Between ages 40 and 50, most women begin to have changes in hormone levels that eventually lead to menopause. The term menopause refers to the end of regular menstrual periods and is diagnosed after 12 months with no period. Typically, it occurs between ages 45 and 55, but can be earlier or later. Although hormonal shifts can cause a number of symptoms, a main concern for many women is increased irritability and changes in mood.

Emotional changes and upsets around the time of menopause are often blamed on hormonal variations that usually occur at midlife. However, other causes, including lack of sleep, stress, and life events such as the death of a parent–all common in midlife–may play a greater role.

Estrogen is the principal hormone involved in menopause, and other hormones also play a role. Researchers do not agree as to why hormones affect mood, but chemicals that work in the brain seem to be involved. One such chemical is serotonin which sends “feel good” messages to the brain.

No one is sure exactly which mood symptoms are related to hormone changes. Some studies have shown that irritability, lack of confidence, depressed mood, and poor concentration seem to be common problems during perimenopause, or the years leading up to menopause. Perimenopause can last about 5 to 10 years.

Is depression common?
True clinical depression probably affects less than 10% of perimenopausal women, but there is not enough information to have precise numbers. One important fact is that hormone changes can affect sleep and cause night sweats that interfere with sleep. In turn, this sleep disruption can cause ongoing fatigue, anxiety, difficulty concentrating, and a depressed mood.

During perimenopause and menopause, sleep problems are often related to hot flashes and night sweats, which can awaken and sometimes frighten women. Hot flashes are believed to be caused by hormone-related changes in the body’s thermostat that lead to expansion of blood vessels and thus increased blood flow when a woman’s core temperature rises. This response causes a rush of blood, especially to the face. In most cases, hot flashes are mild and don’t last long, although sometimes they can be quite uncomfortable. Some women wake up several times a night, drenched in sweat because of the heat generated by this increased blood flow.

What can be done to improve mood?
The most important first step in managing mood changes is letting your healthcare provider know exactly how the problem is affecting you. Treatments are available, and often it is reassuring to learn your concerns are normal. If you are feeling very sad or discouraged, medication might be an answer. Exercise is also an excellent mood enhancer, and your provider probably has other suggestions that apply to your specific situation. In addition, make sure you are getting adequate amounts of B and D vitamins either in supplement form or through your diet.

Good nutrition in midlife seems to be a factor in protecting both mind and body. Support from friends also is a great advantage and helps elevate mood in many women. New activities that keep you busy and involved with others can also help.

When do mood changes end?
Most women find that mood shifts improve when menopause actually arrives. For some women, menopause may still be the dreaded phase of life it once was, but many options are available to help ease the discomfort it can cause. Ask questions to learn more, talk with friends, share experiences and, most importantly, tell your healthcare provider about your concerns.

When should I be concerned about feeling blue?
Menopause usually is not a major cause of severe, or clinical, depression. Other life-changing events, such as children leaving home, death of a parent, loss of a job, or poor health, are more likely to cause depression in both women and men at midlife. However, if you are concerned, here is some information about clinical depression.

Symptoms of serious depression involve noticeable changes in your usual feelings that last for 2 weeks or longer. The following questions provide some clues to severe depression.

___ Are you feeling sad most of the day nearly every day?

___ Have you lost interest or pleasure in all or most activities nearly every day?

___ Have you lost weight without trying, or have you gained weight?

___ Do you get too little or too much sleep nearly every night?

___ Are you feeling sluggish or restless nearly every day?

___ Has your energy level changed drastically?

___ Do you have feelings of worthlessness or guilt nearly every day?

___ Are you having problems thinking, concentrating, or making decisions nearly every day?

___ Do you worry about death or have recurrent thoughts about suicide?

If you checked either of the first two questions and at least four others, you may have serious depression. Please talk with your healthcare provider as soon as possible.


THOUGHT OF THE DAY: “Age is strictly a case of mind over matter. If you don’t mind, it doesn’t matter.” — Jack Benny