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October 3, 2026
Marianne Waldenfels
Menopause can affect mood, sleep, and concentration – and some women experience anxiety or depressive symptoms for the first time. Psychotherapist Sandra Tschöpe explains why this can happen and which warning signs should be taken seriously.
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About hot flashes, sleep problems, and hormones, much is now being discussed. But menopause can also throw the mind off balance – and many women are barely prepared for this. Because psychological symptoms are harder to pin down than some physical ones, it is often difficult to recognize what is really going on. That uncertainty unsettles many women.
Psychologist and psychotherapist Sandra Tschöpe has spent years focusing on the psychological dimension of menopause. In her new book "My Meno Mind" (Kösel), she explores the influence hormones can have on mental health. In this interview, Tschöpe explains when mood swings become a warning sign, what role hormone replacement therapy can play, and why this phase of life can sometimes even bring a previously undetected ADHD to light.
Many women say during menopause: "I don't recognize myself anymore." What happens to our mental health during this phase of life?
The menopause is not only a physical but also a psychological and neurobiological transition. Many women notice changes during this time that they have never experienced before: they suddenly become more irritable, more emotional, more anxious, or more exhausted; they find it harder to concentrate or can no longer sleep well.
Several factors converge at once. The hormonal changes coincide with a life stage that is already full of demands: career, family, partnership, possibly caring for aging parents – all while grappling with the question of what the second half of life should look like.
© Meike Kuether
Sandra Tschöpe is a psychologist, psychotherapist, coach, and menopause counselor.
This can leave women feeling as though they are "no longer functioning" or that they no longer know themselves. What I want to emphasize is that this is neither imaginary nor a sign of insufficient resilience. Menopause can have a very real and significant impact on mental health. At the same time, not every psychological change is automatically attributable to hormones.
What role do the hormonal changes play in this?
For many years, hormones such as estrogen and progesterone, along with neurotransmitters in the brain – including serotonin, dopamine, and noradrenaline – work together in a finely tuned interplay.
During perimenopause, this system becomes increasingly disrupted: initially it is mainly progesterone production and fluctuations that shift; later, estrogen levels also fluctuate and decline. Both hormones influence, among other things, mood regulation, sleep, stress processing, concentration, and emotional stability.
When are mood swings still a normal part of menopause – and when should you seek help?
Occasional mood swings can occur during perimenopause. It becomes a concern when symptoms persist for several weeks and significantly impair daily functioning or quality of life.
Warning signs include persistent low mood, loss of joy and interest, markedly reduced drive, severe exhaustion, feelings of hopelessness, pronounced anxiety or panic attacks, and social withdrawal.
Even when daily life appears to be holding together on the surface, that can itself be a warning sign. Some women are just barely keeping up with their professional and family responsibilities, with little energy left over for themselves or for things that bring them joy.
Some women experience psychological symptoms for the first time during menopause. Anyone who notices that their work, relationships, or quality of life are suffering should seek professional support – the sooner, the better.
Sleep problems are among the most common complaints during menopause – and poor sleep, in turn, takes a toll on mental health. How can this cycle be broken?
Sleep and mental health are closely intertwined. Hot flashes, night sweats, and hormonal changes can disrupt sleep, and lack of sleep in turn increases vulnerability to anxiety, low mood, and stress.
Breaking this cycle calls for a multi-pronged approach. First, the underlying causes of the sleep problem should be identified – such as stress, depression, hot flashes, or sleep apnea.
Beyond that, good sleep hygiene, regular exercise, and relaxation techniques can all help. For more pronounced symptoms, it is worth discussing with a gynecologist or general practitioner whether hormonal treatment might be beneficial.
Chronic sleep problems should not simply be accepted as an inevitable side effect of menopause. They are treatable.
In women with ADHD, symptoms can worsen during menopause – why is that?
Estrogen supports, among other things, the effect of dopamine in the brain. Dopamine plays a central role in attention, motivation, and impulse control – precisely the areas where typical ADHD symptoms manifest.
When estrogen levels drop, existing ADHD symptoms can therefore intensify. Many women report increased forgetfulness, concentration difficulties, emotional overwhelm, irritability, and trouble organizing their daily lives.
