Mood swings with menopause

You’re laughing with your friends one minute and close to tears a few moments later. You feel tired, overwhelmed, and out of control. You’re not crazy—it’s one of the common symptoms of perimenopause (the first stage of menopause, usually in the early 40s): mood swings. And there are ways to cope.

What causes mood swings?

As a woman ages, estrogen levels are fluctuating from one minute to the next, and erratic. Less progesterone is produced (but stabilizes at low levels in postmenopause, around age 55). Estrogen is related to production of serotonin, a mood-regulating neurotransmitter. Fluctuating estrogen and progesterone levels, plus other factors, cause serotonin production disruption, leading to more mood swings.

What to do about mood swings?

Mood swings are a part of aging for many women, but the good news is that you can take steps to help prevent them and manage them when they occur. Often, a healthy lifestyle is the first step in preventing mood swings.

  • Avoid caffeine, alcohol, and spicy foods
  • Eat a balanced, health diet with fruits, vegetables, and whole grains
  • Talk to a therapist or counselor
  • Get enough sleep
  • Exercise regularly
  • Find healthy ways to deal with stress

Mood disorders are common during this time. Lack of sleep can worsen mood, but anxiety and depression symptoms may contribute to sleep disturbances that are also common during menopause. During the menopause transition, there is a significant increased risk of new-onset depression or relapse of depression. This risk decreases again early after menopause.

Sometimes, however, all of the lifestyle changes you make are not enough. For severe mood swings, especially those that interfere with enjoying everyday life, hormone therapy can help.

  • Hormone therapy may help severe mood swings; usually lowest dose for shortest amount of time prescribed (there is no increased risk of breast cancer until after three years of therapy; very few women use therapy for any longer)
  • SSRIs (selective serotonin reuptake inhibitors) can be effective in treating mood swings and other symptoms, such as hot flashes and sleep issues, but have side effects; some doctors suggest effectiveness is increased when a woman is first treated with estrogen
  • Complementary alternative medicines (CAM) such as black cohosh, deep breathing, and soy in some cases; includes treatments such as acupuncture and mind-body therapies such as yoga, tai chi and meditation
  • Low dose birth control pills can shut down the ovarian fluctuation that takes place during perimenopause; offers a fixed dose of estrogen and progestin every day

Always talk with your health care provider about medications, hormone therapy, and before using CAM supplements.

It’s all in the hormones

Technically, ‘menopause’ comes from the Greek words ‘menos’ and ‘pausos’ – your periods stop. But there are lots of other changes, including hot flushes, vaginal dryness, a tendency to put on weight around your tummy and mood swings.

Most of the physical changes of the menopause are due to changes in levels of the female hormone oestrogen, which naturally go up and down during your menstrual cycle. Your oestrogen levels drop after the menopause and come down to a constant low level, usually within a couple of years of your periods stopping. It’s these changes that cause hot flushes and vaginal dryness. Your natural levels of another female hormone, progesterone, also change with the menopause, and this hormone is thought to be mainly to blame for premenstrual syndrome (PMS).

However, if you’ve suffered from PMS it doesn’t necessarily mean your menopausal symptoms will be bad too.

Mood changes – is it just the menopause?

It’s well recognised that major life changes can bring on depression. Unfortunately, many women are going through just such changes (children leaving home, divorce, etc) around the time of the menopause. At the same time, you’re up half the night with hot flushes, and sex may become uncomfortable because of vaginal dryness, possibly causing friction with your husband. Going through ‘the change’ also means you can’t have more children – and even if you didn’t want to, the fact that you now have no choice can take a toll.

Interestingly, in cultures where having a period makes women ‘untouchable’ and childbirth is a dangerous business because of lack of medical facilities, fewer women report depression or mood swings around the menopause. They are free from the monthly social restrictions, and many report that they feel more happy, not less.

