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Mood swings

Many women have experience Mood changes or as its frequently referred to “mood swings” as a symptom of Premenstrual syndrome (PMS) and for most it will get noticeably worse during peri-menopause. The mood changes could be severe, or sudden and might be discomfiting or causing you social anxiety. Totally understandable and you are certainly not the only one. In fact mood swings are so common (23% of women report it) during pre and peri-menopause, that many doctors refer to it as one of the hallmark symptoms of the menopause transition. Many women find it an incredibly frustrating symptom as it can have a significant impact on your daily life. The good news is that mood changes are not chronic, and tend to subside once your hormones settle during post-menopause. There are also effective treatment options available for relief.

The Lowdown on Mood Swings

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

Spikes and drops in estrogen and progesterone during peri-menopause lead to a higher possibility of mood swings and emotional disorders. Estrogen helps to regulate your body’s serotonin and norepinephrine levels. These natural chemicals control moods and emotions, as well as our perceptions of our circumstances and feelings. Peri-menopausal women may have a higher level of the brain protein monoamine oxidase A (MAO-A) as a result. In addition, the chain-reaction operations of progesterone leads to disruption of the Gamma-Aminobutyric Acid system, possibly causing negative changes to emotions, moods, and sleep regulation.

If you are experiencing sudden irritability, depression, anxiety, episodic crying, weepiness, or persistent insomnia, you may be suffering from menopausal mood swings. Hormonal volatility is eliminated during post-menopause and symptoms felt during peri-menopause often recede, including mood fluctuations. However, if your symptoms are interfering with your ability to function daily, do not ignore it. Peri-menopause can last up to a decade and that is much too long to suffer through something that can easily be treated by a medical professional.

It is important to remember that, during peri-menopause, symptoms can come and go and may not be found to need treatment. However, as with all mood-based disorders, if symptoms are ignored and they lead to more intensive levels (such as clinical depression), there is a significant risk to the health and wellness of a woman. There are also excellent treatment alternatives available, should a doctor’s assessment result in a recommendation for medication and lifestyle changes.

Other menopausal symptoms often experienced simultaneously with mood swings include:

  • Lowered libido
  • Hot flushes/night sweats
  • Muscle and joint pains
  • Urinary incontinence and/or frequency

In addition, the following behavioral changes may be triggered by, or positively correlated with, mood swings:

  • Sleep disturbance, trouble sleeping 
  • Increased fatigue, decreased energy 
  • Difficulty in concentration and decision making (“brain fog”)
  • Symptoms of depression (lack of self-worth, changes in appetite, lack of energy, persistent thoughts regarding death or suicide)
  • Anxiety

Diagnosis of a clinical level of mood swings requiring treatment is performed by a medical professional using a woman’s self-reported symptoms when compared to a standardized questionnaire/assessment. Doctors and therapists use a scale-of-severity testing method to determine if symptoms are chronic or temporary. The good news is that, as estrogen levels stabilize in post-menopause, mood related disorders experienced during the peri-menopausal stage normally recede.

Women with a history of strong mood swings during their pre-menopausal menstrual cycles are at a higher risk for reporting mood swings as a troubling symptom during peri-menopause. Women previously diagnosed with postpartum depression and PMDD (premenstrual dysphoric disorder) also have an increased risk for mood-based diagnoses during peri-menopause. 

Aside from hormonal causes, mood swings can also be attributed to other lifestyle factors such as external stressors, work/life balance challenges, caregiving responsibilities, and empty nest syndrome. As these stressors combine in effect, they can negatively impact emotional stability and may contribute to a downward spiral away from the healing properties of adequate rest, good nutrition, daily exercise, stress reduction, and other behavioral and lifestyle norms.

If behavioral symptoms are interfering with your normal daily activities or are disrupting your relationships, it is important to seek a healthcare evaluation. Particularly if you are having depressive or suicidal thoughts, it’s important to receive early and accurate diagnosis and information on treatment alternatives. Mood-based disorders are, unfortunately, a common by-product of hormonal fluctuations and should not be associated with negative feelings of shame or self-blame. With the help of compassionate professionals, mood-based troubles are treatable and manageable. 

Mental health

Will this emotional rollercoaster ever end?

You might feel that PMS or menopause means you're destined for a life of gloom and doom. We are not going to lie for some women these years are not going to be pretty. But there is light at the end of the tunnel: most of these mood related symptoms are due to fluctuations in your hormones. So when you go through Menopause (average age 50-52) and your hormones stabalise, so will these symptoms.

In the meantime - get the help and treatment you need to weather this storm. Do NOT let perceived stigma, embarrassment or the all too common "its not that bad, I can handle this" stop you from getting help. These symptoms are real and there is effective treatment available.

