Perimenopause can be an emotional roller-coaster for women because the same hormones that control menstrual cycles also regulate the brain chemicals that promote mental well-being.
“Our feel-good hormones are intimately involved with how we feel and our motivation,” says Tiffany Woodus, MD, OB-GYN on the medical staff at Methodist Charlton Medical Center. “So when you’re going through these wild fluctuations in hormone levels, it tends to show up as irritability. It tends to show up as crankiness.”
Depression, memory loss, and problems focusing often referred to as “brain fog” are also common during menopause and the years preceding it. Relief is readily available, however, and doctors encourage women experiencing any of these changes to talk to a doctor, rather than suffering in silence.
“You’re not crazy. These changes are real,” Dr. Woodus says. “There’s real science behind the mind-body connection that’s going on with you. You are not alone.”
SPOT THE SYMPTOMS
Memory lapses often accompany middle age, but it can be difficult for women to tell when having trouble concentrating could be a symptom of something else.
“It tends to show up as lack of motivation, loss of joy,” Dr. Woodus says. “Hormones are intimately involved with how we feel and our motivation. It’s really not all just in your head.”
Feelings of depression can be especially pronounced during perimenopause, especially among women with a history of these problems. Anxiety — already more prevalent for women at any age — can also get worse during this stage.
“It’s like getting to know yourself again,” Dr. Woodus says. “It’s rediscovering yourself, finding a new baseline, a new footing, a foundation.”
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WHAT’S BEHIND CHANGE
Understanding the biological reasons behind these mood swings can help women recognize the symptoms and reclaim control.
“We experience mood fluctuations in perimenopause because estrogen really helps support serotonin and dopamine, our feel-good hormones,” Dr. Woodus explains. “These hormonal changes are extremely common.”
The gradual decline in hormone levels known as perimenopause typically begins seven to 10 years before menopause — defined as 12 months after a woman has her last period.
But it’s not just estrogen that contributes to mood swings, anxiety, and depression, before and after menopause, Dr. Woodus says.
“Brain fog is commonly associated with declining progesterone levels, and it can lead to insomnia,” she says. “Waking up at 2 a.m. and 3 a.m. bleeds over into your ability to function the next day.”
HOW TO FIND RELIEF
Antidepressants and anxiety medications can be a lifeline for some patients, and Dr. Woodus notes which symptoms these drugs can help relieve.
“These medications tend to be more helpful for women who have more mood fluctuations, irritability, and also potentially sleep difficulties,” she says. “They can also help with hot flashes and night sweats.”
When it comes to clearing the brain fog, Dr. Woodus suggests resisting the urge to multitask by focusing on one thing at a time.
“I personally have found it helpful to write things down,” she says. “Don’t be above keeping a list because it really helps you maintain focus.”
Finally, many factors beyond hormones can play a role in the emotional peaks and valleys of middle age. Dr. Woodus suggests women focus on the things they can control, like diet, hydration, and exercise.
“Women who move their bodies more experience fewer symptoms and a lower severity of symptoms, as well,” she says. “Resistance training and weight-bearing exercises become critically important as we’re going through this perimenopausal and menopausal transition.”
Above all, Dr. Woodus says, “give yourself some grace,” focus on self-care, and find someone to talk to, whether it’s a doctor or just a friend or family member.
“All of these changes are normal and natural, and this is just a season,” she says. “There’s nothing like having a girlfriend or just a group of women who are also in the same place, who can uplift and support each other.”
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