Your attitude to the menopause really does seem to make a difference, too. Several studies have shown that a negative attitude towards impending menopause makes you more likely to suffer mood changes as well as hot flushes.

Interestingly, there is also increasing evidence that your lifestyle can have a major impact on the symptoms you get around the menopause. For instance, smoking and gaining weight around the menopause are linked to more hot flushes; and lack of regular exercise can increase your risk of hot flushes as well as being linked with an increased risk of depression at any age.

Mood swings – feeling angry, irritable or upset easily – are common with the menopause. To recognise if you are really depressed, see below. If you’re not, there are lots of ways you can minimise the impact of the menopause and get your life back on track.

How do I help myself?

My top tips for mood swings at the menopause:

  • Think positive. This could be the start of a new and exciting chapter in your life – no more worrying about contraception, more time for yourself after years of putting the children first.
  • Watch your diet. Sugary foods cause your blood sugar levels to rise and then fall rapidly. This can make you irritable.
  • Consider adding more soya-containing foods to your diet (soya beans, tofu, soya milk all count). Japanese women, who have a diet high in soya, which contains ‘phyto-oestrogens’, appear to have fewer problems around the menopause.
  • Exercise regularly. This raises natural body levels of endorphins, a ‘feelgood’ chemical.
  • Celebrate you! You are still yourself, and you’re beautiful. You have a wealth of experience and wisdom you never had in your youth.

How do I know if I have depression?

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We use the term ‘it’s really depressing’ a lot, but in medical terms, depression is more than just having a bad day. For a doctor to diagnose depression, you need to have symptoms on several days a week for some weeks. They include:

  • Little interest or pleasure in doing things.
  • Feeling low or hopeless.
  • Changes in sleep (not just caused by hot flushes and sweats).
  • Changes in appetite.
  • Feeling that you have let others down or are a failure.
  • Problems concentrating.
  • Being so sluggish or nervy that others have noticed.
  • At worst, thoughts that you’d be better off dead.

If you suspect you may be depressed, do talk to your GP. There is a wide range of really effective treatments, including talking therapy, available.

With thanks to ‘My Weekly’ magazine where this article was originally published.

Menopause, Mood Swings, and Depression

When Pamela Kragen* was going through menopause, she remembers a woman who became so enraged that she ripped the phone out of the wall.

The woman happened to be Kragen herself.

At times, menopause transformed Kragen into another persona entirely — one that reminded her of a woman whose multiple personalities could not be controlled.

“Normally, I may fly off the handle once or twice a year. But once I started going through menopause, it was like every day,” Kragen recalls. “Somebody had taken over my body. I’d be fine and then suddenly I’d go crazy.”

Mood swings may not be a daily occurrence for all women going through a menopausal shift, but if you do experience mood swings, rest assured that you’re not alone. Women can also suffer depression, anger, and anxiety during menopause. In either case, there are steps you can take to get your moods under control.

What causes mood swings during menopause?

It’s not clear what causes mood swings. However, women who have mood swings related to premenstrual syndrome (PMS) can attest to the connection between hormone levels and emotions. Changing hormone levels during the menstrual cycle are the way parts of the brain — the hypothalamus and the pituitary gland — communicate with a woman’s reproductive system.

Communication between a woman’s brain and reproductive organs may happen differently during menopause, but it’s still happening. Although there isn’t a precise understanding of how hormones affect mood, there are several theories, including some that examine how mood-enhancing mechanisms in the brain are linked to hormone levels. Women using estrogen patches, for example, develop more mood-enhancing serotonin receptors in the brain. Hormones can also affect endorphin levels, the chemical associated with “runner’s high.” Researchers hypothesize that a decrease in a woman’s hormone levels can also alter her general sense of well-being.

Two other common problems during menopause — sleep deprivation and night sweats — are also associated with moodiness. Night sweats, the night version of hot flashes, can make a good night’s sleep difficult. It’s not surprising then, that sleep deprivation can cause someone to be moody and irritable.

