Menopause Psychosis Symptoms: Features And Treatment Options

Menopause can induce a host of physiological changes in a woman's body and mind. While they tend to be rare, menopause psychosis symptoms may arise in some cases. These symptoms, which generally indicate a break from reality, may be partly attributed to the hormonal changes that occur during menopause. Some menopausal women may also experience the onset of new mental disorders, while others may experience the worsening of existing symptoms.

Studies indicate that a sudden decline in estrogen may prompt positive psychotic symptoms like delusions and hallucinations. Menopause-associated symptoms have also been linked to impaired cognitive function. Women experiencing psychotic symptoms associated with menopause may need to seek treatment that addresses both hormonal changes and mental health symptoms, such as hormone replacement therapy, antipsychotic medication, and talk therapy.

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Menopause-associated psychosis 

The transition to menopause, a distinct phase in a woman's aging process marking the end of menstruation, tends to involve hormonal changes. This process may significantly impact a woman's mental health in the form of anxiety, sleep disturbances, mood changes, and sexual difficulties. Menopause can also raise one's vulnerability to mental health conditions by increasing both the likelihood of their onset and the worsening of symptoms. 

In addition to adolescence and early adulthood, the transitional period to menopause is associated with "a second period of risk for new-onset psychosis." One hypothesis for menopause-associated psychosis (MAP) involves estrogen decline in menopause. 

According to this hypothesis, this decline may reduce "the protective factor against processes that contribute to psychotic symptoms." However, researchers are still examining how this process may work. Some studies indicate that estrogen may lead to changes in latent states, affecting cognitive and positive symptoms associated with psychosis. 

Women with schizophrenia, for example, may find that their positive and cognitive symptoms worsen during menopause. 

Positive and negative symptoms 

Psychosis can involve both positive and negative symptoms.

Positive features generally relate to symptoms that alter one's perception of reality, such as hallucinations and delusions. 

Meanwhile, negative symptoms typically refer to symptoms impacting typical function, such as a loss of motivation (avolition) and reduced ability to experience pleasure (anhedonia).

Positive psychotic symptoms 

Positive psychotic symptoms tend to be associated with schizophrenia spectrum disorders and psychotic disorders, as well as mood disorders, such as bipolar disorder and major depressive disorder with psychotic features. 

According to researchers, positive symptoms may be considered "a primary criterion for diagnosis in psychotic disorders such as schizophrenia, and the sole criterion in individuals at clinical high risk (CHR) for psychosis."

Recent findings indicate that the transition to menopause might present a risk factor for psychosis, especially late-onset schizophrenia, which generally involves a person’s first psychotic episode occurring after the age of 40. These findings are largely consistent with others suggesting that women may have a higher propensity for the midlife onset of schizophrenia.

Menopausal symptoms and schizophrenia spectrum disorders

Hormonal changes during perimenopause and menopause can significantly affect a woman's physical, cognitive, and emotional health. Perimenopause normally characterizes the period of transition to menopause, whereas menopause refers to the end of menstrual cycles, marked by 12 months since the last cycle. The process of moving from perimenopause to menopause tends to be gradual, usually occurring over a period of years.

While each person may experience different symptoms, there are usually some common features. 

Perimenopause and menopause symptoms may include the following:

• Irregular periods (during perimenopause)
• Hot flashes
• Sleep disturbances
• Heart palpitations
• A worsening of headaches and migraines
• Muscle aches
• Reduced sex drive
• Discomfort during sex
• Sensitive teeth
• Changes in body shape
• Mood disturbances, such as anxiety and irritation

Moreover, cognitive symptoms, such as trouble managing emotions, impaired short-term memory, concentration, and the ability to multitask, may also be a concern. 

For those at risk of psychosis, the combination of hormonal changes and pre-existing conditions may present unique challenges. Women with schizophrenia spectrum disorders, for example, may encounter changes in their symptoms that can affect their overall quality of life.  

Estrogen decline and other factors 

Studies suggest that the aging process may render women more susceptible to developing mental health disorders. Moreover, menopause may increase the risk of the onset or worsening of mental health conditions. For example, the period of menopause transition can present a higher risk of psychosis, especially in the form of late-onset schizophrenia. Research suggests that estrogen interacts with multiple neural signaling pathways and that "estrogen decline creates a greater vulnerability for psychotic symptoms in menopause." 

Addressing menopause and psychosis symptoms

Menopause-associated psychosis (MAP) may come with a variety of treatment and management challenges. For example, one's response to antipsychotic medication may be worse during menopause because of the decline of estrogen and reduced sensitivity to dopamine. As such, higher doses of antipsychotic medication may be prescribed, potentially increasing the risk of undesirable side effects, such as the worsening of sleep disturbances. 

To counteract these effects, some clinicians may suggest the cautious use of antipsychotic medication and more attention to hormonal therapies. Hormone therapy with estrogen and selective estrogen receptor modulators (SERMs) has been suggested as a strategy for optimizing antipsychotic treatment in postmenopausal women with psychosis. SERMs may reduce antipsychotic side effects while improving menopausal and cognitive symptoms. 

For women with schizophrenia spectrum disorders, findings also suggest that a combination of hormone replacement therapy and psychosocial support may help women manage symptoms and improve their quality of life. 

Therapy for addressing symptoms 

Speaking to a therapist can be helpful for women going through menopause and other life transitions. However, if going to appointments adds yet another demand to your busy schedule, online therapy might be a helpful option for you. Platforms like BetterHelp enable you to speak to a therapist via phone, video, or online chat. 

Studies suggest that online therapy can be effective in relieving symptoms of many mental health conditions and features, including psychosis, although acute symptoms may need to be addressed in person. One review and synthesis consisting of 61 studies noted that "web-based interventions have been associated with symptom reduction" and that "increased engagement is associated with improved outcomes."