How to Manage Moods In The Midst Of Menopause

Dr. Ronald Young talks with a patient

We’ve all watched those “amusing” marital exchanges on TV or in movies that occur during the menopause years leaving husbands wondering, “What happened to my wife?” And while mild mood changes during perimenopause are not uncommon, there are times when women may need a little extra help from their doctor, and it’s not so amusing when it’s happening to you.

Some women go through menopause enduring common, albeit unpleasant, symptoms like hot flashes, night sweats, difficulty sleeping and minor mood changes, but otherwise they are just fine. The mood symptoms look similar to PMS. There’s irritability, tearfulness, and feeling overly sensitive. Someone might say something and you start crying. But often what troubles women most, and what they typically complain about, is the irritability.

If you experienced symptoms like irritability during PMS, it’s common to experience those same symptoms during perimenopause. This generally indicates that you are sensitive to hormonal changes and the mood changes that come with them.

During perimenopause your estrogen levels fluctuate, going way too high and then way too low. This hormonal rollercoaster can be part of what triggers the mood swings and irritability. The good news: once you’ve gone through the transition and your body stops experiencing these ups and downs in your hormone levels, the mood changes will likely stop too.

Replacement hormones may be a good option to help with irritability. Sometimes women come to see me about their mood swings and I recommend they talk to their gynecologist about hormone treatment, which can level off the peaks and valleys of hormone levels that may be contributing to their irritability. Most women don’t need anything more. They can opt for hormonal treatment (often the birth control pill is used in women still menstruating) to deal with the moods and other perimenopausal symptoms, or simply wait them out until the menopause transition is over.

If you have a history of depression, it may be a different story. During perimenopause it’s common for depression to occur again in women who have had episodes in the past. (It’s uncommon for women to have their first episode of depression at menopause, but it can happen.)

I have patients who are doing fine on their antidepressant, then perimenopause hits and suddenly they are no longer doing well. It could be their antidepressant is no longer working due to the change in their hormone levels.  Sometimes increasing the dose is necessary, or a change to a different antidepressant is needed. Sometimes what works well for women when they are pre-menopausal isn’t effective once they enter the menopause years.

Research has shown that using a combination treatment – one that involves both hormones and antidepressants – works better than one option alone for women struggling with depression during perimenopause. The ups and downs of estrogen levels can change your brain serotonin and norepinephrine receptors. If you stabilize estrogen levels, you can stabilize brain receptors, which usually makes antidepressants much more effective.

Bottom line: When I see patients in perimenopause, the first thing I consider is whether their symptoms can be addressed using hormone therapy alone, or does the combination of hormones and an antidepressant make the most sense.  For women who cannot take hormones due to medical reasons, antidepressants can help some of the other bothersome symptoms of perimenopause as well.

If you’d like to learn more about mental health and menopause, visit The Menopause Center at Texas Children's Pavilion for Women.

This post was originally published on the Texas Children's blog here.