A study in the Journal of Psychosomatic Medicine found that women between the ages of 45 and 54 who reported severe depressive symptoms also reported more hot flashes, night sweats, sleep difficulties, mood swings, and memory problems than women who were not depressed.

How can I minimize mood swings?

Making some lifestyle changes could go far in resolving moodiness. If sleep problems are the culprit, following some basic principles of what experts call “sleep hygiene” can help:

  • Don’t drink alcohol or caffeine products within four hours of bedtime. Alcohol may be good at putting you to sleep, but it tends to wake you up as levels of it in your blood fall.
  • Try not to nap during the day because that can make it harder to fall asleep or stay asleep at night.
  • Eating heavy, spicy, or sugary meals can also wake you up at night, so try to avoid eating those close to bedtime . And although there is no scientific evidence to support the claim, some women find that cutting down on spicy foods, alcohol, and caffeine reduces the number of hot flashes they experience, including those night sweats that wake them up. To see if it works for you, try experimenting by removing them from your diet.
  • Make your bedroom more sleep-friendly by setting the heat at a comfortable level, blocking out as much noise and light as possible, keeping the television out of your bedroom, and staying off the phone right before bedtime.
  • If you feel like stress in your life is feeding your mood swings, joining a menopause support group might be the right forum for you. Many women find that yoga and meditation help even out their moods. Some teachers offer yoga classes specifically for women going through menopause. Regular exercise is also helpful in making you feel better overall.

How common is depression during menopause?

It’s not clear how common depression is in menopause. A consensus statement by the National Institutes for Health, for example, reflects the wide ranging results from studies: Between 8 and 38 percent of women going through menopause experience mood changes. A Harvard medical study of 460 premenopausal and perimenopausal women with no history of depression found that women in perimenopause were twice as likely to be depressed as women who had not yet entered perimenopause.

What is clear is that a history of depression does make menopausal women more susceptible to developing it. Women who have experienced PMS, or postpartum depression are at greater risk for depression during menopause than women who did not report being depressed at those times.

It may come as no surprise that women who have an especially long transition into menopause seem to be more prone to depression than those whose transition is shorter, especially if they’re also experiencing other bothersome menopausal symptoms.

What is the treatment for depression during menopause?

Severe depression is defined as feeling down or experiencing a loss of interest or pleasure for two weeks or more, with at least five of the following: depressed mood for most of the day and nearly every day, significant changes in weight or appetite, changes in sleep, a feeling of hopelessness, loss of interest in previously enjoyed activities, recurrent thoughts about death or suicide, inability to concentrate, fatigue, or loss of energy. If you’re severely depressed consult with your doctor.

If you’re feeling a little bit down, but consistently so, exercise and talking with a therapist may work as well as a prescription for an antidepressant medication, according to some studies. Yoga, a gentle martial art like tai chi, or meditation can ease stress or anxiety that may contribute to mild depression. You could also join a menopause support group to share your feelings with other women who may be going through similar feelings.

For Kragen, seeing a therapist twice weekly was helpful in alleviating her moods.Kragen also began exercising more regularly and more vigorously. It took several months, but she was finally able to get her moods under control.

Merck Manuals Online Medical Library. Female reproductive endocrinology, introduction.

Boston Women’s Health Collective. Norsigian, Judy, Pinn, Vivian Our Bodies, Ourselves: Menopause. Touchstone.

University of University of Maryland Medical Center. Sleep Hygiene. Sleep Disorders Center.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association.

Love, Susan, M. Dr. Susan Love’s Menopause & Hormone Book. Three Rivers Press, 2002.

Wayne State University, Public Relations. Wayne State University researcher gains international attention for cell phone study.

How to Identify and Treat Perimenopause Rage

There are steps that you can take to help balance your hormones and regain control of your moods. Once you find space in your mind to accept and address your anger, it may become easier to understand and live with this symptom.

