Mind If We Talk? Season 2: How Menopause Affects Women's Mental Health

Welcome to Episode 8 of Mind If We Talk? Season 2

Mind If We Talk? is an original mental health podcast created by BetterHelp and Acast Creative Studios that opens up real conversations about life's challenging moments, and how therapy can help us navigate them. Over the course of 10 episodes, Season 2 brings two people together to share different perspectives on experiences that are deeply felt, yet rarely discussed. Through guided conversation, guests reflect on what they wish others understood about their inner world and what it means to truly listen and be seen. Each episode is hosted by Dr. Sreela Roy-Greene, a licensed BetterHelp therapist, who gently guides the conversation and offers therapeutic insight along the way.

Episode 8: How Menopause Affects Mental Health

Menopause isn't just a physical experience -- it's a mental one, too. In this episode, host and therapist Sreela Roy-Greene sits down with the mother-daughter duo Dr. Amy Shah and her mother, Rekha, to explore the mental shifts that accompany this change and why the conversation around menopause can be so hard to start. In her midlife, Rekha's anxiety began to feel unbearable. It wasn't until years later that she and her daughter Amy realized that this and other symptoms were due to menopause. Later in the episode, Dr. Natalie Crawford, a reproductive endocrinologist, author, and a leading voice in women's hormone health, joins Sreela to dive further into the science of menopause. Dr. Crawford unpacks the hormonal shifts, the connection between the brain and the ovaries, how to optimize your health before perimenopause, and how to advocate for yourself when you are not getting the support you need.

What was your body trying to tell you?

SREELA:

For decades there has been a limited understanding of menopause, when the reality is that it can be incredibly transformative and life-changing. When you're looking back, what do you feel like your body was trying to tell you?

REKHA:

I started getting more anxious about everything, but more so sleep. I said, is there something wrong with me? Why can't I sleep and why am I getting so anxious? I did not realize that there was something physically going on that was causing this trouble. I just thought it was me and my willpower. I didn't know that that was the first sign that something was going on, and I couldn't recognize what was wrong with me.

SREELA:

That must have been so scary -- to not know and feel like you're not in control.

REKHA:

Yes. It was very, very, very painful.

DR. SHAH:

Almost like you were going crazy.

REKHA:

Yeah. My husband probably thought that I was going crazy because all of a sudden -- why do you have low willpower? Why are you worried about sleep? Maybe you're taking too much stress for nothing. Things like that.

SREELA:

How did that show up in your behavior?

REKHA:

I was working as an HR person and I had payroll on Mondays. Sunday at four o'clock I would start thinking about Monday payroll and freaking out. And then every little small mistake -- my heart was pumping, I don't think I can handle this. At the end, it was getting so much that I had to leave my job because I couldn't handle the pressure anymore. It was giving me too much anxiety.

The early clues -- and what doctors miss

SREELA:

Amy, what were your experiences like -- or the early clues?

DR. SHAH:

I'm coming from it from a different angle because I'm a physician. I started to realize that everyone in my friend circle -- even in their late thirties and early forties -- was noticing changes in hormones: sleep, energy, mood, all these things were happening. And my colleagues, even myself -- we never really learned about a transition that happens in your thirties and forties. We thought of menopause as something happening in your fifties, hot flashes and night sweats. What was surprising was when I started to learn that perimenopause starts in your late thirties and early forties -- wow, nobody knows this. Not even doctors. We didn't learn this in medical school. And all these people are walking around thinking they're not exercising enough, not doing enough, that something's wrong with how they manage stress or their jobs. They don't realize there's something else at play. I started to educate women around it because I didn't want it to be like my mom -- where you chalk it up to something else, or you think you're going crazy or depressed or anxious, without knowing there's this other thing happening.

SREELA:

That lack of awareness, that lack of education -- and wanting to be proactive -- is so important.

DR. SHAH:

Women are always dismissed about their symptoms. They're never really told what's happening to them. The more we can talk about it, the more people can start to tune in. Because if you don't know what could be changing, you almost can't recognize it early and deal with it earlier.

