Marking the end of one's childbearing years can be bittersweet for many, and painful for others. Noting changes in the body can prompt concerns about attractiveness and body image, while contemplating midlife, in general, can lead to bigger questions about one's place and purpose in life. It can also be a time of gaining wisdom and confidence.
While they can be challenging, these feelings are part of the rollercoaster nature of lived experience. For some, though, the process is a bit more jagged.
Nearly a quarter of women experience mood swings before, during, or after menopause.
There are many steps along the way to menopause, while each phase of the process has characteristics and symptoms.
Perimenopause describes the period when estrogen levels in the body start to drop. Some women start noticing symptoms such as menopausal mood swings and hot flashes at this time.
Menopause takes place, technically, after a woman has not had a period for 12 months. After this, she is considered postmenopausal, and many women see differences in their emotional symptoms. From start to finish, the process can take 2-10 years.
According to the North American Menopause Society (NAMS), close to 23 percent of women go through mood swings before, during, or after menopause.
For some women, especially women who are taking hormones or have had their uterus removed, mood swings are their first indication that they are beginning to transition into menopause.
The emotional aspects of perimenopause and menopause are significant. For some, they can be as disturbing as the physical elements of this transition.
Some of the more widespread aspects of menopause mood swings include:
- Irritability: Up to 70 percent of women describe irritability as their main emotional problem during the early stages of the menopausal transition. They find themselves less tolerant and more easily annoyed at things that did not bother them before.
- Depression: Depression is a more common and serious emotional side effect of menopause. It affects up to 1 out of every 5 women as they progress through menopause.
- Anxiety: Many women experience tension, nervousness, worry, and panic attacks during menopause. Some may find their anxiety getting worse while others may develop it for the first time.
- Crying episodes and feeling weepy: This tendency can become more pronounced in menopausal women, as they find themselves weeping over incidents that might not have mattered much before. However, tears can reduce stress as they allow people to release pent-up feelings.
- Insomnia: Insomnia can contribute to mood swings, as it interferes with day-to-day functioning. It is common during menopause, affecting 40-50 percent of women.
How might menopause lead to mood swings?
During the transition to menopause, levels of the hormone estrogen drop, causing wide-ranging changes throughout the body. Many of these changes have direct connections to menopausal mood swings.
The drop in estrogen can cause fatigue, irritability, and difficulty concentrating.
For example, the drop in estrogen is thought to affect the way the body manages serotonin and norepinephrine, two substances that have been linked to depression. Lower levels of estrogen have been linked to irritability, fatigue, stress, forgetfulness, anxiety, and difficulty concentrating.
The impact of these changing hormone levels may not be limited to a direct cause-and-effect relationship with depression, anger, and anxiety. Hormone shifts may also intensify these feelings.
Also, researchers have found higher levels of a brain protein known as monoamine oxidase A (MAO-A), which is linked to depression, in women entering perimenopause.
Sometimes, reactions build on each other, such as with night sweats. These are hot flashes that take place when someone is asleep.
Night sweats can be so intense that a woman is woken and sleep is disrupted. Several nights of disrupted sleep can result in foggy thinking, irritability, and other characteristics associated with menopausal mood swings.
Two of the most important risk factors for difficult menopausal mood swings are a history of severe premenstrual syndrome (PMS) and prior episodes of depression or other significant mental health problems.
Women may also have a greater risk of emotional problems during menopause if they have any of the following situations:
- unsatisfactory relationships with loved ones
- a great deal of stress in their lives
- a difficult living situation
Women going through menopause may find themselves reacting with unexpected emotion to everyday events, moved to tears by pop songs, or enraged by rude drivers.
Others may find it hard to hold onto a train of thought, recall someone's name, or wonder what they were looking for when they went into a room.
These responses can be funny, upsetting, or deeply troubling, and they are not rare.
To cope with the changing landscape of their lives and menopausal mood swings, some women may decide to "self-medicate" with alcohol or other drugs.
Unfortunately, these choices make it more difficult to face and work through their concerns. It may also add substance abuse to the issues they need to address.
Other mental symptoms of menopause
Forgetfulness and difficulty concentrating are problems reported by some menopausal women. One study found a measurable decline in cognitive ability of others. However, these problems usually reverse when women are post-menopausal.
Treatment and lifestyle changes
Emotional problems may not be as easy to see as a broken leg, or as directly diagnosed as heart disease, but they are no less painful, limiting, and potentially devastating.
Fortunately, help is available through counseling, medication, or a combination of treatments.
If menopause mood swings or emotional upheavals are interfering with a person's enjoyment of life, they should see a mental health counselor, or seek a referral from a general practitioner.
Medication and therapy
A counselor can help women deal with emotional changes caused by menopause and perimenopause.
Hormone therapy was once a widely recommended treatment for the symptoms of menopause, but it was later found to increase some health risks. While it is still prescribed today, it is used cautiously, and doctors are exploring other treatment options, including lifestyle changes.
Bioidentical hormones are also used to address menopausal mood swings and symptoms. They are made from plants by pharmacists based on instructions from a doctor and are not regulated by the United States Food and Drug Administration (FDA) for quality, purity, or dosage.
They appear to have the same risks and benefits as conventional hormone therapy.
Some types of antidepressants may be helpful for women who have trouble with hot flashes, in addition to depression.
Many women find that counseling helps them deal with the changes of menopause as well, along with other underlying problems that come to the surface at this time.
Experts have found that exercise, diet, getting enough sleep, and pursuing supportive friendships can all help women with the emotional aspects of the transition into menopause.
Regular exercise is a great way to promote both mental and physical health. Being active helps relieve stress, improves mood, and makes it easier to put problems in perspective.
The Centers for Disease Control and Prevention (CDC) recommend 2.5 hours a week of moderately intense aerobic exercise, such as a fast walk, plus 2 days a week of muscle strengthening.
Diet can also help individuals reduce menopausal mood swings, especially one rich in protein and omega-3 fatty acids.
Some people have also found that practices such as tai chi, yoga, and meditation can help them feel more grounded and make it easier to manage stress, irritability, and other symptoms of menopause.