Mood swings are some of the least-understood aspects of menopause—and the most misrepresented. While pop culture representations of menopause tend to center specifically on mood, they typically treat menopausal women as a caricature of irrationality and hysteria rather than capturing the variability and complexity of menopause-related mood disturbances. Not only does this trivialize the very real suffering many women experience during this pivotal phase of life, but it may also leave you feeling ashamed and immobilized.
In reality, menopause-related mood swings happen due to a variety of physiological and psychological phenomena and the interplay between them. Critically, mood swings can be a direct result of the hormonal changes that women undergo in the years leading up to and after menopause, including falling levels of estrogen and progesterone. In other words, mood swings are far from irrational; they are a symptom of physical transformation.
Unfortunately, the cavalier treatment of menopause-related mood swings in our culture (pop and otherwise) keeps many women from seeing these mood swings as a symptom that can be—and, sometimes, should be—treated medically. But mood changes can have a dangerous impact on both mental and physical health. They can interfere with your confidence and functionality, your relationships, and your overall quality of life. In other words, mood swings can be far from trivial features.
Not all women have mood swings during menopause and the level of intensity can vary significantly amongst women who do. But one thing remains certain: you deserve to be happy, and you have the right to treat mood swings during menopause in the healthiest and most effective way possible.
“Mood swings” is a phrase that everyone says but which has no strict definition. Typically, however, mood swings are understood to include the following:
Critically, there is no one single cause for these symptoms; they can be affected by a broad range of factors and can vary for each person.
Let’s start with proximate causes. Menopause can be an emotional time. It is the end of your reproductive years, which can deeply affect how you see yourself and experience the world around you. It is a time that many use—fairly or unfairly—to mark the passage toward being “old”, which can spark fear, sadness, anxiety, and even mourning in a culture that valorizes youth, particularly in women. It may also be a time of reflection, of evaluating your life thus far and contemplating what the future will hold. These can be hard things to grapple with, and the psychosocial aspects of menopause can have a profound impact on your emotional state.
But of course, menopause also comes with significant hormonal shifts that can impact mood on a physiological level.
Menopause is often marked by hot flashes, night sweats, headaches, and insomnia, all of which can impact mood and functionality. Additionally, sex hormones—including estrogen and progesterone—are known to impact serotonergic activity, which plays a critical role in emotional and behavioral regulation. As estrogen and progesterone levels fall, you may therefore experience shifts in your mood and behavior, including depression, anxiety, and irritability. Researchers have also found that perimenopausal and menopausal women have higher levels of monoamine oxidase A (MAO-A), an enzyme linked to mood disorders like depression, than younger women.
It’s important to note that menopause can both introduce new mood disturbances and exacerbate pre-existing mental health disorders, including depression, bipolar disorder, and anxiety disorders. If you have been diagnosed with a mental health disorder, it is therefore prudent to watch for new or changing symptoms, as you may need to make changes to your treatment plan. In other cases, menopause might be the first time that a pre-existing mental health condition becomes noticeable or disruptive enough to seek mental health treatment. It is important to not assume that symptoms of these conditions are a normal part of menopause.
In short, menopause can affect mood in complex ways. The physical, psychological, and cultural are not separate. Rather, they are intimately intertwined and their impact on emotional and behavioral health can be powerful—and deeply personal.
There is no universal silver bullet for mood swings during menopause. Every woman’s experience is unique, and what works for one woman may not be relevant for another. However, many women find that a personalized combination of the following helps to support greater psychological well-being:
We know that exercise during menopause is important for preventing osteoporosis. But research also shows that exercise can play a significant role in mental health by prompting the release of mood-boosting neurotransmitters and stimulating nerve cell growth in critical areas of the brain, improving brain function and reducing symptoms of depression and anxiety. Additionally, exercise is known to reduce hot flashes, raise energy levels, and improve sleep quality—all of which can support greater psychological well-being during menopause.
