Mood & Emotional Changes

Menopause-related mood and emotional changes are a collective term for the psychological and affective shifts that can occur during menopause. A general alteration in emotional stability and mood regulation can characterize the shifts. Women may find their emotional responses more pronounced or different from typical patterns, finding it more challenging to maintain an emotional equilibrium.

Mood and emotional changes encompass adjustment difficulties, anger, anxiety, depression, general discomfort (malaise), mood swings, and tearfulness. The onset of these symptoms can be abrupt or gradual, with their impacts subtle or significant.

These mood and emotional fluctuations can both trigger and exacerbate physical symptoms, such as hot flashes, disturbed sleep, and fatigue, collectively contributing to emotional discomfort and mood variability.

Hormonal fluctuations primarily trigger the mood and emotional changes associated with menopause. As women approach menopause, their ovaries produce less estrogen and progesterone, hormones that regulate mood. As estrogen and progesterone levels decrease, there is a significant impact on mood-regulating neurotransmitters like serotonin, norepinephrine, and dopamine, often leading to low moods. This hormonal shift can make emotional processing more challenging.

Progesterone’s decline disrupts its interaction with the neurotransmitter Gamma-aminobutyric acid (GABA), essential for brain health. This imbalance can lead to malaise, mood swings, and tearfulness, and make challenges that were once manageable suddenly feel overwhelming.

Additionally, the body’s natural response to these hormonal changes can amplify symptoms. The reduction in progesterone, known as the sleep hormone, adversely affects sleep quality. Lack of sleep, also often caused by menopause-related night sweats, can exacerbate mood changes. External factors like life stressors, the emotional impact of reaching menopause and the end of reproductive years, changes in social roles, and changes in self-identity can do the same.

Thus, the causes of menopause-related mood and emotional changes are multifaceted, combining biological, psychosocial, and psychological factors.

The manifestation of menopausal mood and emotional changes can take on various forms. Women may experience adjustment difficulties, leading to feelings of anger and anxiety.

They may also experience depression, malaise, and tearfulness, with or without mood swings. A woman’s mental and emotional health are impacted by these symptoms, affecting her day-to-day functioning and overall well-being.

Adjustment Difficulty

Adjustment difficulty can manifest as a notable struggle to cope with the extensive changes experienced because of menopause, leading to a persistent feeling of unease or dissatisfaction.

Psychological symptoms may include sadness, irritability, or restlessness, while physical symptoms may include disturbed sleep and fatigue. In severe cases, women may experience feelings of worthlessness or guilt, loss of interest in activities once enjoyed, and difficulty concentrating or making decisions.

While these symptoms typically arise because of the hormonal imbalances associated with menopause, societal pressures, and stigmas surrounding this phase of life can exacerbate them.

Anger

Anger is characterized by increased irritability, frequent bouts of rage, and an inability to control emotional responses. This abrupt anger can be intense, unpredictable, and disproportionate to the situation. There may not be an identifiable trigger for the anger, or it arises in situations that previously would not have elicited such a strong emotional response.

These feelings may manifest verbally or physically, directed towards loved ones like spouses or partners, or inanimate objects, disrupting interpersonal relationships. Anger may be accompanied by psychological symptoms, such as frustration, anxiety, sadness, or feeling overwhelmed and may be exacerbated by physical symptoms, such as night sweats and disrupted sleep.

If not addressed, anger may lead to menopausal rage (also called perimenopausal rage), which involves sudden and intense shifts from feeling stable to feeling extreme irritability in a matter of moments.

Anxiety

Anxiety manifests as various psychological and physical symptoms. Psychologically, women may experience persistent worrying, restlessness, feelings of tension, racing thoughts, inability to relax, and concentration difficulty. Irritability, feeling on edge, and a heightened sense of fear about ordinary situations may also be present. Worry may be generalized or specific about health, aging, and personal well-being.