SREELA:

It can sometimes creep up on a person if they're not paying attention. Rekha, you shared that for nearly 10 years you didn't fully understand what was going on. Were there other sensations or body experiences that you look back on and realize -- oh, that's what that was?

REKHA:

It was giving me hot flashes in the night. I would be freezing and then sweating, and I said, oh my God, I don't know what is wrong with me. First I thought maybe my heart was wrong. I went to a cardiologist, got a stress test, everything came out okay. There was nothing wrong with my heart. So then I said, I don't know what is going on with me. In our Indian group, so many women were wondering -- I can't sleep right, I feel hot and cold, nothing is going right. Nobody had any clue that this was menopause. I had no clue until I talked to Amy. Even Amy at that time, I don't think she had any idea. She was telling me, mom, probably you are stressing out too much -- maybe you should take some mild medicine to calm your anxiety. I started doing exercise, walking one hour every day, taking anxiety medication every day. I was trying to make myself happier, being with the kids, doing all the things that make me happy. It was somewhat manageable, so I thought maybe it's working. But I did not know what was the main answer, how to calm it all down. I was still in the air because I didn't know anything.

"Not having knowledge about menopause and perimenopause -- and just women's bodies in general -- takes a huge toll on women's mental health." -- Dr. Shah

The moment everything clicked

SREELA:

You both mentioned that you realized together that what Rekha was going through was ultimately menopause. How did that moment feel?

DR. SHAH:

When I started to learn all the symptoms, it brought me back to my mom during our wedding time -- which was when she was going through the throes of menopause. I recognized all of the symptoms and I told her: that's what was happening to you at that time. She was like, oh yeah, I had anxiety, sleep issues, mood issues, weight gain -- all of those things she thought were all separate. The carpal tunnel, the palpitations -- she thought those were separate too. All of those things could have all been from the same thing.

SREELA:

People don't realize how interconnected each piece is. And I think oftentimes people are very dismissive even to themselves. Amy, you mentioned earlier -- essentially medical gaslighting. How easy it is, especially for women, to have their concerns dismissed.

DR. SHAH:

I used to think it was so great coming from an Indian culture -- hundreds of people in her family that she communicates with from the time she was little, huge families and huge conversations of women -- but they never knew about what was happening. And I thought that was so shocking. It's only now that she tells the younger generation what she went through and how people should deal with it. She's giving advice now on something she never got advice on.

REKHA:

When I was growing up, I had never heard of menopause. None of my cousins, none of my aunts, any of my relatives or friends -- no one talked about menopause. They just said, oh okay, you're getting older, you're getting fat, you can't sleep anymore. One of my sister-in-laws was going so crazy because of menopause that she ran away from her house because she was getting so anxious and sensitive. She thought nobody was giving her importance, nobody was talking to her. And she left the house. No one realized that was because of menopause. Her life was totally changed.

DR. SHAH:

For their generation, it seems like there were a lot of mental health issues that happened during that time that were taboo, looked down upon, and nobody really wanted to uncover the roots of it.

Entering perimenopause with more knowledge -- and more questions

SREELA:

Amy, now that you're entering perimenopause, you have a very different set of tools than your mother did. You've got the medical training, the research, the societal changes -- the narrative has changed quite a bit. Even with all that knowledge, what still surprises you about this phase of life?

DR. SHAH:

Unfortunately we now have so much information, and sometimes it's competing information. A lot of what I'm dealing with for myself and my patients is: what's actually the right way to go? What are the right treatments, the right tools? I still think there's a lot of confusion. We don't have all the answers, we don't have all the research.

SREELA:

Maybe it's good that we're coming at it from a place of curiosity rather than trying to suppress.

DR. SHAH:

Society used to think of menopause as a decline -- like women just weren't as important anymore. But what I'm understanding now is that it's not necessarily a decline. It's just a reshifting of the body and brain, and you have to adjust to that.

