Making the menopause a positive experience. Two senior women at the beach enjoying a walk.

Menopause – boosting mood and busting stress during menopause and perimenopause

The menopause is defined as the cessation of menstruation. The term menopause is often used incorrectly – menopause means a woman’s last menstrual period. Climacteric describes the gradual changes and symptoms which occur as the production of hormones, and ovarian function, diminishes. In the UK, the average age for a woman affected by the menopause is 51. However, women can begin to experience changes to their physiology for up to 10 years before the menopause, this period is known as perimenopause.

Perimenopause or ‘menopause transition’ is the time when the ovaries will start to decrease the amount of oestrogen they produce and physiological changes first become noticeable, usually beginning on average 3-4 years before the menopause, but can be longer. Initial symptoms of perimenopause are mainly cognitive: brain fog, mood swings, increasing anxiety or low mood.

Therefore women in their late 30s and 40s who are experiencing low mood and/or anxiety should consider the possibility of perimenopause playing a role.

During climacteric, the ovaries no longer release eggs and oestrogen production slows drastically. Menopause occurs when there has been a permanent cessation of menstruation for 12 months. During this time, symptoms such as hot flushes and night sweats occur and can be severe – this also has a detrimental effect to mood and mental wellbeing.

This blog considers the cognitive aspect of perimenopause and menopause and how these debilitating symptoms can be ameliorated to support wellness and make ageing a positive, even enjoyable experience.

Skip to Key Takeaways

Menopause: oestrogen and the brain

Many women complain of changes in their cognitive function during the menopause transition, with the majority reporting worsening of memory and depression.

Several large prospective cohort studies have shown a three-fold increased risk of a major depressive episode during perimenopause compared with pre-menopause.

Even women with no history of depression are still three times more likely to experience depression during the menopause transition compared with the pre-menopause.1,2 

Function of oestrogen in the brain

Oestrogen is a growth promoting hormone and therefore can stimulate the growth and development of nerve cells, particularly within the brain. It is known that oestrogen affects cholinergic (acetylcholine), dopaminergic (dopamine) systems and mitochondrial function within the brain.

Oestrogen also stimulates synaptic plasticity, via activation of BDNF (brain derived neurotropic factor) and elicits neuroprotective effects.

The drop in oestrogen, due to menopause, has been shown to reduce nerve function within the brain, and physiological changes can be observed as reduced dendritic spines, decreased synaptic density, decreased numbers of specific synapses, changes in connectivity, and increases or reductions in grey matter volume in specific areas.

There is also reduced acetyl choline and dopamine signalling, these essential neurotransmitters play a role in cognition and mood.1

All of these are important for mood, memory, learning and concentration, which are affected by menopause and can begin in perimenopause. Therefore, it is essential to support cognitive health alongside balancing hormone levels.

Menopause and anxiety

There is a link between an increased severity of menopausal symptoms and women who experience high levels of stress.

The adrenal glands produce stress hormones including cortisol and adrenaline, which helps the body to deal with stress.3 They will also take over some of the work of the diminishing ovaries by continuing to produce oestrogen after the menopause. The adrenal glands, however, will always favour the production of the stress hormones over the production of oestrogen (survival rather than fertility).

If menopausal women are overly stressed, the adrenals can become worn out and oestrogen production will drop as the adrenals find it difficult to meet demands.

Anxiety symptoms have been found to precede depression in some cases and anxiety may also be viewed as increasing a woman’s vulnerability to depression. We know that stress and anxiety can increase during this time, putting a strain on the adrenal glands, and can therefore worsen symptoms.

Stress can be a key factor in causing hot flushes and night sweats through the release of adrenaline. Adrenaline causes increased heart rate and vasodilation leading to a rise in temperature. A hot flush is your body’s reaction to an increase in temperature, which it attempts to cool down by sweating etc.

Optimum adrenal function is therefore important and hence support for the adrenal glands is a necessary consideration for menopause transition.4,5

Nutrients and dietary interventions for menopause

Nutrients which support cognitive function and mood

B vitamins

Vitamin B6 may support hormone related depression via its role in the proper metabolism of various neurotransmitters. Deficiencies in vitamin B6 have been reported in women with hormone related depression i.e., premenstrual syndrome (PMS) and premenstrual dysmorphic disorder (PMDD) and is linked to symptoms of discomfort.

