5 Tips for Coping With Menopausal Mood Swings
Mood swings during menopause can make many women feel out of control, affect their relationships and cause them difficulties in the workplace. The North American Menopause Society states that approximately 23% of women experience mood swings before, during or after menopause. Anecdotally, the percentage may be much higher.
Perimenopause is the period in the lead up to menopause and can last several years, with some women experiencing perimenopausal symptoms for up to fifteen years. During this time, women experience a fluctuation and decline of hormones which play an integral role in mood regulation.
Hormones responsible for menopausal mood swings
Estrogen is the main female sex hormone and is produced in the ovaries. It has a major impact on mood, primarily by affecting levels of serotonin in the body. Serotonin is a mood-balancing chemical that is sometimes called the “happiness hormone”. During perimenopause, as estrogen levels start to drop, so do our levels of serotonin. This is one of the reasons why we may feel more depressed and are more likely to cry at the drop of a hat than we would have been in the past.
The other significant sex hormone in a woman’s body is progesterone. Like estrogen, it begins to drop during perimenopause. As progesterone falls, estrogen may become the dominant hormone, leading to irritability and depression. Progesterone is responsible for calming the braining and promoting sleep. Low levels of progesterone are associated with a range of symptoms including sleep disturbances, migraines, hot flashes and unexplained anxiety. The combination of these symptoms can have a major impact on mood.
Hormonal fluctuations and imbalance
Hormones are complex, as is the human mind and body. We’re not just talking about a steady decline. Instead, the production of estrogen becomes unstable and unpredictable. At times, the ovaries may start to overcompensate in producing estrogen, resulting in a hormonal surge. At other times, there will be a very noticeable reduction in estrogen. These fluctuations can be highly destabilising in terms of mood and upset the delicate balance of hormones in relation to each other.
Lack of sleep, life changes and responsibilities
Lack of sleep is a major problem for many women during menopause which has a significant knock-on effect on mood. This is also a time when many women are facing responsibilities including children, elderly parents (the sandwich generation), high degree of career responsibility and the prospect of ageing. Trying to meet this wide range of responsibilities is particularly difficult when you’re exhausted, experiencing hot flashes and night sweats and your hormones are fluctuating like nobody’s business.
How can you help manage your mood swings?
Half the population is going to go through menopause and, whilst some women experience only a minor disruption in their lives, others are stopped in their tracks as the result of their mood swings. Adopting a biomedical solution can be the options for some women and Hormone Replacement Therapy (HRT) can help some women during menopause by replacing the levels of female hormones which are reducing at this time. However, not all women are suitable candidates for HRT and, although small, there is an increased risk of some cancers, including breast cancer. Anti-anxiety and anti-depressant medications can relieve some of the difficult mood symptoms for women but, as with HRT, medications can have negative side effects and not all women wish to take medications. Either in conjunction with a medical approach, or as alternative to it, there are many measures you can take to help minimise the impact of mood swings during menopause.
The devastating impact of lack of sleep is one of the main symptoms I hear about in my clinic. Chloe described how, out of the blue, she started waking up with a pounding heart. “I started waking up, feeling like I’d been shot or something. In a total panic. At other times I wake up soaked in sweat. Sleep’s become a nightmare”. I’ve written here about the importance of establishing a clean sleep routine during menopause. Avoiding spicy foods, alcohol and coffee can all help reduce the risk of triggering a hot flash happening during the night. Napping during the day, if you get a chance, can also help you catch up on lost sleep.
Menopause isn’t an illness, but it is a significant change. Some women find it useful to look at their lifestyle and responsibilities and think about what might need changing to support their changing needs. Marianne told me, “I refused to admit I couldn’t cope. I just thought I have to keep on doing what I’ve always done. It felt like utter failure to do anything else. But I was so ill I realised that if I didn’t take action, I’d have to leave work or go off long-term sick. So I stopped doing overtime, became strict about leaving on time and got a cleaner for my dad whose house I’d been cleaning in my spare time. It’s amazing how much better I felt just for doing these things”. Admitting that some things aren’t working for you as well as they previously did isn’t failure. It’s a recognition that you need to take control of your life at this point.
Hypnotherapy and Cognitive Behavioural Therapy are both proven to significantly help women during menopause. Whilst CBT is effective in helping women respond more positively to menopausal symptoms, which in turn helps minimise their impact, and CBT can help women with bigger issues in life(1), hypnotherapy has been shown to reduce hot flashes and night sweats by as much as 74%(2). It also helps with mood, self-esteem, sleep, relaxation and exploring life issues.
Yoga, meditation and mindfulness
Many women find yog`a a helpful way to feel better and more relaxed, generally and both meditation and mindfulness can help women feel better about themselves. Stress has a negative impact on mood and yoga and meditation have a great track record in helping people reduce their stress levels.
Diet and exercise
Looking after yourself through making adjustments to your diet and exercise can all help manage mood swings. As well as certain foods which tend to trigger hot flashes and night sweats, including coffee, spicy foods and alcohol, other dietary changes such as reducing sugar levels, ensuring hydration through drinking sufficient levels of water and ensuring that you eat enough protein rich foods and vegetables can all help to stabilise your mood. The mind and body are connected through the longest nerve in the body, the vagus nerve, which transmits information from the mind to the gut and other organs in the body, and from the gut back up to the mind. What you eat has a direct effect on how you feel. Finding the right type of exercise not only helps self-esteem but also tends to have mood-lifting benefits, helping to minimise some of the effects of the hormonal imbalances you may be experiencing.
If having to think about your body in this way is new to you, you’re not alone. Una summed up her journey like this. “I suddenly reached an age where I felt rubbish doing everything I’d always done. I was achy, exhausted and upset all of the time. Much as I didn’t want to change anything, I noticed a huge difference when I started cutting down the booze, meditating and eating healthily. I couldn’t go back to the old me now”.
Green SM, Donegan E, Frey BN (2019) Cognitive behavior therapy for menopausal symptoms (CBT-Meno): a randomized controlled trial. Menopause. 26(9):972-980. doi: 10.1097/GME.0000000000001363. PMID: 31453958.
Elkins, G, Fisher, WI, Johnson, AK et al (2012) Clinical hypnosis in the treatment of postmenopausal hot flashes. Menopause: The Journal of the North American Menopause Society DOI: 10.1097/gme.0b013e31826ce3ed