Perimenopause and mood: Help is out there and in more ways than you think……
By Tracy Macfarlane
It is terrific to see growing discussion of menopause and how it affects women and how we can navigate through this time of life more effectively. A lot of changes occur in the perimenopausal period, many of which impact mood. Mood changes experienced during this stage of life are often put down to being wholly accounted for by hormonal changes, but there are actually many factors around this time of life that can be contributing or exacerbating factors with regard to mood changes, and understanding this can help women seek appropriate treatments or interventions to ultimately minimise the negative effects experienced.
Let’s begin by defining perimenopause. Perimenopause refers to the time “around menopause”, the time before and after menopause. Menopause is usually defined as the time when a woman has not had a menstrual period for 12 months or longer. The symptoms associated with menopause begin before, and can continue on for some time after, a woman ceases to have a menstrual period. Perimenopausal symptoms can last for a few years, or for up to 10 years. It often starts in our early forties, and can begin earlier or later. There are no hard and fast rules!
Research has shown that a significant number of women will experience mood swings during perimenopause. Some women may suffer severe mood swings and may experience anxiety and depression for the first time in their lives. The mood swings often seem to come out of the blue and may be far more severe than anything experienced in the past. These mood swings can be one of the hardest perimenopausal symptoms to cope with.
Common Perimenopause Symptoms:
· Changes in menstrual periods
· Hot flushes
· Night sweats (hot flushes that happen at night)
· Sleep problems
· Depression and mood swings
· Increased anxiety
· Dry, itchy, or sore vagina, which may lead to painful sex and diminished sexual interest
· Difficulty holding urine, leaking urine
· Forgetfulness and difficulty thinking clearly (“brain fog”)
· Headaches
· Weight gain, especially around the waist
Let’s understand perimenopausal mood swings a little better by looking into the causes:
Firstly, the hormonal changes that occur during the perimenopausal period are influential on mood. Put simply oestrogen and progesterone levels decrease. These are hormones that are important in regulating a woman’s menstrual cycle.
Oestrogen has a major impact on mood, primarily by affecting levels of serotonin in the body. Serotonin is a mood-stabilising neurochemical. During perimenopause, as oestrogen levels start to drop, so do our levels of serotonin. This is one of the reasons why we may feel depressed or low.
The other significant hormone in a woman’s body is progesterone. Levels of progesterone begin to drop during perimenopause. Low levels of progesterone are associated with a range of symptoms including sleep disturbances, migraines, hot flushes, and unexplained anxiety. The combination of these symptoms can also negatively impact mood.
Hormonal fluctuations play an important role in mood changes and instability of mood. Oestrogen production might be in decline but this happens in an unstable or unpredictable way.
Hormonal imbalance also impacts mood as the hormones work in combination, and during perimenopause the balance of hormones is disrupted. For example, when progesterone decreases, women can end up being “oestrogen dominant” which can cause a range of physical symptoms such as bloating, decreased libido, and fatigue, as well as mood changes.
Many women experience severe sleep disturbances during perimenopause, even if they have never had problems sleeping before. Hot flushes experienced at night can impact sleep patterns. Hormonal fluctuations can lead to anxiety, which can also keep women awake at night.
Hot flushes are a sudden surge of heat, and can last between 30 seconds and 10 minutes. Sometimes, these flushes can be very noticeable to others, and cause embarrassment and anxiety about having a flush. The difficulty in dealing with hot flushes can contribute to anxiety and low mood.
Other symptoms that can impact mood include weight gain, reduced interest in sex, vaginal dryness, tender breasts, bloating, loss of breast fullness, thinning hair, and dry skin. Coping with these changes can be quite overwhelming.
The perimenopausal period can also be a stressful time of life. Raising children, caring for aging parents, working and perhaps even re-entering the workforce or taking up study. It can also signal a transitional time of life. Coming to terms with the end of childbearing years, whether or not you have had children can be issues that come into focus.
This sometimes coincides with the “empty nest” time of life, when children leave home and roles change. It also is a time when we are starting to be confronted with the prospect of aging, and this can lead to anxiety about this stage of life, and in turn affect mood.
Mood changes during the perimenopausal period can range from very mild to severe, and it is important to acknowledge that there are real physical changes that are happening in your body which are impacting how you feel and behave. It is also important to understand the other factors that can also contribute to these mood changes.
The good news is, as we are becoming more educated about the side effects of menopause, it is easier to find treatments that help.
Below are some options:
Looking after yourself and managing stress: Engaging in self-care is really important and can include making sure you find time to do things that bring joy to your life, it might be as simple as finding half an hour in the evening to read a good book – it doesn’t have to be too time consuming or hard. In terms of managing stress – look at the aspects of your life that you have some control over, and those that you don’t. Focus on the areas you can influence and learn to accept the things outside of your sphere of influence.
Sleep: Getting an adequate amount of sleep is critical at any age for good mental health. Aim for eight hours, give or take an hour. Anything less than seven hours is likely to result in what we call a sleep deficit. Hot flushes definitely impact sleep so speak with your GP if this is a problem you are experiencing. Your psychologist and your GP can help you manage sleep problems.
Medication: Anti-depressants can help alleviate symptoms of depression, anxiety and low frustration tolerance.
Psychological Therapy: Psychological treatment can help determine which factors are responsible for your mood fluctuations and provide appropriate treatment. Talk to your GP about referral options.
Exercise: Physical activity and fitness are proven mood enhancers. Start with small, achievable goals in relation to exercise, and you will very likely see your mood improve.
Relaxation: Engaging in relaxation exercises such as mindfulness, meditation and yoga for example, are proven to help reduce stress and improve mood. There are a lot of helpful Apps available, such a Smiling Mind, Calm, and Head Space, to name a few.
Nutrition: Eating a healthy, well balance diet is good at any age, but seems even more important during menopause.
Connection: Talking to friends, and having meaningful connections is the strongest predictor of resilience, so it is definitely something we should tap into.
In summary, hormonal changes in menopause can trigger anxiety and depressive symptoms, but other things can contribute to, and there are treatments/interventions that help. A better understanding of symptoms helps women to act and seek the most appropriate professional care and support.
Some useful links:
Acceptance and Commitment therapy in perimenopause:
https://www.psychologytoday.com/us/blog/how-healing-works/202107/3-steps-healthy-perimenopause
https://www.jeanhailes.org.au/resources/menopause-fact-sheet
Tracy Macfarlane is a clinical psychologist with many years’ experience working clinically with individuals and families across the lifespan. She has held clinical positions at a number of settings including the Bathurst Community Health Centre, Bloomfield Hospital (Adult Acute and Sub-Acute Mental Health), Orange Hospital Chronic Pain Management Service, headspace Bathurst, and most recently Tracy works in her independent psychology practice. Tracy also has a keen interest in education and currently holds positions as lecturer at Charles Sturt University, Adjunct Lecturer at Western Sydney University, and she delivers workshops as a Training Associate with Phoenix Australia, Australia’s National Centre of Excellence in Posttraumatic Mental Health. Tracy has an interest in educating the public about mental health issues, and de-stigmatising mental health problems to help people access appropriate supports when needed, and to this end she participates in a fortnightly psychology chat with ABC Central West radio to discuss psychology issues. Tracy has also undertaken specialist training in the treatment of eating disorders. Tracy has a keen interest in helping people overcome unhelpful life patterns, and to help individuals and families to live well. Tracy also provides clinical supervision to mental health trainees and clinicians across a number of disciplines.