It has been hypothesised that vitamin B6 may be useful in supporting hormone related depression based on an association between B6 deficiencies and concurrent symptoms of depression and its role in the metabolism of carbohydrates and sex steroid hormones.

B6 is important for both the production of serotonin and oestrogen, however folate and B12 play a further role when it comes to mood.

SAMe is a major methyl donor, along with L-Methylfolate and methyl cobalamin (B12), and methylfolate increases levels of SAMe. All of these are involved in the methylation of tetrahydrobiopterin (BH4). BH4 is a coenzyme and is essential for activating enzymes that manufacture serotonin and dopamine, both of which are important for mood. Methylfolate, B12 and SAMe all stimulate BH4 production. Deficiencies of folate and B12 have been associated with depression, and the reason for this is at least partly thought to be due to the activation of BH4.6

Essential fatty acids

A 2017 review of omega-3 fatty acids for menopausal symptoms of hot flashes, depressive and cognitive symptoms found mixed results, however this may be due to poor methodology of the studies reviewed.

Several large studies have demonstrated an inverse correlation of omega-3 or fish intake and improvements in depressive symptoms or disorders in women but not in men. This gender specific association could be explained by the oestrogen–associated effects of omega-3 fatty acids.7Oestrogens have been found to cause higher DHA concentrations in women than in men by upregulating synthesis of DHA from vegetable precursors such as ALA.7

Studies on 500mg of evening primrose oil taken twice daily have found it can reduce the severity of hot flashes compared to a placebo.8


Zinc is a cofactor for more than 70 metalloenzymes, and low zinc levels have been associated with depression. It is also essential for regulating hormone production as well as modulating the stress response.5

Vitamin D

Vitamin D deficiency had been attributed to low mood associated with seasonal affective disorder. It has been suggested that vitamin D influences nerve growth factors, acetylcholine, serotonin, testosterone and thyroid hormone all of which have implications in the pathogenesis of depression.5

The gut, menopause & probiotics

Interestingly, approximately 90% of serotonin is produced in the digestive system, and although this cannot cross the blood-brain barrier, it does have many functions relating to gut health. Serotonin produced in the gut binds to receptors which stimulate the vagus nerve (the nerve that runs from the gut to the Central Nervous System, CNS) and is part of our enteric nervous system.

Natural stimulation of the vagus nerve in the gut can influence the brain and effect mood. When there is normal stimulation, mood can be improved. However, when stimulation is abnormal due to dysfunction within the digestive system, mood can be disturbed.9

Gut microflora have a strong influence on the production of serotonin within the gut and therefore on the stimulation of the vagus nerve. Research suggests that commensal bacteria within the gut stimulate the host intestinal cells to produce serotonin.10

Therefore, supporting the balance of the microflora within the gut is also important for both serotonin production and the maintenance of stable mood.

Phyto-oestrogens and hormonal balance

Foods rich in plant phyto-oestrogens are believed to help maintain hormonal balance.

Phyto-oestrogens are oestrogenic plant compounds that resemble the chemical structure of human oestrogen molecules. They are abundant in pulses, seeds, beans and soya, and can bind with oestrogen receptor sites, which act to mimic oestrogen in the body. The mild oestrogenic effect can help to reduce menopausal symptoms.

A meta-analysis of clinical trials concluded that phytoestrogen supplementation was associated with modest reductions in the frequency of hot flashes and vaginal dryness.11

There are limited studies that have unequivocally identified improvements to mood or cognitive function with soy, although many suggest there may be a link. In particular, hot flashes have been shown to contribute to depressive symptoms and also activate the HPA axis, which can contribute to anxiety and depression.

Therefore, ameliorating the effects of hot flashes and hypothalamic signalling may indirectly support other associated cognitive symptoms.12

Nutrients and herbs that can help to support adrenal gland function

Vitamin C

In the body, the highest concentration of vitamin C resides in the adrenal glands and is used here for the production of the adrenal hormones, including cortisol.

