The menopause mental health connection and how Long Island women can get help

Sitting around the kitchen table with her kids, Ingrid Dodd suddenly pushed her chair back. Something was wrong.

She laid down on the couch, struggling to breathe while what felt like the weight of an elephant had landed on her chest. Suddenly dizzy, she put her head in between her legs.

At 45 years old, Dodd was having her first anxiety attack.

"It felt like I was going to die," said Dodd, now 58. "It’s the scariest thing that ever happened in my life."

Dodd started doing some research to find out how this happened: "Figuring out my health became a full-time job," said Dodd, who lives in Lido Beach. "I had to dig into hormones, sleep, nutrition, exercise, mindset, and it took me a while to put my puzzle together."

With the help of her doctor, eventually, she realized how the pieces connected: Dodd was in perimenopause.

For some women like Dodd, the physical and hormonal transition of menopause can bring health struggles like anxiety and depression for the first time. For others, existing mental health problems can worsen, according to Dr. Amanda Tinkleman, a Northwell Health psychiatrist who specializes in behavioral health for women.

"Perimenopause and menopause have profound impacts on mental health," she said.

There’s a sharp rise in new onset depression and anxiety disorders during perimenopause, and often a recurrence of episodes or worsening of disorders that may have existed already.

- Dr. Amanda Tinkleman, Northwell Health psychiatrist

On Long Island, there are nearly 400,000 women aged 40 to 60, according to recent census data. Many of them could be experiencing menopause transition symptoms without a full understanding of how to treat them or access help, experts say.

 

Mental health issues that arise throughout menopause can be treated by lifestyle shifts such as changes to nutrition and exercise, counseling or even hormone replacement therapy for the right candidates, experts say. But the first step in seeking help with mental health challenges during this transition is to talk about it, experts agree.

Mentality during menopause

Menopause occurs around the average age of 52 in the United States, according to the Centers for Disease Control and Prevention, while perimenopause, the transitional period leading into menopause, can last between two and eight years. During this time, the natural production of estrogen and progesterone in a woman’s body drops, which can bring on symptoms such as hot flashes, night sweats, vaginal dryness, poor sleep, mood changes and brain fog.

In perimenopause, estrogen levels can "fluctuate pretty wildly," said Brittain Mahaffey, a clinical psychologist with Stony Brook Medicine. "Those changes can trigger feelings of hopelessness, anxiety, low mood and there’s emerging evidence they may even, in some people, be associated with suicidal thinking."

There are also social pressures throughout this transition period: A woman going through menopause could be climbing the ladder in her career, while also caring for children and aging parents.

"You get that sandwich generation effect during that time, which can be incredibly stressful," Mahaffey said.

Thoughts around aging and mortality can also be triggered, said Dr. Elizabeth Murphy Fitelson, director of the women's program in the department of psychiatry at Columbia University Irving Medical Center.

"It’s the end of this fertile period of their life," she said. "Even if they don’t intend to have children, people are surprised by the emotions that come up for them when that door closes."

These stressors combined with the physical symptoms of menopause "create this perfect storm," Fitelson continued.

Sleepless nights were common for Dodd, and impacted her mentally. "When you don’t get enough sleep, it completely affects your anxiety," she said.

Dodd has noticed it's common for women to sum it all up as: "I just don't feel like myself." But judgment from outsiders can be particularly damaging in such a vulnerable time.

"Historically, that's kind of what happens if you have brain fog, anxiety, they'll say, 'This one's losing her edge,' " Dodd said. "That's not really it."

How to get help

Not everyone going through menopause will be equally sensitive to these hormonal changes. Some will experience severe mood changes while others will not, and there is not a clear understanding as to why, Fitelson said.

But for those in this age group feeling symptoms of depression or anxiety, or cognitive issues like brain fog, there is a way to figure out where they’re coming from.

"If people are having symptoms, whether they're mood or cognitive symptoms, they can track them alongside their cycle," Tinkleman said. "If the changes began at around the same time that cycles became irregular, then it’s likely your brain is reacting to hormonal volatility."

Tinkleman advises women in these situations, "do not convince yourself or let anyone else convince you that it’s just in your head."

Treatment depends on the significance of the symptoms or distress, Fitelson said. At any level, voicing your feelings and concerns is the place to start.

"I think connecting with your friends and peers who are going through similar experiences is probably the most helpful thing," said Fitelson. "It’s incredibly validating, and it can be fun and irreverent."

Speaking with a psychotherapist openly about the physical and emotional symptoms can also make a difference, she added.

For those experiencing mental health challenges coupled with vasomotor symptoms (such as hot flashes and night sweats) or sleep disruption, changes in diet and exercise can help, Fitelson said. A review published by the National Library of Medicine shows that "vitamin D, calcium, vitamin C, B vitamins and protein intake," along with regular exercise, can mitigate menopause symptoms.

Since increased anxiety or depression during this time can be hormonally driven, "stabilizing the hormones through things like menopausal hormone treatment could be and should be part of the initial conversation," Tinkleman said.

Experts say that menopause hormone therapy is effective at reducing or eliminating symptoms when it is started within 10 years of menopause, which occurs when a woman has not had a period for 12 months. But women who undergo this treatment may have a higher risk of developing a stroke, blood clots or breast cancer, according to The Menopause Society.

With the risks and benefits to menopause hormone therapy, it’s important to discuss this option thoroughly with a doctor. The same goes for those who want to learn more about medications like SSRIs to treat anxiety and depression.

There are Facebook menopause support groups (for example, the recently founded support network Menopause Long Island), and webinars often hosted by the Katz Institute for Women's Health at Northwell Health on this topic. Tinkleman is hopeful that women in years to come will benefit from having a more open conversation about this phase of life — just talking about it goes a long way.

"Normalizing it is the most helpful thing," she said. "Then people feel much more comfortable sharing their symptoms and asking for help."

Continuing the conversation

For Dodd, carefully documenting all of her symptoms and bringing them to a physician who focuses on women's health helped create a full picture of what was happening to her body. But while connecting with other women in this stage of life, she realized that not everyone has the time, confidence or information to figure it out like she did.

"No one's helping them connect the mental and physical symptoms," Dodd said. "That's really why I started the podcast."

In 2024, Dodd started Rebranding Menopause to interview experts and fill a void where she felt an "unapologetic conversation" could take place. Most of the women in her life around this age were "actually getting stronger" in their careers and personal lives, she said: Reinventing themselves, starting businesses and getting promotions.

"They were actually becoming more interesting, not less interesting," Dodd said. "But there was no place, not even amongst my friends, to have an intelligent conversation about what’s really happening to us physically, mentally, sexually and inside our families."

Two big changes Dodd made to cope with her anxiety was to put more care into her sleep schedule, and change her relationship with alcohol. With a better night of sleep, she said she doesn’t feel anxious during her day.

Vera Sweeney, 49, is a full-time content creator in Garden City. Her Instagram content centers the well-being of midlife women. The mental health conversation for this particular demographic is an important one, she said, because women have had to "learn as they go" while adapting to a new way of life.

"We’ve been spending decades putting our children first, living for family, and I think a lot of us have put ourselves on the back burner," she said.

Sweeney’s content ranges from women’s health and the anxieties that can come with it, cultivating friendships, rediscovering hobbies and overall self care. Her comment sections are constantly filled with women relating to her journey, she said.

With puberty and pregnancy, women have classes, books and elders to guide them. "With menopause, I feel like you’re just thrown to the wolves," Sweeney said. "That part, thankfully, is being slowly corrected now."

Newsday's Arielle Martinez contributed to this story.