HOW do fluctuating hormone levels during menopause contribute to anxiety, depression and cognitive changes in women – and in what ways do societal narratives around ageing and femininity exacerbate or alleviate these psychological shifts?
Psychiatrist Dr Jason Ng says while a lot of research is still needed to find out the precise neuroendocrine mechanics of the process, both oestrogen and progesterone are implicated in several potentiating and inhibiting pathways that regulate mood as well as cognition.
When both these hormones are decreased, there will be a cascading effect through various systems that influence mood, leading to the down-regulation of symptoms that play a role in improving mood, including GABA (gamma-aminobutyric acid which is responsible for response to stress), serotonin (emotional stability and mood regulation) and dopamine (reward and motivation) pathways, he explains.
Dr Ng says similarly with “brain fog”, the reduction of oestrogen levels is thought to be related directly to how oestrogen receptors are present in many areas of the brain involved in memory and learning.
“And so in menopause, it leads to a decreased stimulation of these receptors. The brain fog symptoms are then amplified by the other symptoms involved in menopause, such as vasomotor symptoms like hot flashes and night sweats, which can affect both sleep and mood.”
He says also important to bear in mind is that separate from the physiological changes that are ongoing during menopause, cultural and societal narratives have an equally significant impact on the experience.
“In some societies, ageing is seen in quite a negative light, as if it is the sign of the beginning of the end.
“Loss of fertility and youth in cultures that emphasise the importance of these values lead to a drop in self-worth and esteem of menopausal women.”
He points out that while it might not be an overt expression, women can absorb these messages both consciously and unconsciously, which can then compound the feeling of a loss of “femininity” as well as feelings of invisibility and social isolation.
“In contrast, there are different cultural perspectives where ageing is paired with wisdom and respect, and menopause is seen as a ‘rebirth’ of sorts, when women are less shackled by societal expectations and have more freedom as well as independence.
“Overall, menopause is not just about the process that is happening physically, but also psychologically in the individual, and culturally in the way people treat them.”
Dr Ng’s view is echoed by obstetrics and gynaecology specialist from Indonesia’s Universitas Sumatera Utara Medicine Faculty, Dr Anditha Rezky Sitompul, in painting a picture of a universal challenge.
She says culturally, menopause is still something many Indonesian women keep to themselves.
“There’s a sense that it’s a private matter, sometimes even a source of shame. This is especially true in rural or conservative communities, where talking about hormonal changes, sexual health, or emotional struggles isn’t common either within families or in healthcare settings.
“As a result, many women suffer in silence, thinking what they’re going through is just something to ‘endure’.”
However, Dr Anditha says in urban settings, things are changing, albeit slowly.
“In cities, this is slowly changing. More women, especially professionals and younger generations, are starting to talk about menopause openly, thanks in part to social media and women’s health advocacy.
“But in much of the country, traditional expectations and lack of education still prevent meaningful conversations, leaving women without emotional or social support.”
She says silence, in this context, can affect mental health, self-esteem and even a woman’s place in her family or at work.
“There’s no real workplace policy around menopause in Indonesia, and family roles often remain demanding even as women themselves are navigating complex physical and emotional changes.”
