Menopause is caused by a hormonal imbalance in women between ages 45 and 55, after they have stopped having their menstrual cycles for a year at a stretch.

Menopause comes with a range of mental health issues, alongside vasomotor, genito-urinary, and cognitive symptoms.

Hormone therapy coupled with lifestyle interventions can help women overcome hormonal mood swings; sensitivity and awareness among people surrounding menopausal individuals also help in maintaining a better quality of life

Menopause Mood Swings: The What, When & How

Menopause is a normal transition for women between ages 45 and 55 (although some individuals beyond the scope of the gender and pronouns used in this blog may also experience menopause). It is biologically defined as a point after twelve months of a woman’s last menstrual cycle (amenorrhea) without any other pathological or physiological reason. 

Menstrual irregularity (and eventual cessation) is due to the rapid decline in the number of follicles alongside neuroendocrine changes in the ovary. This results in increased levels of follicle-stimulating hormone (FSH) and a reduction in inhibin-B levels – a marker reflecting declining follicular numbers.

Menopause brings about many physical and emotional challenges for women. The years leading to the menopausal transition in women also known as perimenopause, mark the beginning of physical and emotional manifestations like hot flashes, night sweats, pain during intercourse, vaginal dryness, irritability, depression, or a culmination of more than one of such symptoms. 

Menopause mood swings are clinically referred to as physiological changes in the brain caused by hormonal shifts in the body, contrary to the popular belief that “if she is a woman, she is bound to be moody”. Some women are more sensitive to such hormonal shifts (mostly fluctuation in estrogen levels) leading to increased neurotransmitter activity in the brain.

Risk Factors For Menopause Mood Swings: Can Perimenopause Hit Early Than Usual?

Considering that women in their forties and fifties are most likely to encounter major challenges in their respective lives with their jobs, families or personal goals, menopause mood swings only add to their stress and pose mental health issues. Further, if women have suffered from pre-menstrual syndrome (PMS) or clinical depression in the past the perimenopause phase brings with it a significant bout of mental and physical health issues. 

Some women can also be predisposed to early menopause depending on multiple factors like ethnicity, lifestyle in their early ages and their medical histories. 1-3% of women experience early menopause before the age of 40, and 5-10% of women experience it between 40 and 44, without any obvious reasons.

Studies have shown that women born to mothers harbouring unhealthy lifestyle choices like smoking, lack of physical activity, or alcohol abuse are all risk factors for early menopause. Additionally, smoking, poor cognitive abilities during childhood, gynaecological complications in women’s early thirties, surgical removal of ovaries in early adulthood, and even chemotherapy are also associated with early menopause.

The Hormonal Conundrum in Menopause

Biologically speaking, the emotional roller coaster in menopause is largely attributed to hormones. A steep decline in the production of sex hormones – estrogen and progesterone, and a gradual decline in testosterone levels cause hormonal mood swings as one enters menopause. This “hormonal chaos” is a root cause to most mental health issues women face during this specific decade of life. On an average, this phase lasts for two years. 

There is widespread research on hormonal mood swings during menopause. Reduced estrogen production has been linked to a reduction in serotonin and norepinephrine levels during menopause. Both serotonin and norepinephrine are neurotransmitters (hormones) which are part of the “happy hormone” spectrum and are crucial to cognitive, emotional, and anti-inflammatory responses within the body. Low levels of estrogen have also been linked to fatigue, irritation, lack of concentration, and forgetfulness, among other emotional traits.

Monoamine oxidase A (MAO-A) is another protein marker secreted in high levels during perimenopause, which has been linked to emotional stress, depression, and even dementia owing to its role in development of oxidative stress and apoptosis in the brain.

Common Symptoms During Menopause

• Vasomotor Symptoms

  One out of every three women face hot flushes during menopause. This in turn leads to physical discomfort, irregular sleep cycles, irritability, palpitations, increased heart rate, and emotional outbursts which may appear ‘out of the blue’ to people nearby but are not. It is important to remember that in their late forties or early fifties, several women might be facing multiple body image, fertility and ageing issues which also get aggravated by hot flushes and irritation. Hence households with women in the defined age group should be aware of such behavioural patterns and be more sensitive towards these issues.

