What are mood changes and rage?

Many symptoms of menopausal transition are neurological, although the clinical definition of the menopausal transition focuses on functional changes in the reproductive system.

About half the women in menopausal transition will experience fast, intense changes in their moods (mood swings) and longer term emotional changes.  The swings in mood state can range between euphoria, rage, mania, anxiety and depression. Changes in mood and memory are strongly linked with hot flashes, insomnia, cognitive changes and fatigue.

It is still unclear how much responsibility for mood swings can be placed on hormones versus the impacts of other menopause symptoms such as hot flashes and insomnia. However, it has been shown that women who have severe PMS-like symptoms are more sensitive to changing hormone levels, and may also experience worse symptoms during perimenopause. 

Emotional difficulties women experience prior to the menopausal transition. Chronic stress can both contribute to mood swings and be worsened by them.

Neurological symptoms during the menopausal transition, such as mood swings and emotional changes, can signal future neurological diseases. The presence of these symptoms as well as their duration, variation and intensity may be warning signs for increased risk of neurodegenerative diseases later in life. Please make sure your healthcare provider is aware if you are experiencing these symptoms.

Self-care for mood  changes and rage

Have compassion for yourself. This is a very difficult time for so many women. Support yourself in times of emotional distress with meditation, journaling, taking a green bath (walking through the forest) in nature or engaging your creative side through art and music.

Talk to your girlfriends about menopause! Have a conversation with family about what you are experiencing, and ask for support and compassion from your employer.

Seek professional help, individual therapy and counseling to learn tools for recognizing and working through these common but hidden symptoms of perimenopause. 

Try to choose  a healthy lifestyle when you can, with enough quality sleep, good nutrition and recreational exercise. 

Journal and track emotional events carefully on a daily basis – a symptom app can help with this process. Look for patterns and triggers such as certain people, events, activities and even foods.

Cut down on alcohol, recreational drugs, and late nights.

Shot of senior woman canoeing in lake on a summer day. Mature woman paddling a kayak in lake.

Therapy for mood changes and rage

It can be very difficult to get validation for menopausal transitional changes related to mood. If you know you have emotional or mood disorders, please ensure you have professional therapeutic care heading into perimenopause.

If you do not already have a healthcare practitioner who is familiar with identifying and treating symptoms of menopause, the North American Menopause Society provides a list of menopause practitioners  here.

Your care providers and therapists may ask you to try medications tailored to your specific emotional needs. 

Hormone Therapy (HT) with estrogen is safe and often effective for reducing hot flashes and night sweats, which may help improve sleep quality. This, in turn, may help regulate emotional ups and downs. Collaboration with qualified health care providers is essential.

African psychologist hold hands of girl patient, close up. Teenage overcome break up, unrequited love. Abortion decision. Psychological therapy, survive personal crisis, individual counselling concept

The Science

The causes of neurobiological and psychological troubles during the perimenopausal transition aren’t clear, since basic and applied research is scant and often conflicting. What is known is that if you suffer from mood swings you are not alone. 

Brinton et al 2015

It is clear that insomnia can negatively affect mood, emotions and cognition, so anything that can be done to help get quality sleep will likely help.

As well, a dysphoric, or unhappy mood and depression have a strong socio-economic basis and are also strongly linked to chronic stress.

The current hormone therapy (HT) for mood and emotion is intensely debated.

Use of nutraceutical therapies (those that use food to provide medical or health benefits), may offer relief to some women, although currently there are no FDA -approved (i.e. clinically proven safe and effective) nutraceutical treatments.

Statistics

0%

Women who indicate irritability as their primary mood complaint during perimenopause

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Women have a two-fold higher lifetime risk of depression compared to men

0%

Reduction in the odds of depressive symptoms in midlife women if they have high levels of social support.

Changes in mood and cognition during menopause.

FALSE

Unfortunately, women experiencing menopause continue to be excluded from the workforce where they feel embarrassed and isolated by their untreated symptoms. Slowly this is changing as employers and insurance companies start to realize that leaving the health concerns of this enormous group of workers unaddressed is costly.

While the obvious answer is found in gender, age and racial inequity, the study of mid-life women’s sexual and reproductive health has historically been less profitable than fertility. Thankfully the “menopause market” is on the rise, which will hopefully drive more dollars into the evidence-based scientific research that is so badly needed to drive more safe, effective and personalized treatments for menopausal women. 

Compiled References

1. Baber, R. J., Panay, N., Fenton, A., & IMS Writing Group (2016). 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric : the journal of the International Menopause Society, 19(2), 109–150. https://doi.org/10.3109/13697137.2015.1129166

2. Björn, I., Bäckström, T.,Lalos, A. & I. Sundström-Poromaa (2006) Adverse mood effects during postmenopausal hormone treatment in relation to personality traits. Climacteric, 9(4), 290-297. doi: 10.1080/13697130600865766

3. Brinton, R. D., Yao, J., Yin, F., Mack, W. J., & Cadenas, E. (2015). Perimenopause as a neurological transition state. Nature reviews. Endocrinology, 11(7), 393–405. https://doi.org/10.1038/nrendo.2015.82

4. Bulan, S. E. (2019). Physiology and Pathology of the Female Reproductive Axis. In Melmed, S., Koenig, R., Rosen, C., Auchus, R. & F. Goldfine (Eds.), Williams Textbook of Endocrinology (14th ed., pp. 574-641). Elsevier.

5. Minkin, M.J.(2019).  Menopause Hormones, Lifestyle, and Optimizing Aging. Obstetrics Gynecology Clinics of North  America, 46(3), 501–514. https://doi.org/10.1016/j.ogc.2019.04.008

6. Sabia, S., Fayosse, A., Dumurgeir, J. et al. (2021). Association of sleep duration in middle and old age with incidence of dementia. Nature Communications, 12(2289).  https://doi.org/10.1038/s41467-021-22354-2

7. Zaidi, M. (2018) FSH, Bone Mass, Body Fat, and Biological Aging. Endocrinology, 159(10), 3503–3514. doi: 10.1210/en.2018-00601

8. Schmidt, P. J., Nieman, L. K., Danaceau, M. A., et al. (1998). Differential Behavioral Effects of Gonadal Steroids in Women with and in Those without Premenstrual Syndrome. New England Journal of Medicine, 338(4), 209-216. https://doi.org/10.1056/NEJM199801223380401

9. Drogos, L. L., Rubin, L. H., Geller, S. E., Banuvar, S., Shulman, L. P., & Maki, P. M. (2013). Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms. Menopause (New York, N.Y.), 20(12), 1236–1242. https://doi.org/10.1097/GME.0b013e318291f5a6

10. Greendale, G. A., Huang, M. H., Wight, R. G., Seeman, T., Luetters, C., Avis, N. E., Johnston, J., & Karlamangla, A. S. (2009). Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 72(21), 1850–1857. https://doi.org/10.1212/WNL.0b013e3181a71193