SREELA:

Taking away that stigma that menopause means the end -- and instead looking at it as an opportunity to reinvent yourself. How have your journeys differed? How have they been similar?

DR. SHAH:

I'm catching it earlier, so I'm watching myself. Knowing what she went through, I know the things to watch for. For her, the big piece of her journey was the anxiety -- something she always struggled with that just got so exaggerated. For me, I understand my journey might look a little different. But definitely I'm looking at sleep issues, energy, mood -- lots of different things. I'm still pre- and peri-menopausal, whereas she really felt most of her symptoms at the very end, which is typical. And she didn't have access to or even a discussion about hormone replacement therapy. At the time it was a taboo subject and nobody really prescribed it because of fears around cancer risks. That wasn't even an option for her. She would've been a perfect candidate.

SREELA:

Rekha, knowing what you know now -- what are some of the ways you'd want to show up for Amy when she gets to that point?

REKHA:

I will do anything and everything for her, whatever support she needs. The medicine side, she will take care of -- the hormone therapy, whatever she can do. But as a mentor, whatever she needs help with, I will be ready for her.

DR. SHAH:

She has a family group of like a hundred people, and she gives advice there all the time about health and life. She's not just supporting me and my brother and my kids and her husband -- she's supporting an entire extended family who really takes her advice.

SREELA:

You're showing up for those hundred-plus people in the way you wish somebody had shown up for you.

"Not having knowledge about menopause -- and just women's bodies in general -- takes a huge toll on women's mental health. And feels unfair, really." -- Dr. Shah

Changing the narrative for the next generation

SREELA:

Now that you've both had this opportunity to get clarity -- how are you changing the narrative for the kids and grandkids in this generation?

DR. SHAH:

For me, I'm talking about it very naturally. My son jokes that he's the 18-year-old boy who knows the most about perimenopause and menopause. And we laugh, but it's true. It should be a conversation that's not taboo or weird. It's not just for girls, it's not just for older people -- it's for everybody to understand. It's part of life. It's like pregnancy. Everybody knows what happens when you get pregnant. That's how I talk about it now -- freely, without any shame.

REKHA:

You should openly share what knowledge you have about menopause. People should not be ashamed of asking what's going on, because if you can help someone, that will be very, very nice. It should not feel shy to talk about it -- because it's a very regular thing that people go through.

SREELA:

Has going through this journey brought you both closer together?

DR. SHAH:

Knowing what she went through and looking at it through the frame of -- this was a normal part of her life -- makes me understand her so much more. She really thought she was having some kind of mental and physical breakdown. And this makes me realize she was just going through part of her journey. And what a difficult part it was, because she didn't really have a lot of support -- from doctors, from her family, from her friends.

SREELA:

A lot of respect for getting through all of that.

REKHA:

We are getting more and more closer because of all this conversation about menopause. She tells me, this is what you were going through. And it feels so much better. I feel so much closer to Amy when we have that conversation.

The science of perimenopause -- what's actually happening

SREELA:

Amy and Rekha are now creating a support system for other female family members, so they don't have to suffer alone and in confusion the way Rekha did. But there is still so much misinformation, lack of research, and even gaslighting in the medical field that can make these conversations tricky to navigate. So I sat down with Dr. Natalie Crawford, a reproductive endocrinologist, to better understand the mental and psychological changes that take place during menopause, and how women can best prepare and advocate for themselves.

SREELA:

What inspired or ignited your passion when it comes to menopause and perimenopause in women?

DR. CRAWFORD:

What has inspired me and always kept me trying to educate women and create content is the number of times I've sat across from a really smart, educated woman who said: I wish I'd known this information sooner. Just this basic fact that we are not taught about our bodies -- as simple as how our menstrual cycle really works, what we need to do to optimize or understand our fertility. And that just becomes even more apparent as we progress through the later reproductive years and into perimenopause and beyond. We know that when we go through such a huge hormonal transition, it impacts not only how we feel right now, but also our long-term health. Ovarian health and function -- the ovaries are my favorite organ. That's what I'm so passionate about: helping women really understand so they can be making the decisions that are right for them, from a place of knowledge and data.

