Menopause as a biological and psychological transition

Midlife for women includes the menopause transition. Menopause can be accompanied by substantial symptoms, disruptions and health changes that can require specialized attention and intervention. However, midlife can be a time of psychological growth and well-being for women. A growing body of research underscores the complex interrelationships between mental health and well-being and menopausal symptoms such as vasomotor symptoms, sleep disturbances, problems with sexual function and cognitive symptoms. Similarly, an increasing number of behavioural interventions have become available that can help to manage symptom occurrence and enhance mental health. In this Review, we approach midlife and menopause as both a biological and a psychological transition. We summarize the changes in reproductive hormones and cessation of menstrual cycles that characterize menopause stages and detail the connections between the biological and psychological changes and symptoms that are common during these stages. We complement this information by discussing behavioural approaches that can help to manage menopausal symptoms and related mental health concerns. On the basis of this integrative approach, we finalize the Review with recommendations for research directions to optimize women’s health and functioning at midlife and beyond. There are complex interactions between physical changes during the menopause transition and mental health and wellbeing. In this Review, Thurston et al. integrate these interactions and outline behavioural approaches to managing menopausal symptoms and related mental health concerns.