Menopause, Sex, and Mental Health: Reclaiming Wholeness in a Changing Season

By: Dr. Tameca N. Harris-Jackson, PhD, LCSW, LMFT, CSE

Picture it: It’s 2022, and I am sitting in a routine doctor’s appointment when I'm told my blood pressure is “pretty high.” I had no history of hypertension, yet the numbers were high enough for my doctor, who had known me for years, to pause with a look of concern. We agreed it was likely stress (surprise), and I left with a gentle reminder about slowing down and lowering my stress levels.

A few days later, I am in my office, mid-session with a client, when my foot and leg suddenly go numb. Odd. Alarming. But I held it together until the end. I usually walk clients to the door, and this time, I walked behind her so she would not notice the slight Frankenstein shuffle I had going on.

I called the healthcare number on the back of my insurance card and spoke to a nurse who recommended that I go to the ER. This began a year and a half of testing on nearly every system in my body, accompanied by the same puzzled expression from provider after provider. The line of questioning became so predictable that I could have recited it in my sleep:

“Do you drink?”

“No.”

“Do you smoke?”

“No.”

“Any drugs? Pills? Even over the counter?”

“No.”

“How’s your diet?”

“I’m a vegan.”

“So you don’t drink, you don’t smoke, and you’re relatively healthy. I don’t see any issues. Let’s run more tests. Maybe it’s…”

And each visit to a new specialist brought a new possibility: a transient ischemic attack (TIA) with nothing visible on scans but a “good likelihood it could return,” long COVID, autoimmune disorders, a migraine with aura (that one was new), and so on.

The symptoms continued to stack up: headaches, heart palpitations, a burning tongue (what is that?), itchy skin, dizzy spells. If there was a symptom, I likely had it.

I was emotionally and mentally exhausted. Then, one day, sitting in my doctor’s office, I simply let the tears come. I am usually pretty jovial, but she saw something different that day. She looked at me with such care. We both admitted that we were out of ideas, and I appreciated that she was still in the fight with me.

In that appointment, in April 2024, I randomly asked:“Could it be menopause?”

She paused and said, “Maybe. Let’s see.” She sent me home with a saliva-testing hormone kit to use after my next menstrual cycle, which was supposed to come in May.

It never came.

One year later, in May 2025, I “celebrated” my official menopause day - Marking twelve consecutive months without a cycle. And yes, I absolutely celebrated! The celebration honored a new chapter in my life - one I see as prestigious. I also celebrated finally having an answer for so many of my symptoms.

One of my "new chapter" gifts to myself - flying high and carefree over rice terraces in Bali.

There are women all over the world with stories like mine, and many with experiences far more intense, frightening, or confusing. Entering this phase of life can feel like taking a nose dive into the unknown. Most women receive little to no preparation or education about what menopause truly involves.

Thanks to people like Melani Sanders and her “We Do Not Care Club,” more people are talking about perimenopause and menopause. Even so, there is still a great deal of confusion, misinformation, and stigma. Shame often silences women, preventing them from getting the support, care, and knowledge they deserve, not just to survive this season, but to thrive through it.

Here is the truth we do not say enough: Menopause is not an ending. It is a shift. A powerful, complex, sometimes messy, and beautifully dynamic shift. And women deserve support, compassion, and accurate information throughout this journey.

As a woman in menopause and a clinician who specializes in women’s mental and sexual health, I understand just how misunderstood this chapter can be. So, let’s talk. Let's discuss menopause, sex, and mental health with honesty, warmth, and the affirmation that you are still whole, worthy, and capable of pleasure and joy.

Here’s the truth we don’t say enough: Menopause is not an ending. It’s a shift. A powerful, complex, sometimes messy, beautifully dynamic shift! And women deserve support, compassion, and accurate information every step of the way.

Menopause, Sex, and Mental Health: Understanding the Mind-Body Connection

Menopause is not simply “the end of your period.” It is a hormonal transition that affects nearly every system in the body. Decreases in estrogen, progesterone, and testosterone can trigger:

• Hot flashes and night sweats

• Mood changes such as irritability, anxiety, or sadness

• Sleep disruptions

• Brain fog

• Vaginal dryness or discomfort

• Shifts in libido

• Changes in body image and self-esteem

• And more

  
  

These symptoms are not signs of weakness, and you are not imagining things. Your body is recalibrating. This endocrine transition influences mood, memory, and arousal, which explains why mental health and sexual intimacy may feel different during this time.

Mental Health and Menopause: It’s More Than Mood Swings

Women are often told to “push through” menopause, or that they are being dramatic. But the emotional impact is real and deserves compassion and support.