SREELA:

Could you educate us on the differences between perimenopause and menopause, and what to look out for?

DR. CRAWFORD:

Let's think about what's actually happening at the ovarian level. I want everybody to imagine that inside your ovary is a vault where all your eggs are kept. Women are born with all the eggs they're ever going to have, and we run out of them over time. Every month, a group of eggs is sent out of the vault. Each egg grows inside a follicle, and during our ovulatory years, one of these eggs will grow to maturity and ovulate -- and the rest will die. So we are constantly losing eggs every single month.

Over time, we run out of eggs and the vault gets emptier. The brain and ovary are perfectly coordinated, but they can't actually see what's happening. As the vault gets emptier, fewer eggs come out every month. But the brain doesn't know this and starts sending out its normal signal. This is when we start to see some of the signs of perimenopause. One of the first signs is that your cycle will actually shorten. Classically, a woman will sit across from me and say, my periods used to be 28, 29 days, and now they're 24, 25 -- isn't that curious? And I'll say, oh, that's not curious at all. I'm immediately thinking her egg count is lowering. She's starting to enter the perimenopausal transition.

We're growing an egg faster, we're ovulating sooner, and we're actually having fewer days of that unopposed estrogen. The follicular phase -- the first half of the cycle -- is when your body gets its high estrogen time. You're feeling your best, feeding your blood vessels, your bones, you have peak libido. You get fewer days of that when you start ovulating sooner. So women start to have the number one symptom of: I don't feel like myself. And it's because their overall estrogen is lower. One of the problems is that many providers will think perimenopause is when you start having irregular cycles -- so a woman will say, but my cycles are regular, and get dismissed. It's really important to understand what's happening physiologically. When you start to have just fewer total days of estrogen in the month, you will start to feel it mentally -- mood, energy. That is the driving factor.

I would say perimenopause equals what we call in the fertility space diminished ovarian reserve. For most women, they will have these hormonal changes in the five to seven years before menopause. And the average age of menopause is 51 to 52.

"Estrogen is a really important hormone for the female brain. To act like we should just transition through having it be gone -- and be a perfectly normal same version of ourself -- is really such a ridiculous claim." -- Dr. Crawford

How hormonal changes affect mental health

SREELA:

How do those hormone fluctuations impact our psychological and emotional health as women?

DR. CRAWFORD:

Things can be natural or normal, and it doesn't mean that suffering should be normalized. Estrogen receptors exist throughout your entire body, but especially in the brain. We know that at times of higher estrogen, you have improved cognition, improved mental health. And at times of lowest estrogen, you have more depressive episodes, more mood swings, higher anxiety levels -- in addition to feeling more off, less stable, less happy, and having more brain fog. So estrogen is a really important hormone for the female brain. To act like we should just transition through having it be gone and be a perfectly normal same version of ourself as we were when we had high estrogen -- that is really such a ridiculous claim.

Every woman should make the decision on whether hormone replacement is for her or not. We should have choices and be able to leverage all the tools in front of us. When estrogen leaves the system, you notice it. You don't feel like yourself -- your mood will be low, your energy will be low. Brain fog, difficulty concentrating, anhedonia, lack of joy in things that previously brought you joy. Those are really shared experiences from a low estrogen state. Something as simple as starting very low-dose estrogen, titrating it and getting it to the right level -- women come back crying saying they really just thought this was something they'd have to suffer with forever.

One of the most important things is that if you are considering hormone replacement therapy, you have a doctor or provider that you trust and who will listen to you. If you feel dismissed or gaslit -- we're past that. Please go seek somebody else.

