Hot flashes get all the attention when it comes to talking about menopause. But what’s left out of the conversation for millions of menopausal women is the mental and emotional punch it packs. Those who may have never experienced anxiety, depression, or eating disorders suddenly find themselves struggling with their emotions and “not like themselves.” 

Women in midlife aren't facing the same physical, emotional, social, medical, and nutritional challenges they did before. Many hit perimenopause right in the middle of the "sandwich generation" years, the time in life when they’re simultaneously raising children while caring for aging parents, experiencing career burnout, and navigating an ever-changing body.  

That convergence of biological and life-stage stress is significant – it sets the stage for triggering an onset or relapse of mental health issues. When the body's stress-response system is already dysregulated by hormonal shifts, these external pressures hit differently. Women who have never experienced depression are two-to-four times more likely to have a depressive episode during the menopausal transition — a sobering fact that catches many women completely off guard. 

And these hormone fluctuations impact more than the physical body. Areas of the brain responsible for emotional processing and memory contain estrogen receptors. So, as estrogen fluctuates and declines, so can mood stability, cognitive sharpness, and the ability to manage stress.  

When it’s more than just a “mood swing” 

There's a tendency to dismiss what women experience during this stage as "just hormones." Nearly 60% of women report feeling depressed or experiencing cognitive issues like brain fog, while sleep disturbances affect about half of those going through menopause. Poor sleep, in turn, fuels anxiety, irritability, and emotional dysregulation in ways that compound quickly. 

Despite their prevalence anxiety disorders during menopause are similarly underrecognized. Generalized anxiety, panic attacks, and heightened physical awareness, such as palpitations or shortness of breath, often emerge or worsen in perimenopause, potentially triggered by hormonal instability and compounded by sleep disruption. 

For women with a prior history of depression or anxiety, the risk is even steeper. Those with a history of depression are up to five times more likely to receive a diagnosis of major depressive disorder during perimenopause. 

Onset of eating disorders during peri/menopause 

Hormonal changes in perimenopause and menopause can impact the way your body carries weight and processes food. Living in a society steeped in diet culture and weight stigma, this can be especially difficult for those women who are struggling with disordered eating and body dysmorphia. But when the “control” never seems to be enough and your thoughts about food, eating, or exercising become all-consuming, when your relationship to food and your body become strained – it's time to seek support.  

Knowing When to Seek Support 

StrongHer at Eating Recovery Center in Plano is one of the only specialized eating disorder treatment programs in the nation created specifically for women ages 40+ to help navigate the unique challenges women in midlife face. The program offers age-appropriate support, with a treatment team that stays with you through each level of care, to help women navigate their mental health.  

Midlife and menopause can bring significant shifts and changes in a woman’s life; suffering in silence doesn’t make you resilient. With the right support, recovery is possible so you can look forward to all that life has to offer in this next phase.  

About the Author 

Stephanie Setliff, MD, CEDS, is the Regional Medical Director of the Texas Region at ERC Pathlight and a dedicated child, adolescent, and adult psychiatrist based in Dallas, Texas, specializing in the treatment of eating disorders. She founded the eating disorders program at Children’s Health in North Texas and was subsequently invited to establish a comprehensive program for the Eating Recovery Center and Pathlight Mood & Anxiety Center. Under her leadership, ERC Dallas has evolved into a fully integrated treatment program, providing inpatient and residential care for individuals of all ages. Click here to view her full bio.