If you’re in perimenopause, you may have noticed changes to your mood. Perhaps you’ve felt a little “off,” or noticed that you become annoyed by little things that never used to bother you.
Perhaps you’re lacking motivation, feeling down and sadder than usual, along with alternating spikes of anxiety.
If so, you may be experiencing some mental health changes that are common during this stage of life.
Perimenopause and mental health
Mental health changes during perimenopause and menopause are real, complex, and often overlooked. And usually, the cause isn’t one thing–it’s an interconnected web of biological, psychological and social factors–often occurring at the same time.
Here are some of these factors that may be affecting your mental health.
Hormonal changes and mood
You’re likely aware that changing hormones can affect many bodily functions during the menopause transition. But these changes don’t just affect your body physically–there are mental effects as well.
Estrogen has an influence on neurotransmitters such as dopamine, serotonin, and norepinephrine. So when our estrogen levels rise and fall, this can affect our mood and lead to symptoms such as brain fog, difficulty concentrating, and low mood or depression.
Another hormone, progesterone, affects nervous system regulation and stress response. When progesterone declines, anxiety and irritability may rise.
Disrupted sleep patterns
Hormonal changes also contribute to sleep patterns that can become dysregulated. When we don’t sleep well, we don’t function at our best and have a harder time managing stress, controlling emotions, and staying emotionally regulated. Eventually, a feedback loop begins where our hormones cause poor sleep, which leads to poor mood, which is worsened even more by fluctuating hormone levels.
Pre-existing mental health conditions
A recent NIH study shows that over a quarter of American women have a diagnosed mental health condition. For some of these women, hormone changes can exacerbate an already existing condition–such as major depressive disorder or panic disorder–and make symptoms worse.
Life pressures and relationship changes
Midlife is an increasingly busy time for many women. We’re juggling busy schedules, work demands, and may be caring for aging parents or still shuffling teenage children to and from activities. All of these create additional stress and pressure, which compounds and adds to our mental load.
Social expectations
Though it’s getting better, historically, women have not been encouraged or supported in talking about the changes all of us go through–from puberty to pregnancy to menopause. So when menopause hits and our health is affected, we’re expected to be business as usual. This societal expectation only places additional stress on our already taxed systems and can lead to mental health issues.
Supporting your mental health during perimenopause
Some of the changes that occur in our mental health may sneak up on us subtly and be hard to recognize. Something feels off–we may feel a bit different or out of sorts–but we’re not sure why. Or we may not acknowledge it.
So, how do we know if we need support with our mental health during perimenopause? Here are a few suggestions.
Recognize that you need help
Like most things in life, understanding starts with education and awareness. If you’re not feeling like your usual self, it’s important to acknowledge this and consider that you may need support.
Know your mental health baseline
It can be hard to know the difference between mental health changes based on hormones and those based on psychological factors–especially for those of us with pre-existing mental health conditions. It might be helpful to keep a daily journal and track how you feel. Be specific and document your symptoms. For example, you could list specific emotions and feelings (sadness, lack of motivation, anxiety) and rate them as low, medium, or high. If you notice a significant change in mood right before your menstrual cycle begins, this may indicate hormonal causes. Keep this journal handy and use it as a list of symptoms to show your healthcare provider, if needed.
Watch for menopause irritability and anger
Hormonal fluctuations can decrease our tolerance threshold. Everyday things that normally wouldn’t bother us much–such as our teenage kids not putting away the ketchup bottle after dinner–can cause a case of menopause rage. This shift from mild annoyance to rage could be an important indicator that hormonal factors may be at play.
Seek support
If you’ve tracked your mood and noticed something is off, the next step is to seek support. Reach out to family and friends and ask if they’ve noticed changes in you, and enlist their help in monitoring your moods. Contact your healthcare provider and discuss your list of symptoms.
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Changes to our mood and mental health can feel challenging, but it doesn’t have to disable us. By recognizing our symptoms and seeking support, we can get back to feeling like ourselves again.
Continue the conversation with our podcast episode: Mental Health During Perimenopause and Menopause Hormones, Mood, and Sexual Health