SREELA:

So glad you touched on gaslighting. As a therapist, I often say this to my female clients who are going through any medical issue -- but especially when it comes to hormonal and life changes that are perfectly normal but dismissed: you deserve to be heard, and you certainly don't deserve to be gaslit.

DR. CRAWFORD:

It's really important because sometimes we just assume this is the experience everybody else is having. We don't know what a good empathetic practitioner can look like if all we've experienced is the other version. Your health is so crucial to your wellbeing, to your entire lived experience -- and it is worth fighting for and advocating for. I like to think about it in three buckets. One: learn what's normal -- we've got to raise your fund of knowledge. Two: be empowered to advocate for your own health -- find the right doctor, know the questions to ask. And three: take control and optimize the things in your world that can influence what you're experiencing. Those are the three buckets women should focus on when it comes to hormone health through these transitions.

Five ways to protect your health before perimenopause

SREELA:

Are there ways women can protect themselves or prepare for these normal life changes?

DR. CRAWFORD:

There's a lot we don't know, but there is information we can take from the fertility data and apply to the midlife time period. The longer we can live a healthier life and decrease inflammation, the greater the potential to influence how long we can extend our ovarian lifespan. Even going through menopause one year later substantially improves health outcomes -- decreases your risk of heart attack, cardiovascular disease, metabolic syndrome, stroke, even cancer. So we should pay attention to ovarian health before we're in the midlife stage.

I put these into my five non-negotiables that every woman should think about. Number one is getting enough sleep. Sleep is when your body has its internal cleanup system. Cutting your sleep window short increases your foundational inflammation and impairs how your brain sends signals to your ovary.

Number two is chronic stress, and I'll loop in number three -- exercise. We really have to understand the word insulin resistance, which becomes a big player in midlife. Exercise is key. Building skeletal muscle when you lift weights is something women should start doing much earlier. More skeletal muscle means more ability to use glucose without needing insulin -- lowering glucose levels, lowering insulin levels, making your cells more insulin sensitive. Build that muscle base beforehand and you'll be in a better position.

Then in those high-stress moments -- when you get out of a bad meeting or you see something triggering on your phone -- try to activate that skeletal muscle. Go for a five-minute walk, do 10 squats. Your body releases more glucose in those moments; use it up, and get back to baseline. The earlier we make this part of our day-to-day life -- sleep, stress, and exercise -- the lower our inflammation levels will be.

Number four is diet. Ultra-processed foods and artificial and added sugars are highly inflammatory with no nutritional benefit. If most of your diet is fruits, vegetables, fiber, whole foods, and healthy fats, then having cake on your birthday is no big deal because your total inflammatory burden is lower. We want to make those day-to-day choices from a place that will decrease inflammation and improve our gut microbiome.

And number five is environmental toxins. Paying attention to getting rid of plastics, limiting toxin exposure. I often hear somebody say, well, I can't control every toxin out there, so I'm gonna control none of them. Instead, let's control what's in your home -- where you spend most of your time -- and make that environment as low-toxin as possible. We also have to talk about behavioral toxins that we've normalized in society: cannabis, nicotine, alcohol. They don't provide any health benefit, and they do increase inflammation in addition to damaging the number of eggs you have and how they function.

Estrogen is an anti-inflammatory hormone. When estrogen starts to drop, women start experiencing fatigue, weight gain, bloating -- all high inflammation symptoms. Instead of waiting until you have a problem to start figuring this out, I really want women to start looking at this earlier.

SREELA:

One thing I find in my practice is that working mothers so often put themselves on the back burner. I don't have time. As women, mothers -- we have to hold it together. But we need to also get the sleep, check our diet, check our toxins, make sure we're getting our exercise -- before it all adds up and our systems get overwhelmed.

DR. CRAWFORD:

Absolutely. And it doesn't have to be perfect to be impactful. If you didn't get as much sleep, it's now more important that you eat those healthier whole foods, don't drink alcohol that night, and use your skeletal muscle. Every day doesn't have to be perfect -- we get a fresh start the next day. Women take care of everybody else but themselves, and that will work until it doesn't. You will get so sick, you will feel so bad, that you can't take care of anybody, including yourself. We really have to switch that martyr narrative and say proactively: if I can do these things now, I will show up as a better version of me. Because when you lose your health, it is so hard to get it back.