• Self-esteem Issues

  Knowing that one is now incapable of reproduction can also take a toll on the self-esteem of women with menopause. Coupled with the chronicles of daily jobs, socio-economic demarcations in different households also add up to reduced self-esteem among menopausal women. Having a stressful job, adolescent children, ageing parents, and not getting enough credits for managing a household add up to the miseries of menopausal, middle-aged women.

• Anxiety

  One can get anxiety due to multiple reasons and menopause is also one of them. Women can get overwhelmed easily, can be nervous, tensed, or even get panic attacks during episodes of anxiety. This is worse for people who have had anxiety issues in the past.

• Depression

  Clinical depression during menopause affects one in every five women. It is an extremely sensitive topic, trivialised or even ignored by many. Previously it was only known to be a perimenopausal issue but recent research has shown that depression is a lingering post-menopausal concern as well. Moreover, women with a history of mood swings during PMS in their early lives and post-partum depression are more predisposed to developing clinical depression during menopause as well.

Menopause also causes

• Genito-urinary Irregularities

  like pain and discomfort during intercourse, reduced sex drive, vaginal dryness, and frequent episodes of urinary tract infections (UTIs).

• Insomnia

  due to frequent mood swings, irritability, anxiety, severe headaches (especially in people with migraines) and continued muscle pain.

• Brain fog

  due to difficulty in concentrating on things, forgetfulness and other cognitive impairments owing to lower levels of estrogen and increased levels of MAO-A.

• Reduced bone density

  caused because of low estrogen levels. This also leads to increased risk of developing osteoporosis and joint pain issues.

• Addiction

  when people try to ‘self-medicate’ and resort to alcohol and substance abuse to overcome their mental health issues.

Beating The Blues: Treating Menopause Mood Swings

Despite the many challenges posed by menopause, there are ways by which women can improve their mental health and overall quality of life. Depending on the stage and severity of their mental health issues, women can resort to pharmacological and lifestyle modifications. Hormone therapy remains the cornerstone of menopause mood swing treatment. It treats major vasomotor, and genito-urinary symptoms, and reverses some of the more harmful effects of lowering estrogen levels like bone-density reduction, and improves cognitive abilities. It is always advised that women consult their gynaecologists before resorting to any form of medication. Hormone therapies have their own benefit-to-risk ratios for women under 60 and within ten years of the onset of menopause. However, women over 60 years of age and later than ten years of menopausal onset are more prone to developing cardiac complications and breast cancer. Hence, any hormonal medication should always be accompanied by regular professional check-ups. Seeking help from counsellors and mental health professionals is always an option for perimenopause mood swings treatment. Lifestyle interventions like moderate exercise, yoga, meditation, eating a balanced diet, journaling, listening to music, and pursuing hobbies can help keep the mind diverted and providing a sense of purpose for otherwise mundane and tedious days. Some professionals may also recommend cognitive-behavioural therapy and clinical hypnosis, while prescribing selective serotonin/serotonin-norepinephrine reuptake inhibitors, anti-convulsants, and muscle-relaxants for menopause syndrome treatment.

Please Remember :

If you have an individual in your circles undergoing menopause mood swings or menopause syndrome treatment, being sensitive, aware, and patient will help in alleviating symptoms and ensuring a better quality of life for everyone.

FAQ

Q. Is it necessary to visit a gynae if I have skipped the menstrual cycle for more than a year?

A. Yes, even if you are beyond natural child-bearing age, or are not facing any menopause syndromes, you should still get a check-up done to ensure all other vitals of your genito-urinary health.

Q. Does menopause expose women to cardiac complications?

A. Yes, lowering estrogen levels and increasing age makes women prone to heart diseases. Regular check-ups are the key to staying healthy across ages.

Q. Can natural supplements be taken to treat menopause syndromes?

A. Most over-the-counter supplements are not well regulated and can contain dangerously high levels of hormones. Please consult an ob-gynae before resorting to supplements.