By Laurie Udesky
When Pamela Kragen* was going through menopause, she remembers a woman who became so enraged that she ripped the phone out of the wall.
The woman happened to be Kragen herself.
At times, menopause transformed Kragen into another persona entirely -- one that reminded her of a woman whose multiple personalities could not be controlled.
"Normally, I may fly off the handle once or twice a year. But once I started going through menopause, it was like every day," Kragen recalls. "Somebody had taken over my body. I'd be fine and then suddenly I'd go crazy."
Mood swings may not be a daily occurrence for all women going through a menopausal shift, but if you do experience mood swings, rest assured that you're not alone. Women can also suffer depression, anger, and anxiety during menopause. In either case, there are steps you can take to get your moods under control.
What causes mood swings during menopause?
It's not clear what causes mood swings. However, women who have mood swings related to premenstrual syndrome (PMS) can attest to the connection between hormone levels and emotions. Changing hormone levels during the menstrual cycle are the way parts of the brain -- the hypothalamus and the pituitary gland -- communicate with a woman's reproductive system.
Communication between a woman's brain and reproductive organs may happen differently during menopause, but it's still happening. Although there isn't a precise understanding of how hormones affect mood, there are several theories, including some that examine how mood-enhancing mechanisms in the brain are linked to hormone levels. Women using estrogen patches, for example, develop more mood-enhancing serotonin receptors in the brain. Hormones can also affect endorphin levels, the chemical associated with "runner's high." Researchers hypothesize that a decrease in a woman's hormone levels can also alter her general sense of well-being.
Two other common problems during menopause -- sleep deprivation and night sweats -- are also associated with moodiness. Night sweats, the night version of hot flashes, can make a good night's sleep difficult. It's not surprising then, that sleep deprivation can cause someone to be moody and irritable.
A study in the Journal of Psychosomatic Medicine found that women between the ages of 45 and 54 who reported severe depressive symptoms also reported more hot flashes, night sweats, sleep difficulties, mood swings, and memory problems than women who were not depressed.
How can I minimize mood swings?
Making some lifestyle changes could go far in resolving moodiness. If sleep problems are the culprit, following some basic principles of what experts call "sleep hygiene" can help:
How common is depression during menopause?
It's not clear how common depression is in menopause. A consensus statement by the National Institutes for Health, for example, reflects the wide ranging results from studies: Between 8 and 38 percent of women going through menopause experience mood changes. A Harvard medical study of 460 premenopausal and perimenopausal women with no history of depression found that women in perimenopause were twice as likely to be depressed as women who had not yet entered perimenopause.
What is clear is that a history of depression does make menopausal women more susceptible to developing it. Women who have experienced PMS, or postpartum depression are at greater risk for depression during menopause than women who did not report being depressed at those times.
It may come as no surprise that women who have an especially long transition into menopause seem to be more prone to depression than those whose transition is shorter, especially if they're also experiencing other bothersome menopausal symptoms.
What is the treatment for depression during menopause?
Severe depression is defined as feeling down or experiencing a loss of interest or pleasure for two weeks or more, with at least five of the following: depressed mood for most of the day and nearly every day, significant changes in weight or appetite, changes in sleep, a feeling of hopelessness, loss of interest in previously enjoyed activities, recurrent thoughts about death or suicide, inability to concentrate, fatigue, or loss of energy. If you're severely depressed consult with your doctor. Standard treatments for depression are talk therapy, medication, or both. The most common medication for depression is a class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs are Prozac, Zoloft, and Lexapro.
Some doctors believe taking these medications can be worthwhile even if you aren't severely depressed. A combination of antidepressants and therapy may work best, even if you're mildly depressed.
If you're feeling a little bit down, but consistently so, exercise and talking with a therapist may work as well as antidepressant medication. Yoga, a gentle martial art like tai chi, or meditation can ease stress or anxiety that may contribute to mild depression. You could also join a menopause support group to share your feelings with other women who may be going through similar feelings.
For Kragen, seeing a therapist twice weekly was helpful in alleviating her moods. Because her doctor determined that Kragen had a low personal risk for side effects from hormone replacement therapy, she was prescribed the lowest dose possible. Kragen also began exercising more regularly and more vigorously. It took several months, but she was finally able to get her moods under control.
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Boston Women's Health Collective. Norsigian, Judy, Pinn, Vivian Our Bodies, Ourselves: Menopause. Touchstone. 2006
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Last Updated: March 11, 2013