"It doesn't have to be perfect to be impactful." -- Dr. Crawford

How to talk to your doctor -- and actually be heard

SREELA:

One of the barriers I see is having those difficult conversations with doctors. What are some openers or suggestions for how people can better advocate for themselves?

DR. CRAWFORD:

Three things. First: schedule the right type of appointment. If you are feeling fatigue, hormone changes, irregular cycles, painful periods, pain with intercourse, gaining weight -- schedule a problem-specific visit, not just your annual. Call in and say, I have irregular periods, or I have fatigue. Then your doctor walks in and the first question is: what's bringing you in? You already have the opening.

Second: think about your story. Your medical history provides so many clues, but patients often have a really hard time verbalizing what they've been experiencing. Take the time to think through what is bothering you. Prepare your answer for when your doctor asks what brings you in today. Every question they ask will depend on that. If your doctor gives you pushback, try to get to the bottom of why, or say: these are the tests I'd really love to have because X, Y, Z. They may not be trying to be prohibitive -- they may just be thinking you don't want to pay out of pocket.

And the last one is really important: you deserve to know what happens next. If your doctor doesn't round out the visit with next steps, you can end it that way yourself: wait, I just want to clarify the next steps. Always clarify the what next. And if you do not feel like your doctor is listening to you -- please go find somebody else.

Listener questions

SREELA:

One listener wrote in to ask: I feel like I lost my spark. Does it come back?

DR. CRAWFORD:

It does come back. And hopefully it can be sparklier than ever -- but it also might look different, and that's okay too. Just like any life transition, you're going to come out of it as a new version of yourself. Our goal is to help you come out of it as a better version -- not to be left in the darkness. I encourage you to really seek care from a doctor you trust, really learn about your body, and then control those other factors. The unknown for women specifically is the scariest thing. When we don't know what's happening to our body, and we don't know what we should do, and we don't know where to go -- we feel more lost. And our spark is more dull than ever. So start on this journey of exploration. Your health is worth prioritizing. Learn your body, advocate for your health, control what you can. And I bet you'll come to the other side feeling better than ever.

SREELA:

Is it normal to grieve who I used to be?

DR. CRAWFORD:

Absolutely. Grief is a normal part of evolution and life being dynamic. And I always say: if we can leverage that grief into gratitude for who we were, and use that to seek who we want to be on the other side -- that's the work. When patients bring this to me, I ask: what is it we grieve the most? And how do we seek to find something like that feeling again? How do we prioritize joy so that we can feel our best? You shouldn't have to navigate this transition alone. Think about your care team as multi-persona -- a doctor you trust, a therapist you love, prioritizing community and your friend group. Which gets harder as we start to feel more isolated or less like ourselves. We can grieve who we were, but we should actively work to become the next version of ourself that makes us no longer grieve the past -- because we're excited to be where we are.

SREELA:

It is so important to have that social network and community, as well as your medical experts. Obviously I'm going to say: have a therapist you trust. But lean on the people you know are going to support you. It's easy to isolate and sometimes feel like you're an island unto yourself -- but it is all the more important to make sure you're getting those touches in with the people you can trust, especially going through a difficult time.

CREDITS:

SREELA:

I want to give a big thank you to BetterHelp for their passion for this project, and for giving us a platform to champion the well-being in all of us. Mind If We Talk is produced by Acast Creative Studios in collaboration with BetterHelp, and hosted by me, Sreela Roy-Greene. If you like what you just heard, drop us a review on Spotify or Apple Podcasts, and share the episode with your friends! Maybe one of our topics will help someone in your life. And remember, your happiness matters.

Mind If We Talk is intended for entertainment and education, not for mental health diagnosis or medical advice.