Menopause and Irritability: Everything You Need to Know

Are you one among those middle-aged women who feel that their attitude towards themselves and others has changed recently? Do you over-react in quite normal situations and then feel you shouldn’t have done that? Do you realize that you are getting more and more irritable but couldn’t help yourself?

Knowing what actually happens inside you and the reasons for these changes will help you to anticipate such embarrassing situations and handle them in the best possible way. We are here to help you – know everything about menopause and irritability!

Irritability is nothing but an excessive response to stimulus. The stimulus could be a biological, environmental, situational or an emotional factor that provokes the vulnerable candidate to over-react or burst out. Women in the phase of menopausal transition often present with irritability. It is characterized by frequent episodes of emotional outbursts in the form of anger, impatience, frustration or melancholy. It is one among the most unpleasant symptoms that are related to menopause.

Women in peri-menopause (rather than pre- and post-menopause) are more prone to irritability. Let me quickly go through these tricky terms.

While menopause (permanent cessation of menstruation) represents a single point in time, peri-menopause is a period that usually begins several years before menopause and ends with the twelfth consecutive month of amenorrhea. Any time before menopause is called pre-menopause and any time after the permanent cessation of menstruation is called post-menopause.

Irritability generally occurs during the period of transition to menopause. Women in the early peri-menopause are at a higher risk of getting irritable. Studies report that irritability decreases gradually with diminishing physiological and hormonal changes and it is less commonly observed in post-menopausal women. 1 2

What causes irritability?

Many studies have been conducted to determine the exact mechanism that leads to irritability in middle-aged women. But the reports have been controversial till date. Two possible mechanisms are generally proposed. One suggests a biological cause and another says it should be a psychological cause. Studies have proposed a few other contributory factors also.

1. Hormonal imbalance causes irritability

Most of the studies attribute a biological cause to irritability. Researchers propose that the hormonal imbalance that occurs during the period of transition to menopause is the cause of irritability and other mood disturbances. 3 4

These are the hormones involved – Estrogen, FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone).

    • Decreased estrogen levels

A drop in blood estrogen level due to decreased ovarian activity nearing menopause causes myriad physical symptoms in women. Researchers confer that the emotional symptoms are also due to the decreasing estrogen levels as it is well-established that the hormone has a positive effect on the brain.

How does estrogen act on brain?

It is a very complex mechanism. To put it in simple terms:

      • Estrogen increases the levels of the neurotransmitter serotonin that plays a key role in mood regulation.
      • Estrogen increases the number of serotonin-receptors on brain thus increasing the sensitivity of the brain to serotonin.
      • Estrogen increases hypothalamic beta- endorphin production which in turn decreases response to pain and stress. Serotonin and endorphin are ‘feel-good hormones’ that help to reduce irritability and anxiety.
      • It also indirectly increases the levels of other neurotransmitters like nor-epinephrines that act as brain stimulants.

Mood swings (defined as extreme fluctuations in mood) in peri- and post-menopausal women are also attributed to decreased estrogen levels and the altered estrogen-serotonin interaction. Irritability is one form of presentation of mood swings.

    • Altered FSH and LH levels

In a study, Spyropoulou et al, divided irritability into ‘outwardly directed’ (irritability expressed towards other people – spouse, children, friends or even strangers) and ‘inwardly directed’ (irritability directed towards oneself) and found that ‘outwardly directed’ irritability had a positive correlation with the levels of gonadotropins (FSH and LH). Though the researchers could not find a direct association between the hormones and irritability, they suggest that there could be a link between irritability and menopause because gonadotropins are identified as markers of ovarian aging. 5

2. Irritability is related to coexisting chronic diseases

Another finding of their study is that both outwardly and inwardly directed irritability are related to the presence of chronic diseases in peri- and post-menopausal women. By chronic disease, they refer to hypertension, diabetes or any disease affecting heart or thyroid gland. 6 Thus it gets clear that women with any of these diseases tend to be more irritable than those who are otherwise medically healthy.

3. Other unpleasant vasomotor symptoms may be the cause of irritability

Some studies contradict the biological cause and report that the frequent, disturbing and unpleasant vasomotor symptoms like hot flushes, night sweats and vaginal dryness are the causes of irritability in women. 7 Of course, it is natural for any woman, who was quite normal till then, to burst out in anger, frustration and confusion when these symptoms disturb her daily life routine.