A growing body of evidence suggests that mind-body practices such as meditation, yoga, and tai chi can alleviate a range of menopause-related symptoms, including mood disturbances. Whether you sign up for yoga classes or prefer to meditate in solitude, these practices have the potential to support greater emotional stability and fulfillment in this new stage of life.
Whether your mood swings are new to you or you have been struggling with mood disturbances for years, therapy can be an essential part of restoring mental health. An experienced therapist can give you the space and support you need to explore your thoughts, feelings, and experiences, disrupt harmful patterns, and develop meaningful strategies to address your symptoms.
For many women, bioidentical hormone replacement therapy (BHRT) is one of the most essential components of maintaining emotional wellness during menopause. Under the guidance of a bioidentical hormone replacement expert, BHRT can restore estrogen and progesterone to levels that are comfortable for you and may reduce—or even eliminate—menopause-related mood symptoms. However, its benefits do not end there. As noted by Drs. Claudio Soares and Benicio Frey in Psychiatric Clinics of North America, “[T]he use of hormonal strategies, particularly estrogen-based therapies, has shown to not only improve depressive symptoms but also to promote alleviation of menopause-related complaints (eg, vasomotor symptoms, sexual dysfunction, sleep disruption) and better overall functioning and quality of life.”
Psychotropic medications, such as antidepressants, can be life-changing for women who experience serious mood disturbances in the years leading up to and after menopause. If you are already taking such medications, new mood symptoms that arise during the menopause transition may require changes to your treatment plan, including medication and dosage changes. For the best outcomes, it’s important to seek treatment from a highly-trained psychiatrist who understands the unique challenges women face during menopause and can create a treatment plan based on the latest knowledge in the field. Interestingly, there is also evidence that some psychotropics can alleviate flushing, hot flashes, and night sweats, potentially contributing to greater emotional wellness.
A 2018 study found that 26% of women undergoing menopause reported experience insomnia with “severe symptoms that impact daytime functioning,” and many more experience less severe sleep disturbances. This can have a hugely deleterious impact daily life, with both immediate and long-term consequences for your mental and physical health, social and professional functionality, and overall mood. Getting treatment can help you sleep again, reduce the intensity of mood swings and protect your long-term health.
Although some women can address their mood symptoms using only one of these strategies, many must use multiple strategies to fully achieve relief. In fact, some strategies are known to work better when used in concert. For example, research suggests that using estrogen therapy with an SSRI is more effective at treating depression in perimenopausal women than either estrogen therapy or SSRIs in isolation. By combining multiple paths to healing, you have a greater chance of recapturing your sense of wellness.
If you are approaching or have gone through menopause and are experiencing mood disturbances, don’t be afraid to reach out for help. Today, there are more resources available to help you address the impact of hormonal changes than ever before.
If you don’t know where to begin, a health care practitioner who specializes in hormone health is a good starting point. They can offer state-of-the-art hormone testing to gain greater insight into your hormone levels, help you explore your treatment options, and create a holistic treatment plan that makes sense for you. They can also work with any other practitioners you may need, including your psychiatrist, to ensure you receive safe, effective, comprehensive care.
But first, you have to accept that you want—and deserve—help for your mood swings. This can be hard. Women often feel they have to ignore or dismiss these symptoms of menopause. Or feel ashamed of them and apologize for being so emotional. But there’s nothing to apologize for. Mood swings are a logical outcome of menopause because of how our minds and bodies function. You shouldn’t apologize for being human. Instead, you can vow to live your fullest life. Part of that is treating mood swings. The other part is remembering that no matter what, you are still you, still in this world, and still a vital part of it.
Are you looking for ways to treat mood swings during menopause? BodyLogicMD can help. The BodyLogicMD network is made up of the top bioidentical hormone replacement therapy specialists in the country. When you partner with a BodyLogicMD practitioner, you’ll receive a customized treatment plan designed to help you achieve optimal physical and emotional health—both now and in the future. Contact a local practitioner today to schedule your first appointment and start feeling like yourself again. Or, take the BodyLogicMD Hormone Balance Quiz to learn more about how hormones impact the female body.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure or prevent diseases.
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