Although most women transition to menopause without experiencing psychiatric disorders, an estimated 20% suffer from mood swings and depression at some point during menopause.
There is a well-established connection between changes of various hormonal systems and psychiatric health issues, both in psychiatric and endocrine patients. The transition into perimenopause and menopause may be a tempestuous experience for some women. Modifications in hormone levels may impact neurotransmitters in the brain.
The reduction in estrogen levels during perimenopause and menopause can lead to uncomfortable symptoms, like vaginal dryness, irregular periods, hot flashes and disturbed sleep. These causes menopausal and perimenopausal depression symptoms like low mood, anxiety, irritability, fears, and mood swings. Menopause mood swings can wreak havoc on your psyche. The irritability caused due to menopause depression may also result in difficulty in concentrating and memory lapses.
Women who had severe premenstrual syndrome in their younger years may experience severe, sharp and inexplicable changes in mood during perimenopause. Also, females with a history of clinical anxiety and depression seem to be particularly vulnerable to recurring clinical depression during menopausal months or even years before actual menopause.
Women transitioning to menopause are found to suffer more depression with the following states:
- Dismissive and pessimistic mood before menopause
- Interpersonal stress
- Little or no exercise
- Hatred towards partner
- Poor self-perceived health
Other stressors that correspond with menopausal symptoms are postulated to show association with depression include the following:
- Taking care of old parents
- The onset of any sickness in others or self
- Alteration in employment
Several psychological and social conditions have been suggested to explain why females may become develop depression pre and post menopause or during perimenopause. Some of the conditions are related to the following factors:
- empty nest syndrome (a feeling of grief and loneliness that parents may feel when their kids leave home for the first time)
- change in the process of conceiving
- inability to reproduce (infertility)
A personal or family history of postnatal depression and premenstrual dysphoric disorder (severe depression symptoms, irritation, and anxiety before menstruation) are major risk factors for developing depression in the menopausal period. However, even women without a family history of major depressive disorder are at risk of a perimenopausal depressive syndrome.
The emotional characteristics of perimenopause and menopause are significant. Estrogen is the hormone that takes care of most of a woman’s reproductive functions. When women transition to menopause, the ovaries reduce their production of estrogen. Estrogen controls the amount of serotonin being produced in the brain. Serotonin helps regulate the moods.
If estrogen production is low, serotonin levels will also be low. This impacts mental stability and optimism level. Hormonal imbalance is the main cause of mood swings and menopausal anger.
Three stages of menopause during which women experience widespread aspects of menopause mood swings include:
- Perimenopause — this is the period before menopause when all the symptoms occur. Mood swings during this period take the form of extreme and sudden feelings of anxiety, panic, and anger. Women become less tolerant during this phase and get annoyed at even trivial things.
- Menopause — hormonal shifts can contribute to mental fogginess.
- Postmenopause — due to the extremely low levels of estrogen, there are increased feelings of depression and anxiety.
The decline in estrogen is thought to impact the way the body manages norepinephrine and serotonin, 2 substances which are responsible for causing depression. Reduced levels of estrogen cause mood swings.
Mood changes are directly associated with menopause and can take mild forms such as feeling upset or irritated, or more severe like aggression.
Feelings commonly experienced due to hormonal changes include:
- anxiety accompanied by rapid heartbeat, sweating, dizziness, and unstable breathing
- depressed or unstable mood
- lack of motivation or energy
- lack of focus
- disturbed sleep
- crying episodes and feeling weepy
- panic attacks
- discouraged confidence
- memory loss
The mood changes that happen in the menopause transition cause women considerable trauma, distress and affect their overall well-being. This also impacts other people, particularly spouses, family and colleagues with whom the woman spends a considerable amount of time.
Depression and mood swings during perimenopause and menopause are treated in much the similar way as depression that strikes at any other time. If you are experiencing menopause mood swings and other symptoms of anxiety like fatigue, irritation, sadness and thoughts of suicide, consult your doctor and he can help you find the best menopause depression treatment that will work for you. Some treatments and medications for menopause mood swings are:
Hormone replacement therapy
This therapy is helpful for women who have undergone hysterectomy (surgery for removal of the uterus). There are different types and doses of HRT that compensate for the low estrogen levels. These doses are administered as pills, patch or gel. The pills available are as conjugated estrogens or estrogens. Estrogen patch is worn on the abdomen. Patches are used to reduce the risk of osteoporosis. Another method of making up for low estrogen levels is Topical Estrogen. In this creams, gels and sprays are used for getting estrogen into your system. Last but not least is the Vaginal estrogen which comes in the form of a cream, vaginal estrogen tablets or vaginal ring.
Menopause and depression have a strong connection. Reduced levels of estrogen found during menopause can cause feelings of hopelessness and sadness. Estrogen therapy boosts serotonin levels which helps combat depression and promotes a good and healthy sleep. It also elevates GABA, the calming neurotransmitter and increases endorphins, which make you feel good.
It is very important to focus on your mental and physical wellbeing during your perimenopause and menopause. Lifestyle changes like proper diet, improved ways of eating a healthy diet, minimize intake of processed foods, limit alcohol consumption, stop smoking, consume Mediterranean-style diet and undertake regular exercise is really beneficial to your body, especially during a transition time in your life.