1. Changes in identity or purpose

During this season of your life you mind find yourself asking questions such as "Who am I?" and "What do I really want?" Many women begin reevaluating their careers, relationships, and priorities. When you've been pretty consistent throughout your adult life, this can feel unsettling; however, consider this time to be a powerful invitation to revaluate your priorities and reclaim your sense of self.

2. Anxiety or depression

Hormonal shifts can heighten emotional sensitivity. You may cry at commercials, lose patience for no clear reason, or feel overwhelmed by things that once felt manageable. Allow yourself to feel what you feel. If it becomes too intense, reach out to a provider who understands menopause. Women with prior mental health conditions may experience flare-ups during this transition. Seek support, you do not have to endure this alone.

3. Sleep changes

Night sweats, early-morning waking, and insomnia can affect concentration, energy, appetite and mood. Nightly tossing and turning does not have to be your story. Support can include changes to your sleep hygiene, supplements, medication, or lifestyle adjustments (e.g., a consistent sleep schedule). A caring provider can help you find what works best.

4. Grief

Grieving earlier versions of yourself is normal. You may mourn your youth, your fertility, your previous energy levels, or the life you once imagined. This reflection can bring feelings about purpose, change, and mortality. Talking about these emotions is healthy and normal. It does not make you negative, morbid, or a "Debbie downer". It makes you human.

These experiences are part of the transition of menopause, and you deserve to be supported, informed, and cared for throughout this journey.

Women are often told to “push through” menopause symptoms, but the emotional impact is real and deserves support.

**Let’s Talk About Menopause and Sex

(Yes, You Can Still Want It, and Yes, It Can Be Pleasurable)**

Sexual intimacy during menopause can shift in unexpected ways. Some women experience a decrease in desire, while others feel more open, confident, or connected. Many fall somewhere in the middle.

Hormonal changes may influence:

• Vaginal dryness or pain during sex

• Desire (spontaneous or responsive)

• Arousal

• Physical response time

But here’s the good news: Menopause does not mean the end of sexual pleasure. It simply means that your mind and body may need different care, different pacing, or different approaches - and all of that is normal and workable.

Ways to support your sexual well-being:

Use lubrication

This is not taboo and it does not mean anything is "wrong" with you. You are not broken. Adding lubricants is a wonderful way to increase comfort and pleasure.

Explore sensuality without pressure

Touch, massage, connection, conversation - sexual intimacy is expansive. There are so many beautiful things you can engage in to experience pleasure. Explore!

Talk openly with your partner

Share what feels different, what you need, and what helps you to feel desired or comfortable. If you are not feeling as confident or attractive, talk about that too. Your experience matters.

Honor the mind-body connection

Stress, fatigue, lack of sleep, and anxiety can reduce desire. Pleasure thrives when your nervous system feels supported. Take steps to take care of you.

Seek professional support when needed

A sex therapist, gynecologist, or pelvic floor specialist can help identify underlying causes and offer solutions. Reach out to providers who understand menopause and will listen to your needs.

Caring for Your Whole Self During This Transition

Menopause, sex, and mental health are deeply interconnected. Menopause is not a problem to fix. It is an important life stage, a rite of passage, in a woman's life. And it deserves support, compassion, and understanding.

Embrace the fullness of this transition. Keep the following 4 priorities in mind to help care for the whole self:

1. Prioritize rest and nervous system regulation

Sleep hygiene, guided meditation, yoga therapy, journaling, breathwork, and exercise can ease mood changes.

2. Reconnect to your identity

You are evolving. Give yourself room and grace to discover or rediscover your passions, joy, and your sense of self.

3. Build a support team

Therapists, medical providers, nutritionists, partners, and trusted friends are essential. You do not have to go through this alone!

4. Seek medical care when symptoms disrupt your daily life

Hormone therapy, supplements, lifestyle adjustments, or integrative care may provide significant relief.

Menopause, sex, and mental health are deeply interconnected. Menopause is not a problem to fix. It is an important life stage, a rite of passage, in a woman's life. And it deserves support, compassion, and understanding.

Final Thoughts: You Are Not Losing Yourself. You Are Becoming More Wonderfully You!

Menopause is a dynamic intersection of biology, identity, sexuality, and emotional wellness. When we talk about it openly, with compassion and without shame, we make room for women to feel empowered, desired, seen and supported.

You deserve pleasure.

You deserve comfort.

You deserve to understand your body.

You deserve to be heard.

You deserve support throughout every season of your life.

And most importantly, you deserve to feel whole, beautiful, and amazing, because you are.