1. Accept your anger

You may want to suppress your anger so that it doesn’t inconvenience anyone else. But research tells us that “self-silencing,” or finding ways to keep yourself from acknowledging and expressing your anger, puts you at a greater risk for experiencing depression. Listen to your body and accept that what you’re experiencing may be a result of your body’s adjustments.

2. Learn your triggers

There are some lifestyle habits, like high caffeine intake and smoking cigarettes, that trigger anxiety. Dehydration can also make you more prone to mood swings. And if your sleep is frequently interrupted by hot flashes, it may be hard to navigate complicated emotions. But everyone’s body works differently.

Try to identify these triggers by keeping a daily journal for at least two weeks. You should record what you ate, how many hours of sleep you got, if you exercised, and how you felt at different points during the day. If journaling isn’t your thing, mood tracking or period predicting apps are also a great way to track this information.

3. Take a step back

When you’re in the midst of a heated moment, practice taking a step back to mull over where your emotions are coming from.

Don’t discourage yourself for being angry, but do address the cause of your anger. Ask yourself questions like, “Would I be so angry if I were feeling better?” and “Does this person or situation deserve the level of anger that I want to direct at them?”

By being mindful that you’re prone to escalated emotions right now, you’ll be better equipped to deal with frustration appropriately.

4. Meditate

Mind-body therapies, such as meditation and yoga, have been found to have benefits for women in perimenopause. Deep breathing techniques and other mindfulness practices can help you sleep better and cut back on hot flashes that wake you up during the night. You can start to incorporate these practices into your life by using a mindfulness app on your phone or attending yoga classes to learn the basics.

5. Find an outlet

Finding an outlet to work through your emotions may help your mood swings diminish.

Physical outlets like aerobic exercise can help keep you from gaining weight as your metabolism slows down. Exercise also taps into the serotonin supply that you need to boost and manage your moods.

A creative outlet, such as gardening, painting, or sculpting, can help you focus on cultivating a quiet space in your mind to work through your emotions and get space for yourself.

6. Take medication as needed

Medication might help you deal with perimenopause rage and anxiety. Birth control pills, such as Loestrin or Alesse, can be prescribed to even out your moods and suppress uterine bleeding. Antidepressants, such as escitalopram (Lexapro), may also be taken as a temporary measure to help you feel more balanced.

If you think medication may be helpful, talk to your healthcare provider. They can walk you through your options and help you find something that suits your individual needs.

7. Consider therapy or anger management

Counseling and anger management are tools that can help you manage your anger. In one 2017 study, researchers found that women with both diabetes and menopausal symptoms greatly benefitted from a group counseling setting that encouraged self-care.

See if your healthcare provider knows about support groups, anger management groups, or a counselor that specializes in perimenopause rage.

Meet my friend Sally. She’s an absolutely lovely woman and I’ve known her for years. She’s the lucky kind of person who would make you green with envy.

You know what I mean. She has the partner of her dreams, a beautiful home she loves, a family who adore her, a group of close friends that mean the world to her and she even goes on the kind of escapades abroad that would leave you feeling incredibly envious.

But things are not quite as perfect as they might seem in Sally’s life.

Behind the smile lies some really intense anger issues that have been coming to a head lately and are starting to have a profound effect.

She’s been feeling so irritable she finds herself erupting over even the slightest thing, shouting at other drivers, screaming at the poor cashier in the local supermarket, making biting comment to her friends, hurling abuse at her partner.

And she’s embarrassed to admit that she even threw something across the room the other day that narrowly missed his head.

The poor man doesn’t know what to do. He’s getting increasingly scared to be anywhere near her, and he feels like she’s a ticking time bomb. Everyone around her is treading on eggshells and moving further away from her when this is the time when she needs their support the most.