Stress increases the demand for vitamin C and chronic stress can rapidly deplete levels, so it is important to ensure there are plenty of vitamin C rich foods in the diet, such as leafy green vegetables and citrus fruits to help support oestrogen production.


Another necessary nutrient for addressing stress. Stress can deplete magnesium and when levels are low symptoms can occur such as lack of energy, sleep disturbances, anxiety and depression. Vegetables can boost levels and help relieve symptoms. Oral magnesium supplementation was found to be an effective treatment for symptoms of menopause and perimenopause.13

Magnesium deficiency is a risk factor for osteoporosis and obesity. Magnesium has calming effects on the nervous system, and several studies have found magnesium to be an effective intervention for insomnia and improving sleep, as well as supporting HPA function and reducing central and peripheral cortisol production.5

B vitamins

Help to support the functioning of the adrenal glands, provide energy and regulate mood swings. Studies have shown that pantothenic acid in particular, can boost adrenal hormone production. Vitamin B1 and B6 have been shown to be beneficial in reducing hot flushes and mood swings. B3 and folate are needed for the production of oestrogen.5

Adaptogenic herbs

Ashwagandha is an adaptogenic herb used traditionally in Ayurvedic medicine and has demonstrated great results for lowering cortisol and balancing hormones in small trials.14 Ashwagandha can therefore help to mediate the stress response and promote balance.

Results of an RCT concluded that ashwagandha root extract safely and effectively improves an individual’s resistance towards stress.14

Clinical trials on Ayurvedic herbs including ashwagandha concluded that it was beneficial for mild to moderate physical and psychological symptoms of menopause.15 Ashwagandha is an established adaptogen and may help the body to respond to stress. It also has anti-inflammatory, antioxidant and neuroprotective properties.16

Menopause and exercise

A recent study found that women who are sedentary are 28% more likely to have severe menopausal symptoms than active women.17 Women with depleted adrenal function however, may find cardiovascular intensive exercise will further diminish adrenal reserves.

Gentle exercise is favourable and useful for relieving stress and anxiety and weight-bearing exercises can help to strengthen bones and improve density.

Yoga is very relaxing, which can help with common symptoms such as anxiety and depression – the breathing exercises can also help reduce hot flushes and mood swings.

Meditation is another good way to calm your mind and address anxiety. Oestrogen helps lift our mood so, when levels drop, we may feel more depressed. Getting outdoors in the fresh air and connecting with your surroundings and nature has been shown to boost mood and relieve anxiety.18 Being physically active is associated with a lower risk of depression and cognitive decline.

Menopause and sleep

Sleep is fundamental for health and regeneration and the healthy production and balance of hormones. During the menopause, declining levels of oestrogen and progesterone can be unsettling and may contribute to insomnia, night sweats and other sleep issues. Adults aged 18 to 64 need to sleep for 7 – 9 hours a night.


Research has shown that mindfulness training reduced the distress associated with hot flashes and improved physical, psychosocial and sexual functioning. Improved sleep was an important outcome of the study.19

An RCT concluded that yoga may be effective in reducing insomnia and menopausal symptoms as well as improving quality of life in postmenopausal women with insomnia.20

Key Takeaways

  • Perimenopause symptoms can start up to 10 years before menopause. The most common symptoms described are low mood, anxiety and brain fog.
  • Oestrogen is essential for normal cognitive function and the drop of oestrogen due to menopause has a significant effect on cognitive physiology, which can lead to symptoms experienced in perimenopause and menopause. Therefore, supporting cognitive function is essential.
  • Nutrients that support cognitive health include B6, folate, B12, essential fatty acids, zinc and vitamin D -these should therefore be a priority for women with cognitive issues at this time.
  • Additionally, the adrenal glands play an essential role, during menopause. They take over oestrogen production form the ovaries. As the adrenals are also responsible for the stress response, menopause can exacerbate stress and vice versa. Therefore, supporting adrenal function can help with anxiety and mood and also menopause symptoms such as hot flushes and night sweats.
  • Nutrients to be considered for adrenal support include B vitamins, magnesium, vitamin C as well as adaptogenic herb such as ashwagandha. Clinical trials on Ayurvedic herbs including ashwagandha concluded that it was beneficial for mild to moderate physical and psychological symptoms of menopause.
  • Exercise, relaxation and supporting sleep can help with both menopause symptoms and improving mood and anxiety, therefore these should be a priority.

