and progesterone irregularly before these hormone levels drop sharply. These hormones are not only vital for reproduction; they also help regulate brain chemicals such as serotonin, which directly affect mood.
When hormone levels fluctuate, many women experience mood swings and increased irritability. Some develop heightened anxiety or even panic attacks, with sudden feelings of fear, heart palpitations and a sense of being overwhelmed.
For women with a history of mood disorders, the risk of developing depression rises significantly during this stage. Symptoms can include persistent sadness, loss of interest in usual activities, fatigue and feelings of hopelessness.
Another common complaint is “brain fog,” where women report memory lapses, poor concentration and difficulty finding the right words. These cognitive challenges can disrupt work performance and family life.
Beyond these symptoms, many women also struggle with low self-esteem and confidence. Physical and emotional changes, combined with mid-life pressures such as career responsibilities, caring for ageing parents or adjusting to children leaving home, can worsen feelings of isolation or inadequacy.
In Kenya, where mental health is still stigmatised and menopause is rarely discussed openly, many women suffer in silence, unaware that what they are going through is common and treatable.
The good news is that there are effective treatments and coping strategies. The best approach is personalised, depending on a woman’s symptoms, medical history and lifestyle.
Menopausal Hormone Therapy, also known as Hormone Replacement Therapy, is one medical option. It works by replacing declining hormone levels and can help reduce hot flashes, night sweats and mood-related symptoms such as anxiety and depression.
Oestrogen patches are one common form of therapy. However, a healthcare provider must be consulted to weigh the benefits and risks. For those who cannot use hormone therapy or who need additional support for mood disorders, doctors sometimes prescribe low doses of antidepressants such as selective serotonin reuptake inhibitors. These can ease depression and anxiety while also reducing hot flashes.
As with any treatment, medical supervision is essential. Lifestyle changes also play a critical role in improving mental wellness during this stage of life.
Cognitive Behavioural Therapy, a form of talk therapy, helps women reframe negative thought patterns and develop practical coping strategies.
Regular physical exercise boosts mood, reduces stress and improves sleep. Eating a balanced diet rich in omega-3s, fruits and vegetables supports brain health, while limiting caffeine and alcohol helps stabilise mood.
Practices such as mindfulness, meditation, yoga or even simple deep-breathing exercises calm the nervous system. Perhaps most importantly, seeking social support—talking to friends, family or joining support groups—reduces isolation and helps women feel understood.
If you are experiencing mental health challenges during perimenopause or menopause, know that you are not alone and that help is available. Consult a healthcare professional who can assess your symptoms and recommend a plan that improves your quality of life.
Mental wellness is as important as physical wellness, and talking about it openly is the first step to breaking the stigma.
Dr Nelly Kamwale is a wellness doctor passionate about social change, gender and mental health advocacy.
