I Can’t Stand ANYTHING or ANYONE!: Navigating Perimenopausal Mood Changes

Dealing with shifts in mood and emotions is a key concern that many of my patients at MauveMD bring up. They often feel embarrassed to discuss them or feel like they are the only ones experiencing them. They often report:

• Increased anxiety

• Depression symptoms

• Increased irritability

• Mood swings

• New onset anger/rage

• Worsening PMS (premenstrual syndrome)

Frequently, these women seek help from their primary care doctors, who might overlook the possibility of perimenopause playing a role and instead prescribe anti-depressants.

Around 50-70% of women going through perimenopause report grappling with mood swings ranging from mild to intense. There’s a noticeable and significant upswing in depression symptoms during perimenopause. Roughly 45-70% of women in the menopause transition (compared to 25-30% of those in premenopause) experience symptoms of depression. In fact, the risk of new-onset depression becomes 14 times higher in the two years before the final menstrual period compared to the premenopausal years. This increased risk even affects women with no prior history of depression.

While there's limited research on anxiety during perimenopause and menopause, from my experience, numerous women talk about waking up at 2 AM with their minds racing and new feelings of anxiety that make it hard to fall back asleep. The lack of sleep starts a vicious cycle that negatively impacts mood during the day.

The brain is brimming with estrogen receptors, especially in the regions responsible for mood and thinking (like the hippocampus and prefrontal cortex). Estrogen also enhances the production and availability of serotonin, a chemical linked to happiness.

For many women, triggers like vasomotor symptoms (hot flashes and night sweats), sleep disturbances, and life's everyday stresses can kickstart or worsen mood changes.

Now, addressing these mood changes involves tackling life's challenges, too.

Antidepressants (such as Celexa and Lexapro) have been proven to significantly alleviate depression symptoms and even menopause-related discomforts like hot flashes and night sweats. However, they come with various side effects, including decreased libido, nausea, drowsiness, and difficulty reaching orgasm.

Numerous studies underline the positive impact of estrogen on mood symptoms in perimenopausal women. Notably, two controlled trials have highlighted marked improvements in symptoms for new cases or recurring instances of major depressive disorder and vasomotor symptoms. Transdermal estrogen (absorbed through the skin) offers a positive effect akin to antidepressants. Additionally, there's growing evidence that estrogen therapy could play a role in preventing depression.

There are also roles for psychotherapy, exercise, a healthy diet, and possibly supplements, including omega-3s. We will touch on these more in a future blog post.

In summary, mood symptoms during perimenopause are prevalent and might encompass anxiety, signs of depression, irritability, anger, and sadness. While antidepressants have their place in treating these mood issues, it's crucial not to overlook the potential influence of estrogen. 

Hormone replacement therapy for perimenopausal women IS as effective as antidepressants in managing mood symptoms in perimenopausal women. 

Plus, it sidesteps the side effects associated with antidepressants while potentially offering perks like bone and brain protection, cardiovascular advantages, and better sleep.

If you are experiencing mood symptoms that might be related to perimenopause, reach out to a menopause specialist who can guide you through all of the options - including hormones, medication options, and lifestyle alterations.