Physically, women may experience impatience, fatigue, disturbed sleep, an increased heartbeat, shortness of breath, and muscle tension. They may notice changes in eating habits, such as overeating or loss of appetite.

These symptoms are interconnected, often exacerbating each other, creating a cycle that can interfere with a woman’s ability to function. Seeking professional help is crucial as untreated menopause-related anxiety can lead to mental health conditions such as anxiety disorders, including panic disorder.

Depression

Many symptoms can indicate depression, including feelings of sadness, emptiness, and hopelessness. A woman may lose interest or pleasure in activities she once enjoyed, including sex.

Physically, it can lead to irritability, disturbed sleep, lethargy, fatigue, and changes in appetite. Cognitively, it can include concentration difficulty, decision and multi-tasking difficulty, and memory impairment.

Thoughts of self-harm, suicide, or death, and unexplained physical problems such as headaches or digestive issues can also occur. Symptoms can be exacerbated by other factors, such as lifestyle, genetics, and existing mental health conditions.

Seeking professional help is crucial as untreated menopause-related depression can lead to mental health conditions such as Clinical Depression (also known as major depressive disorder), including Premenstrual Dysphoric Disorder (PMDD).

General Discomfort (Malaise)

Menopause-related malaise involves a feeling of unease, general discomfort, lethargy, and a sense of not feeling well. Malaise is an emotional response during the menopausal period and is not linked to a specific ailment or condition.

During menopause, hormonal fluctuations contribute to feelings of malaise. Additional symptoms may include physical exhaustion, forgetfulness, concentration difficulty, disrupted sleep, and apathy. These symptoms can exacerbate mood swings and heighten feelings of irritability, anxiety, and depression, creating a challenging cycle to break.

Symptoms may also result in a woman reducing her social interaction and activity, which, besides the other symptoms, negatively affects her quality of life.

Mood Swings

A common symptom of menopause, mood swings, are denoted by a rapid and drastic change in emotions, feelings, and mood. This abrupt shift can range from happiness to severe sadness, sometimes with no discernible trigger.

Mood swings often occur with other symptoms fluctuating in intensity, such as impatience, irritability, anxiety, or low energy. Some women may experience bursts of anger or frustration, followed by periods of tearfulness or depression. Other women may have concentration difficulties, decreased interest in routine activities, decreased sense of well-being, and increased stress levels.

While mood swings may feel similar to premenstrual syndrome (PMS), they occur outside of your menstrual cycle. They may occur for many years with no repeatable timing pattern, with the severity typically reducing over time. If mood swings become severe or persist beyond the menopausal transition, women should consult a healthcare professional. While mood swings are common, they can present with similar symptoms to anxiety and depression and may signal their onset.

Tearfulness

Tearfulness includes crying episodes, sadness, and heightened emotional sensitivity. Hormonal changes and psychological and social stressors associated with the menopausal transition influence tearfulness.

Generally, tearfulness is episodic, sporadically interspersed throughout the day, meaning it comes and goes and may not align with your overall mood or standard responses. Tears can form in short and sudden bursts without a specific trigger, as can uncontrollable crying, which passes quickly, and crying from a range of triggers like watching a movie.

Besides tearfulness, other symptoms, such as irritability, mood swings, anxiety, and depression, may also be present. Tearfulness may lead to social withdrawal, decreased productivity, and disruptions in sleep patterns. While tearfulness has similar symptoms as a labile mood or emotional lability, mood changes are not as extreme and uncontrollable. They are typically associated with underlying health conditions, including those that affect the brain or mental health.

Healthcare professionals primarily rely on patient-reported symptoms and a thorough evaluation to diagnose menopause-related mood and emotional changes. A woman’s physical health, psychological state, and medical history are evaluated.

Healthcare professionals may use Quality of Life (QOL) scales to assess the severity of mood and emotional changes, their impact on day-to-day functioning, and psychological assessments.