On top of this, many women with ADHD have spent years or even decades learning to compensate through high levels of adaptation, perfectionism, and constant self-control. This so-called "masking" demands an enormous amount of energy.
During menopause, these compensatory strategies often become less reliable. The result can be a sudden sense of being unable to cope with the demands of everyday life. Years of over-adaptation and mounting exhaustion not infrequently culminate in burnout. For some women, this period also leads to a first-time diagnosis of previously undetected ADHD.
Can hormone replacement therapy also help when mental health is suffering?
Hormone replacement therapy (HRT) is not a conventional antidepressant. However, studies show that it can improve depressive symptoms in some women during perimenopause, particularly when those symptoms are temporally linked to the hormonal changes.
Not every depression during menopause is hormone-related, so the contributing factors should always be carefully assessed. In cases of pronounced depression, psychotherapy and, if necessary, medication may also be required.
Treating depression with HRT is not yet part of the psychiatric depression guidelines. As a result, doctors assess its use differently, and not all will agree to prescribing HRT with the primary goal of treating depressive symptoms.
This makes individualized medical advice essential – advice that takes into account both the psychological symptoms and the hormonal situation.
Which therapies can help ease menopause?
Not all women experience symptoms during menopause, and when they do, those symptoms vary considerably from one woman to the next. That is why there is no single correct treatment that works for everyone.
The appropriate treatment depends on the symptoms, the individual's life situation, and any pre-existing conditions. Depending on personal needs, various approaches may be helpful: hormone replacement therapy for significant symptoms following an individual benefit-risk assessment; psychotherapy for psychological complaints; exercise and strength training; stress management and self-care practices; and, where appropriate, medication-based treatment of depression, anxiety disorders, or ADHD.
Often it is a combination of different approaches that yields the greatest benefit. It is also important not to attribute all symptoms automatically to menopause – other possible physical and psychological causes should be investigated as well.
Are there two or three simple tips for regaining mental stability?
Yes – small changes can already make a big difference. One of them, as already mentioned, is exercise. Not every woman needs to follow a specific fitness program; what matters is finding a form of movement that fits her life and that she can sustain over the long term.
In particular, two to three short strength training sessions per week are especially beneficial in midlife. They support bone health, maintain and build muscle mass, and counteract the age-related muscle loss known as sarcopenia. Exercise can also have a positive effect on mood, sleep, and stress regulation.
Taking your own needs seriously is equally important: self-care is not a luxury, nor is it selfish. Midlife in particular tends to pile on professional demands, family responsibilities, and other obligations. Continually putting your own needs last can contribute to burnout over time. Regular breaks, sufficient sleep, exercise, and deliberately scheduled time for yourself can help head off overload before it takes hold.
Finally, try not to judge your feelings immediately, and stay aware of your own limits. Many women are alarmed by mood swings and try to fight them. It can be more helpful to notice what you are feeling without immediately passing judgment – and at the same time to ask yourself: what do I need right now? What is too much for me? And where am I allowed to say no?
Where can women turn when they don't know what to do about their symptoms?
The gynecologist is a key point of contact, but far from the only one. A general practice can also be a good first port of call, particularly for taking a holistic look at symptoms, medications, and other possible causes.
There are also doctors who specialize in menopause – often, though not exclusively, working in private practice. Even a single in-depth consultation can be very helpful for putting symptoms into context, learning about treatment options, and planning next steps. Even if such an appointment has to be paid for out of pocket, it can, in my view, be money well spent.
Another option is a qualified menopause counselor. They can provide information on lifestyle, nutrition, sleep, exercise, and mental well-being. One important distinction applies, however: a menopause counselor does not replace a doctor or psychotherapist, but can be a valuable complement and can help women find the right medical or therapeutic support.
Psychotherapists, psychiatrists, specialized sleep medicine specialists, and – where there is good reason to suspect ADHD – ADHD outpatient clinics can all be important points of contact as well.
One challenge, however, is that the public health system currently offers little room for in-depth menopause counseling. This phase of life in particular often requires time for a thorough medical history and individualized support. It may therefore make sense to look beyond the traditional public healthcare system for help when necessary.
Women do not simply have to accept their symptoms. There are now many ways to relieve them and meaningfully improve quality of life.
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