And let’s get one thing clear. She knows her crazy turbulent hormones are to blame. So she’s tried doing all ‘right things’, like cleaning up her diet and prioritising sleep, and has even dabbled in green smoothies and superfood supplements

It’s fair to say she’s noticed some results. Her skin is clearer, her energy levels are up and most of the symptoms aren’t quite so bothersome anymore.

Apart from the anger.

Nothing seems to shift it. She’s edging closer to losing her incredibly patient partner and offending a whole host of her friends and neighbours but she just doesn’t know how to stop.

She’s out of control and she knows it.

Tackling your anger

As a society, we’re thankfully starting to open up and share our experiences of the menopause, but for some reason we still resist talking about the emotional side of the coin.

We conceal the anger and rage we are feeling, somehow ashamed of it, worried that we’re becoming out of control, that somehow we’re bad people, and hoping that we can just bury it and it will resolve itself somehow.

The sad truth is that this just won’t happen by itself, and all the clean eating in the world won’t dissolve your anger if you’re not tackling the problem at the root itself.

The solution comes down to you. Only you have the power to come to terms with your emotions, only you can overcome your anger.

It’s a case of having the right psychological tools at your disposal, and working through your issues with a trusted and experienced professional.

What causes menopausal anger?

If you’ve ever suffered from PMS, you’ll understand the intensity of the emotions you can experience as a result of fluctuating hormone levels.

It’s a similar story when it comes to the menopause. When you enter the menopausal years, your ovaries function less efficiently than before, leading to imbalances in many of your hormones, including oestrogen, progesterone, cortisol, and testosterone.

This affects your brain chemistry and as a result you might feel more irritable, angry, depressed and emotional than before. This helps to explain why you can feel fine one minute then ready to cry (or kill!) the next.

But it’s not only about biological health, it’s about psychological health too.

The menopause can also lead you to question your identity. It’s a time of reassessment that leads you to consider, reflect on and review almost every aspect of your life.

The way you perceive yourself begins to shift, but you’re often not quite sure exactly what this means.

Are you no longer that young, energetic and sexy person? Are you somehow less feminine than before? Will your partner see you differently? What if you haven’t completed your family yet? What will your friends think? Are you getting old?

It’s vital to work through all of these issues if you’re ever to find inner peace. This takes time and patience.

The menopause also brings to light any pre-existing emotional or psychological issues that you haven’t yet dealt with. Perhaps it’s time to admit that your relationship isn’t quite going the way you hoped, or if you feel lonely, or you hate your job.

Times of crisis like these bring out the vulnerability in all of us, the emotional scars and the barriers that prevent us living life to our full potential.

Teamed with the biological chaos, it can often be a potent recipe for disaster, and at the same time, the perfect opportunity to heal.

Letting go of the rage

The first, and most important step to take when dealing with your anger is to admit first that you are suffering from it. Otherwise, it will likely return in the future in bigger and scarier doses. Plus you really don’t want to run the risk of pushing all of your loved ones away, do you?

Then you will be able to benefit from a wide range of psychological tools to help you tackle your anger, relieve any underlying stress, boost your self esteem, lift your mood and help to clarify your thoughts.

These include things like:

  • Positive visualisation
  • Mindfulness meditation
  • Neuro Linguistic Programming
  • Deep-breathing exercises

We can all take control of the way we’re feeling, if we only give ourselves permission to be open, honest and a little vulnerable. Only then can we tackle our issues with anger and save our relationships.

If you’re finding the menopause challenging, you’re not alone. There are many women out there who are going through exactly the same thing as you and can offer the kind of support you need.

Available now from Bloomsbury, Waterstones, Amazon and good bookshops

Rage?

Yep, it’s a peri/menopausal ‘thing’.

Or. Maybe you’re suffering from anger?

That’s also a peri/menopausal ‘thing’.

This is one of the thornier aspects of peri/menopause and one that’s not always acknowledged.

Many women don’t realise this is even happening (it’s everyone else falling out with them – they haven’t done anything!) or they’re aware they’re acting out, they don’t know why and they’re embarrassed about their behaviour.