If you enjoyed this blog, you might also like: Vitamin D and healthy hormone balance


  1. Russell JK, Jones CK, Newhouse PA. The Role of Estrogen in Brain and Cognitive Aging. Neurotherapeutics. 2019;16(3):649. doi:10.1007/S13311-019-00766-9
  2. Maki PM, Jaff NG. Brain fog in menopause: a health-care professional’s guide for decision-making and counseling on cognition. Climacteric. 2022;25(6):570-578. doi:10.1080/13697137.2022.2122792
  3. Gordon JL, Girdler SS, Meltzer-Brody SE, et al. Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: a novel heuristic model. Am J Psychiatry. 2015;172(3):227-236. doi:10.1176/APPI.AJP.2014.14070918
  4. Swartzman LC, Edelberg R, Kemmann E. Impact of stress on objectively recorded menopausal hot flushes and on flush report bias. Health Psychol. 1990;9(5):529-545. doi:10.1037//0278-6133.9.5.529
  5. Bland J et al. Textbook of Functional Medicine.; 2008.
  6. Fanet H, Capuron L, Castanon N, Calon F, Vancassel S. Send Orders for Reprints to Tetrahydrobioterin (BH4) Pathway: From Metabolism to Neuropsychia-try. Published online 2021. doi:10.2174/1570159X18666200729103529
  7. Ciappolino V, Mazzocchi A, Enrico P, et al. N-3 Polyunsatured Fatty Acids in Menopausal Transition: A Systematic Review of Depressive and Cognitive Disorders with Accompanying Vasomotor Symptoms. Int J Mol Sci. 2018;19(7). doi:10.3390/IJMS19071849
  8. Kazemi F, Masoumi SZ, Shayan A, Oshvandi K. The Effect of Evening Primrose Oil Capsule on Hot Flashes and Night Sweats in Postmenopausal Women: A Single-Blind Randomized Controlled Trial. J Menopausal Med. 2021;27(1):8. doi:10.6118/JMM.20033
  9. Dinan TG, Cryan JF. The Microbiome-Gut-Brain Axis in Health and Disease. Gastroenterol Clin North Am. 2017;46(1):77-89. doi:10.1016/J.GTC.2016.09.007
  10. Yano JM, Yu K, Donaldson GP, et al. Indigenous bacteria from the gut microbiota regulate host serotonin biosynthesis. Cell. 2015;161(2):264. doi:10.1016/J.CELL.2015.02.047
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  12. Lee YB, Lee HJ, Sohn HS. Soy isoflavones and cognitive function. J Nutr Biochem. 2005;16(11):641-649. doi:10.1016/J.JNUTBIO.2005.06.010
  13. Porri D, Biesalski HK, Limitone A, Bertuzzo L, Cena H. Effect of magnesium supplementation on women’s health and well-being. NFS Journal. 2021;23:30-36. doi:10.1016/J.NFS.2021.03.003
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  15. Modi MB, Donga SB, Dei L. Clinical evaluation of Ashokarishta, Ashwagandha Churna and Praval Pishti in the management of menopausal syndrome. Ayu. 2012;33(4):511. doi:10.4103/0974-8520.110529
  16. Singh N, Bhalla M, de Jager P, Gilca M. An Overview on Ashwagandha: A Rasayana (Rejuvenator) of Ayurveda. African Journal of Traditional, Complementary, and Alternative Medicines. 2011;8(5 Suppl):208. doi:10.4314/AJTCAM.V8I5S.9
  17. Blümel JE, Fica J, Chedraui P, et al. Sedentary lifestyle in middle-aged women is associated with severe menopausal symptoms and obesity. Menopause. 2016;23(5):488-493. doi:10.1097/GME.0000000000000575
  18. Bratman GN, Anderson CB, Berman MG, et al. Nature and mental health: An ecosystem service perspective. Sci Adv. 2019;5(7). doi:10.1126/SCIADV.AAX0903
  19. Carmody JF, Crawford S, Salmoirago-Blotcher E, Leung K, Churchill L, Olendzki N. Mindfulness Training for Coping with Hot Flashes: Results of a Randomized Trial. Menopause. 2011;18(6):611. doi:10.1097/GME.0B013E318204A05C
  20. Afonso RF, Hachul H, Kozasa EH, et al. Yoga decreases insomnia in postmenopausal women: A randomized clinical trial. Menopause. 2012;19(2):186-193. doi:10.1097/GME.0B013E318228225F

