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Irritability

You know that you are normally a calm and patient person, you are very capable of multi-tasking and dealing with the common pressures of a woman’s 21st century lifestyle. But, recently, you’ve noticed that within seconds you can go from your calm and collected self, to feeling very intense and struggling to keep your anger under control. You are less tolerant and small things make you mad. And tears are quicker to flow. This could very well be an indication that you are experiencing hormonal Irritability, or as its sometimes referred to “Menopause Rage”.‍

70% of women state irritability is the primary emotional symptom during peri menopause.

It can be incredibly frustrating as it feels like you are stuck in a cycle of rage, regret, rage, regret and so on. An increase in irritability is the most common emotional problem reported during the earliest stages of menopause. In fact, 70% of women state irritability is the primary source of peri-menopausal problems. The good news is that your estrogen level will stabilize as you enter post-menopause. Your symptoms can be controlled until they pass due to the full onset of menopause.

According to additional research, up to 51% of women aged 40 - 55 years old report feelings of tension or irritability recently, and 25% report feelings of frequent irritability or nervousness.

The Lowdown on Irritability

Why does this happen, how does it impact you, how is it diagnoses and common triggers/ risk profiles.

As you enter peri -menopause an overall decrease and fluctuation of your estrogen and progesteron levels is triggered. Estrogen is involved in the production of serotonin which regulates our moods and provides that feeling of happiness we seek. The fluctuation and overall decrease of hormone levels in combination with lower levels of serotonin cause an hormonal imbalance, that can result in that irritable feeling (or plane rage). The image below shows 6 months of hormonal levels for a woman going through peri-menopause, and draws a good picture of how frequently and severe these hormonal imbalances can be.

That burning temporary rage or (frequent) irritability can have unfortunate consequences and can easily take a toll on the strongest of relationships both at home and at work. For many women a moment of irritability can result in (strong) feelings of guilt, that can in turn have a negative impact on her self-esteem.

Medical professionals ask questions that allow for self-reporting of symptoms, which the diagnosis is based on.

Being a woman in midlife generally means that you are experiencing pressure, demands and expectations in many different parts of your life: you may be a mother, a caregiver to older generations, an active social life, you may have a (very) demanding career, a partner who relies on you.. It is a very long list of potential triggers that most women will need to figure out how to navigate.

Mental health

Take a walk

10-minute walk has been shown to be effective in reducing a woman’s self-reported level of anxiety for several hours. Active people report lower levels of anxiety than sedentary individuals, and researchers found that women who get regular, aerobic exercise are 25% less likely to develop symptoms related to heightened anxiety.

Prevention and Treatment

Learn more about your options for prevention, management and treatment of Irritability. This is not an exhaustive list of the treatment options available, but a good start.

At this point there are no known effective clinically proven supplements or OTC products available that reduce the frequency or severity of irritability. Your doctor will have however have both hormonal and non-hormonal prescription medications available for you, if a clinical diagnosis of menopause-related irritability is made. Additionally there are a range of lifestyle changes that you can adopt that may have a positive impact as well.

  • Remember to focus your nutrition on non-processed foods containing high amounts of vitamins, healthy minerals, proteins, Omega-3 fatty acids, and probiotics.
  • Avoid over-processed foods, sugary drinks, alcohol, nicotine, and any drug that might lead to mood alteration of an addictive nature.

Performing 50 minutes of aerobic exercise four times a week was found to relieve menopause symptoms, including night sweats, mood swings, and irritability. Exercise also helps to maintain an ideal body weight, preventing comorbidity symptoms such as poor body image, diabetes, and high blood pressure.

Irritability is directly related to mental health. We have listed a few positive mental health activities you can consider doing: it's not a one size fits all, you'll need to trial and error these to see what works for you:

  • Let it out - sometimes letting the anger out is the best remedy. Just be mindful of who is around you when you take this course!
  • Let go of the guilt - you will get angry at the wrong person or overreact at some point. Cut yourself some slack, you are going through a lot and no one is expecting you to be perfect. Explain why it has happened and may happen again, and move on. 
  • Cognitive Behavior Therapy (CBT)
  • Work-life balance - now is a very important time to ensure you have time just for you. 
  • Excellent sleep hygiene
  • Avoid triggers through self-awareness
  • Keep a journal of your moods

There are no supplements that have been clinically proven to reduce irritability.

There are no over-the-counter remedies available for irritability. Self-medication with mood altering substances such as alcohol or drugs may exacerbate or trigger other menopausal symptoms. They also have the potential of becoming abused or addictive.

Non-hormonal treatment options available to you may include antidepressants. Escitalopram (Lexapro) is an SSRI antidepressant which may combat irritable emotions. Taken orally, SSRI treatments affect the level of serotonin in the brain.

  • Systemic Estrogen Therapy (with or without progestin) may be recommended as part of Hormonal Replacement Therapy (HRT). Estrogen replacement may help with your body’s ability to produce serotonin. Serotonin regulates your moods and your sense of happiness. However, it is unclear whether full HRT therapy is necessary for irritability specifically.
  • Oral contraceptives (birth control) such as Loestrin or Alesse have been found to be effective mood stabilizers in women suffering from peri-menopausal symptoms. It is unclear how the medication affects emotional factors, however it is tied to hormonal activity and, specifically, estrogen levels.

FAQs

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Sources used

Medical journals

Born L, Koren G, Lin E, Steiner M. A new, female-specific irritability rating scale. J Psychiatry Neurosci. 2008;33(4):344-354.

Other online sources

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