The reason for this disagreement is that though estrogen seems to have an apparent positive effect on mood, many women show improvement in mood disturbances, during post-menopausal phase even when the level of estrogen is very low. 8

4.Other contributory factors that may cause mood disturbances and irritability

Studies also support the fact that psychosocial factors (stress in earlier life, poor physical and psychological health in the past) and socioeconomic factors including education-level have a great impact on irritability and other psychological symptoms than menopause itself. 9 10

Causes of irritability

Biological Causes Psychological Causes Physical or Medical Causes Other Causes
Reduced Estrogen Levels Vasomotor Symptoms

  • Hot Flashes
  • Night Sweats
  • Vaginal Dryness
Chronic Diseases

  • Hypertension
  • Diabetes
  • Heart Disease
  • Thyroid Disorders

Other

  • Headache / Migraine
  • Cancer
  • Anemia/li>
  • Vitamin Deficiencies
  • Past History Of Depression
  • Stress
  • Alcohol Abuse
  • Smoking
  • Poor / Unhealthy Diet
  • Sedentary lifestyle
  • Low Level of Education
  • Socioeconomic Factors

How is irritability manifested?

Irritability manifests in one or more of the following ways, the extreme manifestations being anxiety, anger outbursts and depression.

  • Anxiety
  • Aggression
  • Reduced control of temper
  • Impatience
  • Anger outbursts
  • Tension
  • Frustration
  • Easily-offended
  • Over-reacting to situations/stimuli
  • Sleep disturbance
  • Social withdrawal
  • Depression

How to get rid of this embarrassing symptom?

As it is evident from the above facts, apart from the hormonal changes, lifestyle and food habits also contribute to psychological and emotional well-being in peri- and post-menopausal women. Hence the initial line of management lies in addressing lifestyle and diet habits.

1. The following are generally recommended:

  • Stick to a healthy diet
  • Avoid smoking and alcohol consumption
  • Indulge in healthy hobbies
  • Spend considerable time with family and friends (Social withdrawal helps in no way)
  • Various meditation-based programs (mind and body therapies) like yoga and tai chi have been found beneficial in reducing mood disturbances like irritability and sleep disturbances. Studies on yoga show that women performing yoga in group-class or home feel a sense of well-being after the practice. 11
  • Aerobic training is also found to be useful in alleviating the menopausal symptoms especially mood swings and irritability. 12

2. Natural Remedies and Alternative Medicine

In recent years women have turned towards natural remedies. Herbs and home remedies are sought for almost all the symptoms of menopause. Botanicals like Ginseng and Black cohosh are found to be useful in improving mood and sleep disturbances. However, recently, questions have been raised about the safety of Black cohosh as it is found to be associated with liver disorders. Women who already have liver diseases should be careful before consuming Black cohosh preparations.

Various homeopathic medicines like Lachesis, Sepia, Sulfur and Argentum nitricum are found to be beneficial in alleviating mood swings and irritability. Alternative medicine promises to avoid the undesirable and harmful effects of Hormone Replacement Therapy and other pharmaceutical preparations.

Some over the-the-counter options are also available but they should be used with a prior consultation with a healthcare provider.

3. Hormone Replacement Therapy

Finally a word about Hormone Replacement therapy – HRT should be of last resort when irritability is not controlled by any other suitable means. HRT can increase the risk of hypertension, cardiovascular diseases, breast cancer etc., and hence a decision on whether to take HRT should be done after a detailed discussion with your doctor.

Know a little about bladder irritability – a physical effect of menopausal transition

All the above facts talk about excessive ‘emotional’ response to stimuli. Women in peri- and post-menopause experience many ‘physical changes’ of which vaginal and bladder tissue atrophy (dryness) are the most common. Due to decreased estrogen levels, the bladder and urethral tissues get dry just like how the vagina gets dry. Due to this dryness, urinary bladder responds to any trivial stimulus by urgency and increased frequency of urination. This is called an OverActive Bladder (OAB) or irritable bladder. This is particularly common in post-menopausal women. Local (vaginal) estrogen therapy is found to be effective in relieving this symptom. 13Pelvic floor exercises, that are commonly advised to control stress incontinence, can also help to control urgency and bladder irritability. 14

Irritability and all other symptoms associated with menopause are quite disturbing. But it is great to know that they are not permanent. Just like all other symptoms, irritability can also be highly problematic in some women while in others, it may go unnoticed. When you realize that you are irritable because you are nearing menopause, feel happy that you at least know the reason behind your attitude-change. Share your problems and concerns with family and friends; consult your doctor for further help and Live Your Life – Menopause and its effects are a part of every other normal woman’s life.

Have you taken steps already to control irritability? What do you prefer? – ‘Medication’ or ‘Meditation’?

