The menopause can cause a whole range of symptoms due to declining hormone levels which lead to hormone imbalances. One of the symptoms that many women experience is mood swings ranging from irritability to increased anxiety.
In this article we take a look at what causes women to have mood swings during the menopause.
Menopause Mood Swings
A study was carried out into the prevalence of anxiety symptoms in women aged 40-55 and it found that 51% of women in this age group reported having tension, nervousness and irritability in the past 2 weeks. In the same study, 25% of women in that age group reported frequent irritability or nervousness. The study also found that women who already suffered from high anxiety before the menopause were unlikely to be at an increased risk of developing high anxiety during the menopause, but women with low anxiety levels before the menopause may be more prone to developing high anxiety during and after menopause1.
“Mood changes are very common and can vary hugely in severity, type of problem and impact on the individual. Other psychological symptoms of the menopause, related to hormonal changes, can be irritability and difficulty coping” Dr Heather Currie, founder of Menopause Matters and an associate specialist gynaecologist and obstetrician at Dumfries and Galloway Royal Infirmary.
Another study found that the risk of developing major depression is greater for women during and immediately after the menopause compared to pre-menopause2. A different study into depression in menopausal women found that the likelihood of depression occurring during the transition to menopause was roughly 30% greater compared with women who were premenopausal3.
The Royal College of Obstetrician & Gynaecologists states that mood changes during menopause should not be confused with depression. Depression is a more serious condition and is defined as having consistent low mood for two weeks or more. However it does state that menopause can lead to mood changes such as anxiety due to fluctuating and declining levels of oestrogen and progesterone.
What Causes Menopause Mood Swings?
The menopause is a result of a woman's ovaries becoming less responsive during the transition phase to the menopause known as the perimenopause phase.
As a woman transitions through the perimenopause phase to menopause, the ovaries produce less oestrogen and progesterone resulting in levels declining in the body. The ovaries become less responsive to the control hormones follicle stimulating hormone (FSH) and luteinising hormone (LH) released by the pituitary gland in the brain. This results in higher levels of these control hormones in a bid to make the ovaries produce more oestrogen. Eventually, this leads to the end of ovulation and the menstrual cycle as a woman reaches menopause.
Hormones play a crucial role in something called the gut-brain axis which describes the complex connection between our gut and our brain. The endocrine (hormone) system has a key role in the gut-brain axis as it is responsible for making hormones which control our mood, growth, development, metabolism and reproduction. So when hormones begin to fluctuate during perimenopause this unbalances the gut-brain axis.
This is important because oestrogen influences the production of the neurotransmitter serotonin. The majority of serotonin is produced by the gut and is used by the brain to influence mood helping to relieve depression and anxiety4. When oestrogen levels drop during the perimenopause, so too can your serotonin levels.
“Women have oestrogen receptors throughout the body, including in the brain, and oestrogen lack can therefore have many different effects on your mood. Oestrogen influences the production and breakdown of serotonin, the chemical involved in the regulation of mood.” says Dr Currie.
Serotonin also plays a role in the production of melatonin which supports the circadian rhythm which regulates sleep patterns. A lack of serotonin will impact the production of melatonin within the body contributing to poor and low quality sleep.
Lifestyle Factors & Other Perimenopause Symptoms
Lifestyle factors such as children leaving home, aging parents and pressures at work can also contribute to stress, anxiety and low mood.
“There are other life events, such as worry over elderly relatives, teenage children, and pressures from work that commonly occur around the time of menopause, that may also contribute to psychological symptoms,” says Dr Currie.
Other perimenopause symptoms such as night sweats and anxiety can cause disturbed or poor sleep quality, and the inability to have a good night's sleep can cause other changes in the body that impact mood.
A lack of sleep impacts another hormone within the body, cortisol. Cortisol is the stress hormone and prepares our 'fight or flight' response. Cortisol levels are at their highest around 9 am and decline throughout the day. However, a lack of sleep can cause cortisol levels to rise during the day upsetting the balance of what's known as the HPA axis.
The HPA axis is made up of the hypothalamus and pituitary gland (both of which are in the brain) and the adrenal gland which are just above the kidneys. It co-ordinates the body's response to stress including the production of cortisol. Sleep and stress response both share the HPA axis pathway and when the HPA axis is over active it can disrupt sleep cycles5. Lack of sleep further unbalances the HPA axis due to an increase in cortisol levels. Constantly high cortisol levels can also affect mood, digestion and the immune system.
A lack of sleep and low energy will also make it harder to deal with every day situations resulting in irritability, stress and anger. In addition, anxiety and constant worrying can also lead to a short temper, stress and anger as the brain is unable to focus on the present moment but is instead trying to solve whatever problems or situation is making it anxious. Anxiety can also cause an increase in cortisol as the body thinks it's under threat and triggers the 'fight or flight' response.
How To Cope With Menopause Mood Swings
With so much going on in the body during the perimenopause that directly and indirectly affects mood, it can be hard to know where to start to make yourself feel better.
The first step is to confirm that your symptoms are caused by your ovaries becoming less responsive to the control hormones and to rule out any other medical conditions as a cause. Female Hormone Mapping will help establish if your ovaries are less responsive by measuring all four female hormones - FSH, LH, oestrogen and progesterone - across an entire menstrual cycle. From this we can produce an ovarian responsiveness score which, combined with symptoms, will indicate if you are perimenopausal. In addition, blood tests for conditions such as an over active thyroid can be carried out to rule out medical conditions.
Once you've got a diagnosis that the symptoms are caused by the perimenopause, Hormone Replacement Therapy (HRT) should be considered as a way to rebalance oestrogen and progesterone levels to help manage the variety of symptoms experienced during perimenopause including anxiety and depression. In addition, HRT will help protect against longer-term health issues caused by declining hormone levels such as osteoporosis.
Some women may be prescribed SSRIs (antidepressants) to help improve anxiety and low mood, however, NICE guidelines advise that women going through the perimenopause should not be prescribed SSRIs to ease low mood as there is little evidence to support that they help unless there has been a diagnosis of depression6. Instead NICE recommends that HRT is offered for treatment where mood changes are due to declining oestrogen levels.
Other therapies such as Cognitive Behavioural Therapy (CBT) can also be recommended, along with meditation and mindfulness to help accept the feelings of low mood and anxiety and learn to live in the present moment. Apps such as Calm and Headspace offer guided mediations to help relieve anxiety, stress and insomnia.
Diet and exercise also play a key role in supporting mental health. Avoiding excessive alcohol consumption, sugar and a diet high in fat will help support your gut's ecosystem and will have a positive impact on your mood. Exercise is also a proven way to improve mental health particularly if you are able to exercise out in nature. Activities such as walking, swimming and yoga will all help improve mood as well as support physical health.
Anxiety and depression caused by a hormone imbalance due to the ovaries becoming less responsive during the perimenopause can be very debilitating. The good news is that there are ways to support your mental health during the perimenopause, including taking HRT, having a good diet and taking regular exercise. Talking to other women going through the perimenopause and sharing your experience will also help improve your mental health.
To learn more about the menopause read our comprehensive guide to the menopause.
- The British Menopause Society
- Menopause Matters
- The Sleep School
- Mindfulness UK
- Breathworks – Meditation and Mindfulness
- Anxiety UK