The anger hit Juliet Doherty like a train. At 48, Doherty had been in perimenopause for two years, living with daily headaches, sore breasts and irregular periods. But it was manageable.
“Naively I thought that if that were all I would be fine,” said Doherty.
That suddenly changed when she began to experience anger like she had never seen it before.
“Emotionally, I was a wreck,” Doherty recalled. “My life was getting out of hand … It was like watching a car crash and you couldn’t stop it.”
She described her anger as “the rage”: an intense burning sensation in her stomach that did not stop until it was released. She hit family, friends – she even broke an electric fan. After that, she would cry, frustrated at losing control.
Where does this anger come from?
Although menopause draws all the attention, women are even more likely to experience mood swings during perimenopause – the pre-menopausal transition period characterized by hormonal fluctuations, inconsistent ovulation, and irregular periods. (Some people will also experience mood swings and an increased risk of depression in the early postmenopausal period.) However, menopause will not be reached until one year after the last normal period, which averages 51 years of age in US perimenopause last between four and ten years and begin in their thirties.
“Perimenopause is a time of vulnerability for women due to hormone fluctuations,” said Dr. JoAnn Pinkerton, Medical Director of the Midlife Health Center and a member of HealthyWomen’s Women’s Health Advisory Board, told HealthyWomen.
She explained that overwhelming anger, much like Doherty, could be related to changes in the body’s levels of estrogen – particularly estradiol – combined with stressors. During perimenopause, estrogen continues to fluctuate, which affects other hormones (like serotonin and oxytocin) as well, and often leaves the body at some point with either too much or too little hormones.
Mood swings, when they occur, are often triggered by the body’s sensitivity to the change. But because of the constant change, Pinkerton explained, it’s not uncommon for anger to linger for a week or two and then disappear as the body adjusts.
According to Dr. Sheryl Kingsberg, professor of reproductive biology and psychiatry at Case Western Reserve University and a member of the HealthyWomen’s Women’s Health Advisory Council, poor sleep can also be a factor in mood swings.
“”[During perimenopause]the decrease in estrogen is the cause of an increase in hot flashes and night sweats, [which can disrupt sleep]”Kingsberg said, adding that the shift in hormones can disrupt sleep by itself, even without hot flashes.
Risk of depression
“26 to 33% of women experience significant depressive symptoms during this hormonal flow,” said Pinkerton.
In women, who are almost twice as likely to be diagnosed with depression as men, depressive episodes are often associated with hormonal life events such as perimenopause (as well as after pregnancy and puberty).
If left untreated during this transition, anger can increase the risk of depression. Women with a history of pre-perimenopause depression or a history of hormone-related mood swings such as premenstrual dysphoria are at even greater risk, Kingsberg said.
Both doctors emphasized the importance of seeking help when feeling overwhelmed with anger or when anger is interfering with your relationships so that depression does not develop.
Tame the anger
There are a number of perimenopause treatments available. According to Kingsberg, mood swings are viewed from a bio-psychosocial perspective – the link between biology, psychology and socio-ecological factors. Pharmacological options include hormone replacement therapy (HRT) and low-dose antidepressants.
“There is no data to suggest that hormones treat major depression,” Kingsberg said. “But we can definitely use it for mild mood swings. We know it can help.”
Hormones and antidepressants can do a double job: delaying neurotransmission to restore mood and reduce hot flashes. But HRT isn’t the only option, and it may not be the right option for everyone. (Kingsberg emphasized the importance of speaking with your gynecologist in order to make joint decisions.)
Cognitive behavior therapy (CBT) is another effective way to address perimenopausal mood changes. This popular type of talk therapy, which provides tools to shift thought patterns away from the negative and back to the neutral and positive, is often used for depression and can help reduce irritability. According to Kingsberg, some of the CBT can help with insomnia and also reduce the intensity and frequency of hot flashes.
Since fluctuations in estradiol make women more sensitive to stress, experiencing stressful life events during the perimenopausal transition increases the risk of developing depression. Therefore, it is important for women to evaluate current life stressors to identify triggers. CBT and other mindfulness tools like meditation can help women react less negatively to stress, which can reduce the development of depression.
“Mindfulness and the ability to step back are really important,” Pinkerton said.
Mediation, exercise, and creative opportunities are useful activities for reducing stress and irritability. However, the most important thing – especially during the COVID-19 pandemic, which has seen a sharp increase in stress levels – is that it is vital for anyone going through perimenopause and feeling particularly overwhelmed (or other physical symptoms like insomnia, loss sex drive or pain during intercourse). to ask for help.
Doherty finally sought help after climbing a ladder to yell at her neighbors for painting their fence.
“I realized that I had lost control of my emotions and called my doctor,” Doherty explained.
She was put on HRT and her mood changed immediately. Today she has more control over her life and her emotions. Her headaches and hot flashes have also stopped.
“I’m usually a very controlled, level-headed person. It hit me like lightning – it was so quick,” said Doherty. “HRT definitely helped manage my symptoms. I don’t want to feel this way again.”
Substance Abuse and Mental Health Administration National Helpline: 1-800-662-4357
National Suicide Prevention Lifeline: 1-800-273-8255