If you have questions regarding the topics that have been raised, or any other health matters, please do contact our team of Nutritional Therapists.
01684 310099

Last updated on 3rd January 2024 by cytoffice


23 thoughts on “Menopause – boosting mood and busting stress during menopause and perimenopause

  1. Thanks for this blog, I’m currently going through it and the info is really useful. However I’ve been getting joint pain as a symptom and this rarely gets mentioned in these articles and can be quite debilitating for many women, and mentally so too when you don’t realise there’s a connection and think your body has slipped into old age- I saw ’menopausal arthritis’ mentioned! Only through specific internet searching I’m finding some blogs and tips on what to take.. ‘devils claw’ apparently… perhaps you could research and add some info on this.. thanks Mel

  2. Many menopausal women will also have a tremendous effect when adding progesterone either together with estrogen or alone. Bio identical hormones that is instead of pills.

    1. What would be the best thing to take for depression during menopause? I would like to take bio identical hormones, but I was diagnosed with breast cancer in 2013. Menopause, is not good. There is a lot out there, but no proof that they make any difference.

      1. Dear Julia

        Thanks for your question on our blog. We have written a couple of other blogs on depression that you can view here and

        Firstly there is much that can be done from a diet perspective to support mood – eating a diet that keeps blood sugar balanced and is anti-inflammatory is important. This would be a diet low in sugar, inflammatory fats and grains and high in vegetables, healthy fats (avocado, olive oil, nuts/seeds, oily fish), with modest amounts of fruit, lean meat and starchy carbohydrates. We have recently produced a publication “Your Guide to Eating Well” – I can email you a PDF or send you a hard copy if you would like.

        With regard to supplements, firstly I would suggest a good all-round multivitamin and mineral with good levels of B vitamins (eg CoQ10 Multi) plus some fish oils (High Potency Fish Oils). Depression can be an inflammatory condition so you could also consider our Phyte Inflam (curcumin, ginger and piperine). Finally, 5-HTP is the precursor to serotonin (the happy brain chemical) and can be taken at bedtime (serotonin is the precursor to melatonin). However 5-HTP must not be taken if you have been prescribed antidepressants (and there has to be a break between using 5-HTP and anti-depressants).

        Other important areas to address to support mood are exercise, adequate sleep (and consider sleep quality), access to daylight (getting outside in the middle of day during the winter is recommended) and of course stress management.

        Keeping a gratitude journal has been shown to help low mood – keep a notebook by your bed (used only for this purpose). Before sleep-time, write down at least 3 good things that have happened during the day. The key with this is to find positives every day, even on bad days. The positives can be small eg sunny day, had nice chat with lady at checkout etc. This has been shown to increase mood within a week.

        We do offer a free health questionnaire service.
        If you complete and return a health questionnaire we will send you some diet and supplement recommendations.

        I hope this helps.

        All the best

      1. Hi Loz – Bioidentical hormones have to be prescribed by a Doctor in the UK. I believe there are some Doctors of Functional Medicine who offer this service and there are some practising in London. I am afraid we cannot help further with this query as bioidentical hormones do not come under the practice of Nutritional Therapy.

        Thanks, Amanda

  3. Thank you Cytoplan for your excellent products and articles! I went into surgical menopause last Nov due to a major Op linked to removing huge ovarian cysts and an appendix tumor. We can totally transform our health by being radical with diet and supplementing well with guidance and oversight. It is so good to know that one can get such thoroughly researched articles and information about supplements, health, excercise and much more from you. As a raw vegan now and during my recovery there are new challenges in getting all the nutrients in the right amounts but I have seen such a rapid return to health and really hold to the ancient wisdom of ‘You are what you eat’. Thanks for all you provide, Cytoplan!