Prevention and Treatment

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

Many lifestyle changes have been evaluated for their effect on symptoms caused by hormonal imbalance. These include exercise, nutritional modifications, mind-body practices, and acupuncture. In general, your healthcare provider is likely to recommend these options before embarking on a treatment plan involving menopausal hormone treatment (MRT) or other, prescription-based interventions. Having said that, there are effective hormonal and non-hormonal prescription medications available for women suffering from severe mood disorders.

Positive nutritional choices are important, including:

  • Adequate hydration
  • Limiting alcohol and sugar-sweetened beverages
  • Reduce the consumption of processed food 
  • Adequate vitamin/mineral rich foods
  • Including Omega-3 fatty acids in your diet

Throughout menopause, a woman’s goal should be to maintain a healthy lifestyle as it can greatly reduce the impact of symptoms. Regular aerobic exercise is necessary to maintain best-possible hormonal balances, body weight, muscle mass, bone density, and cardiovascular health.

  • Exercise and a positive sense of mental wellbeing are closely related. Mood improvement has been shown to accompany even mild exercise routines such as daily walking.
  • During menopause, light-exercise (such as stretching, yoga, walking) was found to be positively correlated with a reduction in self-reporting of troubling mood-based symptoms. Although moderate-to-intensive exercise may be associated with an increase in other menopausal symptoms, such as hot flashes, light-exercise did not lead to additional negative effects.

For menopausal symptoms that stem from brain functions, such as mood swings, positive mental wellbeing is essential. Here are some ideas for fostering optimal mental health:

  • Regular social interactions
  • Reduction in stress from close relationships and work environments
  • Cognitive Behavior Therapy (CBT)
  • Fostering a positive living environment

In an interesting note, women with emotional closeness to at least one friend have higher progesterone levels, thereby enjoying less stress and a boosted mood, naturally.

At this point no supplements have been clinically proven to help reduce the severity or occurrence of mood swings. Having said that, regional and anecdotal knowledge-sharing is common with supplement use and below is an overview of the most frequently recommended supplements:  

  • DHEA. Many women try DHEA (dehydroepiandrosterone) hormonal supplements to control peri- and post-menopausal symptoms. Using natural hormone treatment may be less invasive than prescription treatments and may have fewer risks and side effects. However, DHEA supplements taken in pill or cream form should be used under the supervision of your doctor, as they are introducing elements that affect your already-fluctuating estrogen levels. Even though there is a case to be made for an indirect benefit of mood swings, there is insufficient research that clearly demonstrates a direct positive impact of DHEA on reducing Menopausal Mood Swings. 
  • Ginger, saffron, and cinnamomum. Although ginger (or ginger in combination with saffron and cinnamomum) has been found effective in reducing negative symptoms associated with menopause, it is uncertain what specific effect it has on mood regulation. 
  • Other supplements. There are additional supplements that may help with mood regulation, although not necessarily specifically for menopausal mood swings. Magnesium, chasteberry, St. John’s Wort, primrose oil, GABA (gamma-aminobutyric acid), and Kava Kava (Piper methysticum) have all been found to promote mood stability in various forms, however strong clinical research supporting these claims is lacking as of now. 

We strongly recommend discussing any supplements you may want to try with your healthcare provider, to ensure the trial is appropriate and won’t interact with other supplements or medications you may be taking.

There are no over-the-counter medications available to treat mood disorders. Although some women attempt self-medication using the calming effect of alcohol or the stimulation of other substances and drugs, these options are not recommended due to abuse and addictive risks.

SSRIs and SNRIs are two types of antidepressants that can be prescribed to help manage mood-related symptoms of menopause: 

  • Paroxetine, Escitalopram and Fluoxetine  - are low dose SSRIs (selective serotonin reuptake inhibitors) and can help increase the level of serotonin in your brain, by inhibiting the reuptake of serotonin into your neurons (which is caused by the decline in Estrogen).
  • Venlafaxine - an SNRI (serotonin norepinephrine reuptake inhibitor) also inhibits the reuptake of serotonin into your neurons and thereby increases serotonin in your brain.

Hormone Replacement Therapy (HRT) uses a Systemic Estrogen Therapy approach to supporting estrogen and progestin levels. Although this treatment option can provide relief for some women, the treatment itself can also induce new symptoms such as irritability, depression, and anxiety. Often HRT therapy is used to control other menopausal symptoms, such as night sweats or low energy, and mood swings will be affected to a different degree in each woman.

FAQs

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‍Taavoni S, Ekbatani NN, Haghani H. Effect of Tribulus terrestris, ginger, saffron, and Cinnamomum on menopausal symptoms: a randomised, placebo-controlled clinical trial. Prz Menopauzalny. 2017;16(1):19-22. doi:10.5114/pm.2017.67366

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