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Hormone swings, along with the physical and mental symptoms of the menopause can all trigger mood swings. Women still having periods may notice premenstrual syndrome gets worse.
Menopausal mood swings can be challenging and upsetting to deal with. Unfortunately, they’re common in the perimenopause and menopause for many of us.
During an episode, you can experience a whole spectrum of emotions, including low mood, anxiety, irritability and anger – and you may find yourself feeling tearful completely out of the blue.
You may feel irrational one minute, then wonder what on earth you were thinking of the next. This can be challenging and upsetting.
The drop in oestrogen in our bodies is thought to affect how our brain functions through its effect on serotonin and norepinephrine (and likely to be others), substances linked to symptoms of depression.
Oestrogen is linked to serotonin levels (the ‘happy hormone’) in the brain, so that when oestrogen levels drop, so does serotonin. There is evidence that oestrogen is also linked with cortisol levels – the hormone of stress so that when oestrogen levels drop, cortisol levels rise.
Many studies have therefore shown that hormone changes have been linked with changes to mood and anxiety.
Lower levels of oestrogen have also been linked to irritability, fatigue, stress, forgetfulness, anxiety, and difficulty concentrating. If this sounds familiar, now you know why.
Some brains are more sensitive to these changing levels of hormones. Decreasing oestrogen levels have been shown to reduce your resilience to, or ability to cope with, stress.
Oestrogen isn’t the only hormone involved – testosterone, cortisol and a brain protein called monoamine oxidase A are all also likely to play a role in mood swings.
Sleep – or rather lack of it – can have an impact on your mood. Hot flushes and night sweats commonly affect sleep, so you can see how these things all start to link together. Stress, anxiety and depression can also have an impact, creating a vicious circle. Lack of sleep can make all your other symptoms feel worse.
You may be experiencing stresses at home or work that can affect your mood, at the same time as lower hormone levels which increase your vulnerability and decrease your resilience.
It is hard to put an exact figure on the number of women experiencing menopause-related shifts in mood. Nevertheless, they are widespread, with a survey by The British Menopause Society showing that over half of the women interviewed experienced symptoms related to mood.
Mood swings can be more common in the perimenopause, particularly in the early stages when one of the first signs of your body changing is worsening premenstrual syndrome.
Talking to those you live with can really help your mental health. Try explaining that you are experiencing symptoms related to the menopause and that changes in your behaviour are linked to changing hormone levels. Understanding this can help them to be more understanding and tolerant around you.
The best ways to help with mood disorders are similar to those we use to manage depression and anxiety. Recognise your symptoms for what they are – you’re not suffering from a mental illness or losing your old self – you’re simply dealing with hormone swings that affect your brain.
Help for mood swings comes in many forms:
It’s important to talk about how you feel with family and friends, with your doctor, or with a counsellor – someone you trust with a sympathetic ear. Understanding why your mood is low, or why you feel depressed, can go some way to helping find a solution.
If premenstrual syndrome is a particular issue for you, there are other places to look for help and support. The National Association for Premenstrual Syndromes has good information. Other information can be found online through the Royal College of Obstetricians and Gynaecologists.
If you feel suicidal – call your GP practice, the Samaritans 116123, 111 or 999 if you think you are going to harm yourself.
We sometimes hear women say that they feel guilty or self-indulgent for spending time and money on counselling or coaching. Exploring how you’re feeling (and why) with an objective professional can lift a weight off your shoulders. Any money you spend on this is an investment in yourself, and you’re definitely worth it!
It’s worth talking to your doctor to find out whether HRT could be suitable for you. If your mood changes are related to the perimenopause or menopause, evidence suggests that HRT is better at improving your mood than antidepressants. It may be worth a try, even for a short time, to see if it helps.
HRT improves the overall quality of life, energy levels and sleep and it does not negatively affect libido or cause sexual dysfunction (which may be affected by antidepressants).
You can find out more about HRT here.
Antidepressants have a part to play, particularly if you have clinical depression or premenstrual syndrome. They can lift your mood, help you sleep and help with anxiety. Please talk to your doctor about the risks and benefits for you.
If worsening premenstrual syndrome is a particular issue for you, antidepressants can help to lift symptoms, particularly if you have been advised not to or do not want to take hormones. Some antidepressants may also help with treating hot flushes.
If you’re worried about mood swings in the context of the menopause, see your GP or book an appointment with our menopause clinic.
Dr Clare Spencer
Registered menopause specialist, GP and co-founder
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Source: Studd, J, Nappi, RE. Reproductive depression. Gynecol Endocrinol 2012; 28: 42–45; Cohen, LS, Soares, CN, Vitonis, AF, et al. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch Gen Psychiatry 2006; 63: 385–390.
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