By Dr. Shreya Patel
Mood swings are a natural and unavoidable part of life. Everyone experiences them and they are often due to an imbalance of neurotransmitters (chemicals that transmit signals throughout the brain), certain medical conditions, or significant life events.
Mood imbalance, or mood swings, are a very common occurrence during the menopausal period, with approximately 25% of women experiencing some psychological distress.1 Between 15-50% of women report low mood and depression, up to 70% of women report irritability, and between 40 and 50% of women report anxiety and insomnia during menopause.2
Unfortunately, the psychological aspects to menopause are less well defined, and so are more difficult to diagnose and treat in comparison to physical symptoms. Nonetheless, there are now an increasing number of ways to tackle mood fluctuations.
Why are menopausal women particularly affected?
The menopausal period is associated with a decline in oestrogen produced by the ovaries, as well as a decline in progesterone. However, if we look at individual women, oestrogen levels fluctuate widely as opposed to following a steady decline.3
Oestrogen has a role in modulating neurotransmitters associated with mood.4 It enhances the synthesis and uptake of serotonin (our happy hormone). Thus, the fluctuation and general decline of oestrogen in the menopausal period impacts the way serotonin acts on our brains, which in turn makes women more vulnerable to mood swings.
Low levels of oestrogen have also been linked to anxiety, irritability and fatigue.5 Women that have had severe premenstrual syndrome or a prior history of depression have an increased vulnerability to mood swings and depression during the menopause.6
Mood swings are also more likely to be exacerbated by stressful situations during the menopause. In addition, other menopausal symptoms such as hot flushes, night sweats, weight gain, and the low self esteem that arises due to these symptoms don’t help either.
Our cognition is also affected by declining oestrogen levels. Oestrogen promotes growth and survival of our neurons (brain cells), which is why menopausal women may complain of forgetfulness or difficulty concentrating.7 This can also contribute to the irritability and anxiety women feel, as understandably forgetting things or not being able to concentrate on a task can be extremely frustrating.
What’s the difference between low mood and depression?
The main symptom that really affects women is low mood. Women in the menopausal period are three time more likely than premenopausal women to experience low mood.8 However, experiencing low mood is different to depression, and it is important to know the difference between them as treatments tend to differ.
Low mood, having little interest in activities, having little energy and disturbed sleep are all present during menopause. They are also present in depression, and so women can often be diagnosed with depression.
However, these symptoms fluctuate during menopause, with days in between when women tend to feel better. With depression, the low mood lasts for more than two weeks and tends to severely affect quality of life and everyday functioning. Symptoms of depression include feeling very low with or without suicidal thoughts, appetite and weight changes, feelings of guilt and worthlessness, complete change in sleeping pattern, and not being able to cope.
Do not wait for all these symptoms to occur before seeing a doctor, and if you are generally not coping you should see your doctor. Furthermore, just because your symptoms don’t feel severe, it does not mean you should cope alone.
There are many ways that your doctor can help you with mood swings. Although hormone replacement therapy (HRT) has been the mainstay of treatment, a more holistic and psychological approach to mood imbalance is now the principal way of management.
Treatments for mood swings
There may be contributing factors, such as stressful situations within your own life, that can exacerbate mood swings. Get outdoors, take a walk, or go for a run, as exercise can boost serotonin. Stress reduction through yoga or meditation can also help, and dietary changes to include more foods that boost serotonin include consuming more complex carbohydrates.
The evidence on consuming more soya-based foods (which contain natural oestrogens) and their impact on mood is minimal, but these foods do have a beneficial effect on the cardiovascular system, on bone health, and on cognition.
Eating very sugary foods and a high intake of caffeine can cause ups and downs in energy levels, which may not help with mood swings.
According to one study, 95% of women would try alternative therapies prior to commencing medical therapies.9 Some herbal therapies have been reported to help with mood swings during menopause. Although these are not the primary form of treatment, they can help.
St. John’s Wort has been shown to improve symptoms of low mood and anxiety by approximately 60%, and can be as effective as prescription antidepressants.10
Rhodiola rosea (a herb that acts in non-specific ways to increase resistance to stress) has also been shown to help with low mood.11 Low levels of vitamin D and omega 3 fatty acids have been found in women with depression and are associated with poor memory and cognitive dysfunction. Both play an important role in mood regulation and are safe to take.
Prior to commencing any of these alternative therapies, it is advisable to speak to your doctor as they can interact with other medications and have unwanted side effects. Few alternative therapies have a large evidence base, and there is conflicting information online, which can easily influence the use of alternative therapies.
However, there will be individual women who benefit from some of these therapies. For a full list of therapies that work and are safe, the Royal College of Obstetricians and Gynaecologists have an information leaflet that is up to date and evidence based.
HRT which is essentially replacing the hormones that have declined during the menopause has shown to significantly improve low mood associated with the menopause.12 Antidepressants tend to be used in women diagnosed with depression, and there is no clear evidence that antidepressants actually work to improve low mood in menopausal women who do not have depression.13 That being said, not all women will respond to HRT and it is likely that in these cases a diagnosis of depression may have been missed, and so antidepressants may be required. The benefit of HRT is that it has an overall beneficial effect on other symptoms of the menopause which may aggravate mood swings. As with all medication, your doctor will be able to advise if HRT is appropriate for you. Cognitive behavioral therapy has also been shown to help with low mood and can reduce anxiety, as well as improving hot flushes and sweats. Combined with sleep hygiene and relaxation techniques, CBT can be very effective.14
Mood swings are a normal part of our lives. They are likely to be transient during the menopause. Approximately 98% of women do revert back to their normal self by around six months. However, if mood swings are strong enough to interfere with your daily life, you should see your doctor. Hormonal imbalance is likely to be the cause during the menopausal period but it may just be part of the problem particularly if you are unable to cope, and is something your doctor can investigate further.