Blood tests measuring hormone levels, such as Follicle-Stimulating Hormone (FSH) and estradiol, may be completed if any irregularities are noted or other conditions, such as endocrine (including thyroid) disorders, or mental health conditions with similar symptoms, need to be ruled out.

Keeping track of symptoms and being prepared for medical consultations allows for a more accurate and tailored diagnosis and subsequent treatment.

Treatment for menopause-related mood and emotional changes primarily focuses on medications, therapies, and dietary supplements.

Hormone Replacement Therapy (HRT) typically containing hormones estrogen and either progesterone or progestin, may be suitable for some women to help balance hormone levels and mitigate mood-related symptoms.

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), anti-anxiety medications like benzodiazepines, and mood-stabilizing medications like lithium, may be prescribed to treat severe symptoms.

Conventional therapies, such as cognitive-behavioral therapy (CBT) can provide women with coping strategies and techniques to handle symptoms and change negative thought patterns. Natural therapies such as biofeedback can help gain a greater understanding and subsequent control over physical responses, such as respiration, heart rate variability, blood flow, and blood pressure, which can be heightened when feeling angry or anxious.

Dietary supplements such as St. John’s wort (Hypericum perforatum), Panax ginseng (red ginseng or Korean ginseng), and black cohosh (Actaea racemosa) are associated with alleviating mood and anxiety changes during menopause. Phytoestrogens, plant-based compounds that mimic estrogen in the body, can be an alternative to HRT.

The effectiveness of these treatments varies among individuals and should be discussed with a healthcare professional.

Management of menopause-related mood and emotional changes involves a multitude of lifestyle modifications.

Your mindset affects your mood, so shifting your mindset through mind-body exercises like yoga and Tai Chi, mindfulness practices like meditation and deep breathing, listening to calming music, and focused efforts to monitor and keep track of triggers and symptoms can help manage fluctuating moods and emotions. As can an environment with reduced stress and triggers.

Consuming a diet with nutrient-dense foods that contain Omega-3 fatty acids, B vitamins, and protein can help combat mood-related symptoms. Fluctuating blood sugar levels can trigger mood swings, so consuming minimal carbohydrates, including sugar and processed and genetically-modified organism (GMO) foods, refined vegetable oils, caffeine, and alcohol, can help with stabilization.

Regular physical exercise and activity increases endorphins, which block the perception of pain, increase feelings of well-being, and boost mood and energy levels. Exercise can help improve sleep quality and reduce disrupted sleep, which can exacerbate mood and emotional instability. Sleep hygiene practices, like maintaining a regular sleep schedule and creating an optimal sleep environment, can help manage disrupted sleep.

Sharing what you are experiencing with friends, family, and colleagues can externalize your experiences and start a conversation. This is particularly relevant for spouses and partners who can bear the brunt of these expressions, as they are the ones you spend the most time with and feel the most comfortable around. Employing a structured routine, purpose, and outlet for emotions can also help.

In the context of mood and emotional fluctuations, low libido is common, as well as feeling unattractive. However, on the flip side, sexual activity can boost your mood by releasing endorphins and oxytocin and act as a buffer against mood and emotional fluctuations. Minimizing stress and smoking can also helpful in managing symptoms.

Menopause can introduce a range of mood and emotional changes because of hormonal fluctuations. These fluctuations impact mood-regulating neurotransmitters like serotonin, norepinephrine, and dopamine. As explored, these changes can take on many forms, including adjustment difficulty, anger, anxiety, depression, malaise, mood swings, and tearfulness. External factors like life stressors, the emotional impact of reaching menopause and the end of reproductive years, changes in social roles, and changes in self-identity can also influence these changes. Following diagnosis, treatment, and management may encompass medications like antidepressants and mood-stabilizing medications, therapies, dietary supplements, stress-reduction techniques, dietary changes, regular exercise, good sleep hygiene, and a structured routine and purpose. By understanding the changes occurring in the body, seeking treatment, and taking proactive steps towards management, women can successfully navigate these symptoms.