Antidepressants are medications that help treat symptoms of mood swings, anxiety, and depression. Despite their name, antidepressants can take care of several health issues besides depression. These include:
- panic attacks
- unhealthy eating
- severe pain and migraines
There are four main types of antidepressants that are helpful in treating menopause anger and menopause mood swings:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors (SNRIs)
- tricyclic antidepressants
- monoamine oxidase inhibitors (MAOIs)
Antidepressants are believed to offer relief from vasomotor symptoms of menopause. These symptoms involve the blood vessels and include things like:
- night sweats
- hot flashes
- skin flushing
Psychotherapy is an important part of the treatment of menopause depression. 2 types of psychotherapies are recommended:
- interpersonal therapy (emphasizes understanding human relationships).
- cognitive-behavior therapy (teaches identifying and changing the negative thoughts and beliefs that come along with depression).
Yoga and meditation
Yoga and meditation can help relieve irritability and anxiety brought on by menopause. An integrated approach of Yoga therapy helps in treating symptoms like hot flushes and night sweats. Yoga relaxation and stretching techniques assist in stabilizing mood swings while improving the overall well-being.
Ginseng is one of the most popular medicinal herbs. It has therapeutic health benefits and is helpful in treating menopausal symptoms of stress, cognitive impairments, vaginal dryness, depression, lethargy and anxiety because it is considered an “energizer” and a “normalizer.” It helps improve mood and sleep and can be taken in different forms including tea, powder, and extract.
St. John’s wort
It is a flowering plant of the genus Hypericum and is also called Hypericum perforatum. It has been used as a medicinal herb for its anti-inflammatory properties and antidepressant properties for over 2,000 years. It is most commonly used to naturally remedy depression and symptoms, like fatigue, anxiety, loss of appetite and trouble sleeping. It is an alternative treatment for menopausal mood swings and reduced anxiety and depression.
Maca has been used for thousands of years to reduce the effects of anxiety, stress, and aging on the body by alleviating cortisol levels. It helps in reducing hot flashes, restlessness, low energy/fatigue, and weight gain while improving energy and libido.
Red Clover controls hot flushes, treats breast pain or tenderness (mastalgia), premenstrual syndrome (PMS) and boosts bone mineral density. Red clover comprises of isoflavones which have positive effects in alleviating symptoms related to estrogen loss — like hot flashes, weight gain, disturbed sleep, bone loss, fracture or osteoporosis, heart diseases and inflammation of the joints. Isoflavones present in red clover extract alleviates symptoms of depression and anxiety among postmenopausal women.
Black Cohosh also helps to prevent menopausal symptoms including night sweats and hot flashes. It helps in improving sleep quality, alleviating hormonal imbalances tied to fibroids or diabetes, and even assist females with fertility prior to perimenopause and menopause.
Avoid foods that make menopause worse
These include Packaged and processed foods, conventional meat, added sugar, refined oils and fried foods, carbonated drinks, and alcohol.
If you suffer from severe perimenopause anger issues and menopause depression, consult your doctor and discuss all the symptoms and how they are affecting your life. Mention all key personal information. Your doctor can advise or provide the right treatment therapy. Make sure to discuss the medications offered by your doctor, their benefits and side effects before taking the final call.
Transitioning into middle age often brings increased fear, tension, and anxiety. This is often attributed to hormonal changes, such as alleviating levels of estrogen and progesterone. Disturbed sleep, irritability, hot flashes, fatigue sweating, and other menopausal symptoms may cause disruptions. For some women, menopause may prove to be a time of frustration and isolation. People around may fail to understand what psychological and physical changes what you’re going through. Women who are unable to cope up with such a situation end up developing anxiety or depression.
The good news is that depression during perimenopause and menopause is a treatable condition. It is important to remember that there are multiple treatment options available that may help to relieve symptoms and provide strategies for coping with changes. Consult your doctor to discuss what treatment options may be the most effective.
Bromberger, J. T., & Kravitz, H. M. (2011). Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years. Obstetrics and Gynecology Clinics, 38(3), 609-625.
Clayton, A. H., & Ninan, P. T. (2010). Depression or menopause? Presentation and management of major depressive disorder in perimenopausal and postmenopausal women. Primary care companion to the Journal of clinical psychiatry, 12(1).
Dalal, P. K., & Agarwal, M. (2015). Postmenopausal syndrome. Indian journal of psychiatry, 57(Suppl 2), S222.
Frey, B. N., & Soares, C. N. (2009). Managing depression and anxiety during the menopausal transition and beyond: the window of vulnerability. In The Menopausal Transition (Vol. 175, pp. 102-114). Karger Publishers.
Kahn, D. A., Moline, M. L., Ross, R. W., Altshuler, L. L., & Cohen, L. S. (2001). Depression during the transition to menopause: a guide for patients and families. Postgrad Med, 114-115.
Klein, P., Versi, E., & Herzog, A. (1999). Mood and the menopause. BJOG: An International Journal of Obstetrics & Gynaecology, 106(1), 1-4.
Tam, L. W., Stucky, V., Hanson, R. E., & Parry, B. L. (1999). Prevalence of depression in menopause: a pilot study. Archives of Women's Mental Health, 2(4), 175-181.
Winokur, G. (1973). Depression in the menopause. American Journal of Psychiatry, 130(1), 92-93.