  4. A great article which was unbiased, just factual which is what women need when going through the perimenopause and menopause.

  5. Thankyou for this well informed article. There are so many symptoms of perimenopause and menopause that cause a lot of distress. Palpataions, joint pain, urine infections, heavy periods, anxiety just to name a few that aren’t the talked about common symptoms. You say that taking phytoflavine? Is good for balancing oestrogen levels but what do you recommend for balancing progesterone as this plays a huge part in balancing your hormones too. Any advice would be welcome.

  6. This is the most comprehensive and clearest article on the menopause that I’ve ever read. I’m through it now, and I wish I’d read this 10 years ago! Well done, and thank you. I’m passing it on!

  7. Very good article, I suffered through menopause but once I took magnesium I felt normal again. Wish I had known about it earlier.
    What would you advise Post menopause? Especially for anxiety, as that symptom is still with me.

    1. Hi Vickie,

      Anxiety is a complex condition and a result of both extrinsic and intrinsic factors. To really help you we need to understand more about the problem as it relates to you. We have a health questionnaire service (free of charge), which is designed to collect the information we need to advise effectively on complex problems. You can find out more here.


  8. The article is educative,
    My question is ,it has been made mentioned that the spike in insulin rise is due to high sugar diet that has been consumed,and that cortisol have to intervene by bringing up back the depleted glucose level due to the spike insulin effect.Does this event of such an insulin spike happens out of fine tunning,or out of control? If yes why,if no then why the sequence for such a cortisol need to bring back up the sugar level

    1. Hello – Yes after an “extreme” increase in blood glucose there is a subsequent drop. At this point, blood glucose levels are low and therefore we enter a stress response where adrenaline and cortisol are released. Adrenaline causes sugar to be released from cells into blood stream, thereby again increasing blood sugar, insulin release and another drop in blood sugar. Cortisol and adrenaline are released as it is stressful to be in a situation where blood sugar is too low, as it can be dangerous to life, and they aim to maintain normal a level of blood glucose (there is a healthy range – too high or too low is a problem). These events occur due to high sugar/refined carbohydrate intake on a regular basis so the signalling becomes out of control. If you consume fibre, lean protein and healthy fat, you are less likely to experience the peaks and troughs in blood sugar so the stress response is not triggered.

  9. Hello I would like to know if the soya you use in these tablets is fermented or non fermented?
    Also are these tablets suitable for post menopause, as i do still have these symptoms?
    Thank you

    1. Hi Niki, yes the isoflavones in menopause support are from fermented soy. You can continue to use this product post-menopause and it may be particularly useful if you are still experiencing symptoms.

  10. This is a well-referenced and informative article, thank you. However, there is no mention of the fact that it is the type of oestrogen that changes during peri- and post-menopause and during the menopause itself. Your focus is on the reduction of oestrogen production instead, which is not particularly helpful to the way that the menopause is traditionally regarded as a female ‘deficiency’ of some kind. The psychosocial aspects of this too also are not considered, which in turn could have a bearing for many women who suffer from mood related issues at this time of transition in their lives. I would welcome Cytoplan’s comments here.

    1. Thank you for your query. I agree the alterations to the individual forms of oestrogen is important when considering menopause, if you are a practitioner, you can gain access to our webinar on menopause which highlights this in much more detail. We try to keep the blogs to 1500-2000 words – so we can’t always include everything, but the webinars go into more detail. The focus on the blog was the influence on brain and adrenal function and therefore interventions discussed are relevant for this. Yes psychosocial factors are also important … adrenal support and relaxation techniques are supportive for this but agree can certainly look at further support. We may consider a blog on this at another time.

  11. This was so interesting and very easy to digest, I totally resonated with so much of it. Can you still take all these supplements if you are on HRT?

    1. Hi there, many of the nutrients mentioned in the blog, such as the vitamins, minerals, essential fatty acids and probiotics can certainly be great to take alongside HRT. However, we don’t recommend our Menopause Support supplement, which contains phytoestrogens is taken with hormone replacement as it could affect the action of your prescription.

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