Either way, it’s a very real sign and an important one to talk about as it can impact our greater life and relationships.

But don’t worry you’re not going crazy.

There are plenty of memes online depicting meno women threatening to kill and while they’re amusing they’re also based on fact! I found this one on Pinterest.

Let me say before we go further, there is a scientific reason for it.

It’s not you; it’s your hormones.

I hope that makes you feel immediately better!

Now, let’s dive in.

How Does Peri/Menopausal Rage/Anger Feel?

If you’re one of us lucky (not!) ladies who experienced the intensity of PMS or mood swings during your period or pregnancy it feels similar to that. However, in some cases, it can feel far more elevated depending on how much your hormones fluctuate.

Rage

Menopausal rage goes a bit farther than anger – it boils up and reaches a fever pitch before exploding. That’s rage.

Anger

Anger is slightly milder and something we’ve all experienced at least at some stage in our lives.

Irritability

If you’re more fortunate your short fuse may never get quite as far as rage on your meno journey – you might just get moody, intolerant or irritable. One study found that irritability is a common sign for 70 percent of women.

How Rage Rolls

You may find yourself shouting at other drivers, nitpicking at your husband or worse throwing things at him, or saying things you’d never normally would to your friends and offending them hugely.

Real Life Example

I have a friend who has a history of throwing her toys out of the cot and storming off but recently I notice it’s gotten worse. You can literally see her fuming and on the point of imploding and it’s always someone else’s ‘fault’. So many women don’t actually realise this is happening, that their mood has changed and they’re being offensive to their closest friends and family.

What Causes Peri/Menopausal Rage & Anger?

If you’re a regular reader here you’ll probably have guessed I’m about to say it’s to do with your fluctuating hormone levels – namely estrogen, progesterone, testosterone and cortisol.

When they’re doing their meno dance and bringing on body temperature surges, sleep issues and all of those other pesky signs they also affect your brain chemistry and make you feel more angry and irritable than you usually would.

The female hormone estrogen – or rather the decline of it in our ovaries – is a major player on the meno journey as it affects so many physiological activities one of which is the production of serotonin in the brain.

Serotonin is often called the happy chemical and it’s an important neurotransmitter because it regulates our mood and acts like a happy pill.

Fluctuating estrogen can unbalance serotonin’s production and every time the level of estrogen shifts it throws serotonin levels off-kilter. That’s why you may go through periods of calm between the rage.

How To Deal With Peri/Menopause-Fueled Rage

1. Admit it

The first step is to admit you’re suffering from it.

Yes, it can be embarrassing particularly if you fall into the camp where you didn’t realise this is where you’re at.

It’s super important not to beat yourself up over it – quite frankly your self-esteem probably doesn’t need that – but instead take a strategic approach and move to take control over it. Give yourself permission to be honest and to be vulnerable.

Ask the experts

My wife suffers from depression, will perimenopause aggravate her mood swings?

Doctor’s response

The time of transition to menopause, known as perimenopause, has been associated with an increased risk of depression. The symptoms that occur during the menopausal transition overlap with many of the symptoms of depression. These symptoms include:

  • including fatigue,
  • irritability,
  • mood changes,
  • physical symptoms such as hot flashes, and
  • sleep disturbances.

There are data to suggest that declining levels of estrogen are related to the depression that may occur during the menopausal transition.

Since your wife already has a history of depression, she may experience symptoms of depression during perimenopause. Because perimenopause does not affect all women in the same way, it is impossible to predict the occurrence or severity of symptoms for a given woman. Fortunately, depression is a treatable condition. There are numerous effective methods for control of depression and other symptoms of perimenopause which can be used singly or in combination. These include:

  • hormone therapy,
  • antidepressant medications, and
  • psychotherapy.

Stress management techniques, exercise, and social support networks can also be of benefit in managing depression and other symptoms of menopause.

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