It feels great when you share with others how you handle this emotional disturbance.

Notes:

  1. Bromberger JT, Assmann SF, Avis NE, Schocken M, Kravitz HM, Cordal A. Persistent Mood Symptoms in a Multiethnic Community Cohort of Pre- and Perimenopausal Women. Am J Epidemiol [Internet]. 2003; 158(4): 347-56. Available from: http://aje.oxfordjournals.org/content/158/4/347.full
  2. Freeman EW, Sammel MD, Liu L et al. Hormones and Menopausal Status as Predictors of Depression in Women in Transition to Menopause. Arch Gen Psychiatry [Internet]. 2004 Jan; 61(1): 62-70. Available from: http://archpsyc.jamanetwork.com/article.aspx?articleid=481940#ref-yoa20779-8
  3. Freeman EW, Sammel MD, Liu L et al. Hormones and Menopausal Status as Predictors of Depression in Women in Transition to Menopause. Arch Gen Psychiatry [Internet]. 2004 Jan; 61(1): 62-70. Available from: http://archpsyc.jamanetwork.com/article.aspx?articleid=481940#ref-yoa20779-8
  4. Spyropoulou AC, Zervas IM, Christodoulakos G et al. Irritability in Menopause: An investigation of Its Relation to Menopausal, Hormonal and Physical Factors. J Psychother Psychosom [Internet]. 2009 Mar; 78(2): 128-30. Available from: http://www.karger.com/Article/Abstract/203120
  5. Spyropoulou AC, Zervas IM, Christodoulakos G et al. Irritability in Menopause: An investigation of Its Relation to Menopausal, Hormonal and Physical Factors. J Psychother Psychosom [Internet]. 2009 Mar; 78(2): 128-30. Available from: http://www.karger.com/Article/Abstract/203120
  6. Spyropoulou AC, Zervas IM, Christodoulakos G et al. Irritability in Menopause: An investigation of Its Relation to Menopausal, Hormonal and Physical Factors. J Psychother Psychosom [Internet]. 2009 Mar; 78(2): 128-30. Available from: http://www.karger.com/Article/Abstract/203120
  7. Bromberger JT, Meyer PM, Kravitz HM et al. Psychologic Distress and Natural Menopause: A multiethnic community study. Am J Public Health [Internet]. 2001 September; 91(9): 1435-42. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446800/.
  8. Bromberger JT, Meyer PM, Kravitz HM et al. Psychologic Distress and Natural Menopause: A multiethnic community study. Am J Public Health [Internet]. 2001 September; 91(9): 1435-42. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446800/.
  9. Hunter MS. Somatic Experience of the menopause: A prospective Study. Psychosomatic Medicine [Internet]. 1990 May 1; 52(3): 357-67. Available from: http://www.psychosomaticmedicine.org/content/52/3/357.full.pdf+html
  10. Kuh DL, Wadsworth M, Hardy R. Women’s health in midlife: the influence of the menopause, social factors and health in earlier life. British J Obstet Gynecol [Internet]. 1997 Aug; 104(8): 923-33. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1997.tb14352.x/full
  11. Taylor MR, Booth-La Force C, Elven E, McGrath BB, Thurston RC. Participant Perspectives on a Yoga Intervention for Menopausal Symptoms. Journal of Evidence-Based Complementary & Alternative Medicine [Internet]. 2008 Oct; 13(3):171-81. Available from: http://chp.sagepub.com/content/13/3/171.full.pdf+html
  12. Moilanen JM, Mikkola TS, Raitanen JA et al. Effect of aerobic training on menopausal symptoms – a randomized controlled trial. Menopause [Internet]. 2012 Jun; 19(6): 691-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22334056
  13. Cardoza L, Lose G, McClish D, Versi E. A systematic review of the effects of estrogens for symptoms suggestive of overactive bladder. Acta Obstet Gynecol Scand [Internet]. 2004 Oct; 83(10): 892-7. Epub: 2004 Sep 28. Available from: http://www.rima.org/web/medline_pdf/ActaObstetGynecolScand_892-7.pdf
  14. 11. Alewijnse D, Metsemakers J, Mesters I, van den Borne B. Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long-term adherence among women with urinary incontinence. Neurology and Urodynamics [Internet]. 2003 Jun 9: 22(4): 284-95. Available from: http://onlinelibrary.wiley.com/doi/10.1002/nau.10122/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

Comments

  1. vikashni maharaj says:

    I am really battering with depression anxiety and panic attacks giving up now please help me someone desperate

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