Navigating mood swings, emotional sensitivity, and sudden changes in decision-making among menopausal clients can be one of the more complex aspects of aesthetic practice. Yet these experiences are not just “in her head” - they often stem from profound biological changes that deserve understanding and care.
To help practitioners better support clients going through this transition, Doctor Giuseppe Aragona, a GP and specialist in women’s health at Prescription Doctor with extensive experience in hormonal health and mental wellbeing, has written a guide for aesthetic practitioners. Dr Aragona offers vital insight into the neurobiological underpinnings of menopause-related mood changes and how these manifest in everyday clinical interactions.
Dr Aragona’s article unpacks the science behind menopausal mood disruption, highlights the red flags that call for referral, and equips aesthetic practitioners with practical strategies to conduct more compassionate, informed consultations. Understanding what’s really going on beneath the surface doesn’t just enhance client care, it protects outcomes and professional reputation alike.
When your client becomes tearful during a consultation, struggles to make decisions, or seems unusually irritable, these behaviours often stem from concrete neurochemical changes, not personal weaknesses or difficult personalities.
Women entering perimenopause face an increased risk of developing new-onset depression, even without prior mental health history. This vulnerability period coincides precisely with when many seek aesthetic treatments, creating a complex intersection you encounter daily.
Understanding the neurobiological basis of menopausal mood changes enables more compassionate client interactions, helps you identify when referrals are necessary, and makes sure your treatment recommendations consider whether aesthetic interventions are appropriate for your client's current state. The woman experiencing memory issues during your consultation may be showing signs of hormonal fluctuations affecting her cognitive function.
This knowledge transforms how you approach menopausal clients, moving from potential frustration with challenging behaviour to informed support during a biologically complex transition.
Beyond the well-documented hormonal declines, several overlooked mechanisms drive the mood disruptions you encounter. GABA dysregulation occurs when fluctuating hormones disrupt the brain's primary inhibitory neurotransmitter system, creating anxiety that appears without identifiable triggers. This explains why previously calm clients suddenly seem on edge during routine procedures.
Elevated monoamine oxidase A (MAO-A) levels represent another hidden factor. This brain enzyme, which breaks down mood-regulating neurotransmitters, increases significantly during perimenopause, essentially depleting the brain's natural mood stabilizers faster than they can be replenished.
The neurosteroid cascade presents perhaps the most significant oversight. Progesterone metabolites normally provide natural anti-anxiety effects, but their disruption during irregular cycles removes this built-in emotional buffer, leaving women vulnerable to mood swings that seem disproportionate to circumstances.
Women with no psychiatric history face a two to four-fold increased risk of new-onset depression during this transition - a vulnerability window that catches many practitioners off guard when previously stable clients suddenly present with emotional lability.
Watch for subtle shifts in client behaviour that signal neurochemical disruption. Clients may seem less patient with scheduling details, take longer to process treatment information, or ask the same questions repeatedly within a single appointment. Some become unusually quiet during consultations or mention feeling "not quite themselves" without connecting it to hormonal changes.
Decision-making becomes notably impaired. Clients who were previously decisive about treatments may express uncertainty about procedures they've researched extensively, or seem overwhelmed by choices that would normally be straightforward.
Emotional regulation shifts are particularly telling. You might observe clients becoming tearful when discussing minor side effects, apologising excessively for normal concerns, or oscillating between enthusiasm and anxiety within the same consultation.
Physical manifestations include restlessness during longer appointments, difficulty sitting still during procedures, or mentioning persistent fatigue that affects their ability to engage with treatment discussions. The exhaustion stems from disrupted sleep cycles that compound all other emotional symptoms.
Visceral fat accumulation during menopause creates inflammatory pathways that independently worsen mood disorders beyond hormonal effects. The cycle becomes self-perpetuating: mood disruption reduces motivation for healthy behaviours, accelerating weight gain and further mood deterioration.
For severely obese clients, prescription weight loss pens like Mounjaro may stabilise mood through improved glucose control and reduced systemic inflammation - effects that can enhance aesthetic treatment outcomes by improving emotional resilience during procedures.
Recognise when body composition distress exceeds normal dissatisfaction. Clients expressing severe distress about weight changes or showing disordered eating patterns require medical referral before aesthetic interventions.
While mood changes are common during menopause, certain presentations signal the need for immediate referral beyond your scope of practice. These situations require swift action to be sure of client safety.
Hormonal mood disruptions directly impact treatment outcomes through impaired healing compliance, heightened emotional sensitivity to normal recovery processes, and increased support requirements post-procedure.
Business implications include reduced completion rates when clients defer decisions due to emotional overwhelm, extended consultation times, and reputation risks from proceeding with treatments on psychologically unstable clients.
Recognition enables strategic practice positioning and optimal treatment timing, preventing dissatisfaction while building referral networks with healthcare providers who value comprehensive client assessment.
Hamilton Fraser’s guide to consenting and consultations provides more guidance on carrying out a detailed and robust consenting process.
Recognising menopausal mood changes as neurobiological phenomena rather than behavioural issues transforms your client relationships and treatment outcomes. Understanding GABA disruption, elevated MAO-A levels, and compromised neurosteroid function enables appropriate responses to emotional lability during consultations.
Your awareness of these mechanisms protects both clients and practice reputation while positioning you as a practitioner who understands the complexities of treating menopausal women. The client experiencing mood disruption isn't being difficult - she's navigating profound biological changes that affect every aspect of her wellbeing.
For further reading see Hamilton Fraser’s guide, ‘The business case for adding menopause services to your aesthetics clinic’. You can also find out more about Hamilton Fraser’s policy extension that offers cover for menopause related advice, including consultations, prescriptions and more.
