For many women the changes in mental health experienced during the menopause are the most significant of all their symptoms.

Around 70 per cent of women experience some sort of mental health issue around menopause. They may experience mood swings, feeling overwhelmed, anxious, and struggle with low confidence, cravings, brain fog, fatigue, and insomnia.

It’s important to remember when discussing the menopause that it is a natural transition as the ovaries begin to retire. It usually begins in a woman’s early 40s and is marked by the changing levels of the three sex hormones – oestrogen, progesterone, and testosterone.

Some women find adapting to this change difficult. Your sex hormones follow a downward trend overall but alongside this, progesterone and oestrogen levels fluctuate up and down dramatically. The types of symptoms women experience change as they progress through perimenopause and menopause because of these fluctuations.

Women have oestrogen receptors on virtually every cell in and on their bodies. In the brain, oestrogen plays an important role in the production of serotonin, which influences mood. Adequate levels of serotonin give a sense of positivity, helps balance appetite, and supports a heathy libido.

Both relatively high and low levels of oestrogen can lower the availability of serotonin. This can leave women experiencing less joy, lower resilience to stress and with intense cravings or disrupted eating habits.

For some women, HRT (which replenishes oestrogen) can help balance serotonin levels and help with overall mood. However, for many this isn’t enough.

Hyper-personalised support and testing can highlight specific areas and identify potential dietary changes required and targeted supplements needed to make a striking improvement.

Beyond mood, changing oestrogen levels can impact cognitive function. Low oestrogen contributes to brain fog, fatigue, migraines, difficulty concentrating and forgetfulness. All of these symptoms can lower self-confidence and increase the risk of making mistakes that further damage confidence.

Another common change in mental health through menopause is increased anxiety. Early in perimenopause it can show up as premenstrual tension (PMT), disturbed sleep and feeling overwhelmed just before their periods.

As the perimenopause progresses this anxiety may become a more constant feature. Simple tasks such as planning travel, packing bags, or juggling appointments might start to feel overwhelming.

These feelings are caused by the drop in progesterone that impacts the brain’s ability to move from anxious overthinking to a calmer state. The changes in progesterone explain why anxiety is diagnosed twice as often in women compared to men.

Sometimes women unconsciously self-medicate this anxiety with alcohol or sugary foods which temporarily provide a sense of calm, but at a cost to long term health.

Genetic differences play a role here, genetic alterations to brain receptors can make women more susceptible to using higher levels of alcohol to feel relaxed. Dietary changes and targeted supplements or herbs can help women achieve a sense of calm in a healthy way.

Testosterone levels drop steadily into old age and its most notable impact is on libido, but testosterone is important too for muscle building and self-confidence.

Testosterone levels can be boosted naturally with dietary changes such as avoiding foods that bind testosterone like soya and flaxseeds. Weight training or resistance exercise can also improve symptoms of low testosterone.

During menopause, the adrenal glands should be able to take over from the ovaries as they retire. They have the potential to make hormones that can be converted into oestrogen, progesterone, and testosterone. It’s this hormone production that smooths the menopause transition in healthy women.

Modern life, however, can take its toll on the adrenal glands’ ability to make these hormones. Working too hard and experiencing persistent stress, having children later in life and other factors can all impact the adrenal glands’ ability to supply sex hormones.

This exacerbates both menopause symptoms and mental health issues. Building stress resilience, for example by using techniques such as breathwork, yoga and mindfulness, can help.

A greater understanding of the impact of menopause on mood, motivation and sleep is important while knowing that for most women there is more to regaining mental health than taking HRT alone is essential.

Tailored recommendations and lifestyle measures such as nutrition and exercise can go a long way in helping modern women feel and function at their best.

Sarah Williamson and Victoria Keith-Roach are co-founders at the London-based women’s health platform WomenWise.