Remember when you had your first menstrual period and your mother or girlfriend explained that the reason for your emotional roller coaster was tricky little body chemicals called hormones? It turns out those same pesky hormones that make you a bit sensitive at certain times of the month can also wreak havoc as they begin their descent during the period leading up to menopause, called perimenopause. This symptom differs from woman to woman, but just like those days of puberty, it may help to understand what you might experience and why.
What's Happening Inside
As a woman enters perimenopause -- typically between ages 45 and 55, with the average age of menopause at 51 -- her levels of the hormones estrogen and progesterone begin to fluctuate and decline. That triggers a number of symptoms ranging from irregular periods to hot flashes and vaginal dryness; but about a quarter of women also notice increased mood swings that can range from mild to severe.
Risa Kagan, M.D., a gynecologist with Sutter East Bay Medical Foundation, certified menopause practitioner and former member of the Board of Trustees of The North American Menopause Society, says some women are simply more influenced by the hormones in their bodies. “We don’t understand why some are more sensitive, but it’s clear that they are.”
That sensitivity impacts the body in many ways, including affecting the neurotransmitters in the brain. “Mood changes are not ‘all in the woman’s head’ or imaginary. There’s a true physiological change in the brain brought on by hormonal shifts,” Dr. Kagan says.
According to the North American Menopause Society, women who have struggled with severe PMS or clinical depression before perimenopause are more likely to experience significant mood swings or depression during this stage. Other factors taking place during this stage of life also can contribute to the problem. For instance, if your changing hormones trigger hot flashes (which they do for 75 percent of women), you may have trouble sleeping at night, which can add to a depressed, stressed or anxious mood.
Some women in mid-life may also have concerns about body image, loss of fertility or aging that affect their moods. Work stresses or circumstances with adolescent or adult children and aging parents can further contribute to anxiety, anger and depression.
When combined with fluctuating hormones that make our once-predictable body rhythms feel erratic and unpredictable, these life changes can leave you feeling out of control. But rest assured, many treatment options do exists, and you can feel comfortable – yes, even normal – asking for help from your doctor.
For those whose mood swings are severe enough to interfere with life and relationships, medications are a very effective option. Some women do well with anti-anxiety and anti-depression medications called selective serotonin re-uptake inhibitors, which can be taken just during the second half of the menstrual cycle, or all month, if warranted. Low dose birth control pills or Hormone Therapy drugs are another option, providing women with a steady dose of hormones to reduce symptoms of perimenopause.
For others, talking to a therapist or practicing stress reduction techniques can get them through the mood swings without medication.
Dr. Kagan notes that women who are already taking medications for mood disorders, such as bipolar disorder, depression or anxiety, especially need to pay attention as they enter menopause. “The hormone shifts of menopause can require an adjustment of medication,” she says. “A dose that has worked well for years may no longer be helping. Be alert.”
Other Medical Reasons
Finally, be aware that some of characteristic symptoms of menopause could also stem from other medical issues, such as elevated or deficient thyroid hormones (hyperthyroidism or hypothyroidism). That’s why your first stop in deciphering severe mood swings should be your doctor’s office. After a thorough physical exam, you and your doctor will have all the information needed to safely address all your symptoms.
Perhaps in a few years you’ll be the one comforting a friend with these words of reassurance, “You’re not going crazy. It’s just your hormones treating themselves to a riotous farewell party.”
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