Anger and snappiness, mood swings, anxiety and low self-esteem are all common experiences for women going through the menopause. This article explores why menopause causes emotional symptoms, and what can help.
By Hilly Janes
What causes anger, mood swings and emotional issues in menopause?
Why is the menopause such an emotional time for some women? Are mood swings, anxiety, irritability, crying, anger - and even rage - symptoms of the menopause or negative reactions to realising that we are no longer fertile, approaching old age and uncertain about what the future holds?
Teasing out cause and effect is tricky. Physical symptoms like hot flushes, night sweats and vaginal dryness are caused by the fluctuation and ultimate lowering of the female reproductive hormones oestrogen and progesterone during and after the menopause. This can go on for several years.
Lower levels of female testosterone can result it in tiredness, lack of self confidence and a dwindling sex drive - but this is part of the ageing process in women and men. It is true that some women may experience hormone-related mood changes, but research suggests these are more likely to be associated with life stress, poor overall health, and a history of depression, so dealing with these problems is likely to be more effective than focussing just on the menopause.
Can menopause change your personality?
This isn’t to dismiss menopausal anger and mood swings as being “all in the mind”. Far from it. But the menopause is called “the change” for a good reason, and it is part of a series of changes that women - and their male partners - face at this time of life. Adult children fly the nest, while those still at home may be tricky teenagers. Parents may become increasingly frail and dependent.
“I have three girls in their 20s …. they are all concerned by my mood swings and hot flushes, but they all make me feel blessed as they have each asked individually about menopause and we have discussed the fact that they may well experience the same or similar symptoms.” Community Forum member
Partners may be feeling anxious about physical changes too, like erectile dysfunction - and both of you may worry about financial security at an age when many people are made redundant or forced to take early retirement. You can read more about talking about the menopause to family members here.
It’s all more than enough to drive anyone over the edge, and no wonder that mood swings, crying a lot for no apparent reason, feeling frustrated and angry are all part of the menopausal mix. It doesn’t mean your personality is changing, just that the natural changes to your body and mood might make you feel as if you are being taken over by aliens.
What can help with anger and emotional symptoms in menopause?
There a lots of things to help you through this phase (and it is only a phase). And it’s important to ask for help - a survey by the British Menopause Society showed that only half of women go through menopause without consulting a healthcare professional, and 42 per cent reported that the symptoms were worse than they expected (on the plus side, this means it held no nasty surprises for the majority). Top of the list of problems were hot flushes, night sweats and a negative impact on their sex life.
It’s a question of working out what works for you, and bearing in mind that might take time.
Hormone replacement therapy (HRT)
Hormone replacement therapy (HRT) replaces dwindling oestrogen and progesterone hormones, and can help with hot flushes and night sweats - which in turn can improve your mood and irritability, especially if you have not been sleeping well.
There have been concerns in the past about associated increased risk of blood clots or breast cancer, but doctors now believe that the benefits of HRT outweigh the risks, which are small anyway.
HRT is only available on prescription in the UK so you should talk to your GP about whether it could be right for you. It is likely to be prescribed for only a few years at the most, and any risks will decrease once you stop taking it.
Depression and anxiety in menopause can be a question of chicken and egg. Are the natural menopausal changes to your body prompting negative feelings, or are you prone to depression and anxiety, making it harder to cope with these changes?
Menopausal women with moderate to severe depression may be prescribed antidepressant drugs known as SSRIs to lift their mood and reduce anxiety. These can come with side effects however - including loss of sex drive - so you need to talk to your doctor about taking them as they could be counter-productive. It’s important to bear in mind too that you may find it harder to come off them than HRT when your menopause is complete.
There are plenty of plant-based preparations that claim to help menopausal symptoms and many women feel more comfortable about taking them than pharmaceutical products. They include St John’s Wort for mild to moderate depression and red clover for anxiety. There is less rigorous medical research into natural remedies however; they are unregulated, unlike medicines, and they can interact negatively with prescription drugs, so you need to talk to your doctor about possible risks.
“I'm three months in on HRT patches, and it's made a massive difference to me, but I've also had years of treating my symptoms naturally, so I know that both ways can work. It's a question of seeing what you want for yourself, taking a bit of time, and finding the solution that works for you.” Kaz, Community Forum member
Congnitive Behavioural Therapy
The seemingly uncontrollable negative thought patterns and low mood that can come with the menopause can be tamed by Cognitive Behavioural Therapy (CBT), which helps you rethink and re-evaluate self-defeating feelings. It can also help with feeling less stressed and embarrassed by hot flushes and night sweats. It is approved by the NHS in the UK and you can find courses online or in person - ask your GP.
This therapy helps stop your mind running away with you by helping you to focus on your present surroundings, and to stop feeling anxious about past events or what the future might bring. A study by the respected Mayo Clinic in the USA suggested that women experienced lower menopausal symptom scores and lower stress with improved mindfulness. Try a book, app or short course to get started.
It’s good to talk
Knowing that you are not alone and can share how your feeling with others who feel the same is half the battle. Our community forum and is a great place to start.
Gentle activities like yoga and Tai Chi can help you relax, and more energetic exercise like bashing a tennis ball or martial arts are a great way of getting rid of menopausal “aggro”. Or how about stabbing at the ground with a pitchfork? One woman in our community described how mucking out horses worked for her!
The emotional effects of vaginal dryness
One more thing to consider is vaginal dryness. This is one of the least talked about effects of the menopause and can make sex very painful - in turn leading to tension between you and your partner. He may not understand why you dread having sex and think it’s about him, not you.
“The worst part of this is the total lack of understanding on my husband’s part. He is behaving like a spoilt child … He keeps asking me what’s wrong with me? Why don’t I want him? Am I having an affair? Is he serious? Why am I crying? I tell him I have absolutely no idea and he stomps off in a huff.” Community Forum member
It’s important to talk about this calmly and to take steps to make intercourse less painful. The dryness is caused by lower levels of oestrogen and can be improved either by taking HRT or using a vaginal oestrogen cream, which your GP can prescribe. If the problem isn’t too severe, you can buy and try different lubricants.