Irritability & Menopause

How do your clients describe the irritability they feel during perimenopause? 

They describe it in various ways. Some notice it as a surprising lack of patience, especially when around their family members, whereas others feel it as low frustration tolerance—that even little things set them off. 

I’ve had some patients report that some of the other symptoms of perimenopause, such as poor word retrieval and memory issues, or hot flashes themselves significantly contribute to  the irritability they feel. There are many factors at play during perimenopause that can contribute to mood swings or feeling sad for no clear reason, and it can become a vicious cycle. 

For some, pent up feelings of irritability and impatience may lead to the more extreme, externalized expression of rage. Unfortunately, many women feel regret after expressing their feelings in a rageful way. During menopause, there are so many symptoms at play that can drain people, and this can wear people down over time, leaving them less resilient. 

Some people say that perimenopause is a bit like puberty in reverse. From your perspective, does that ring true?

Yes and no. There are ways that puberty and menopause do overlap. In both transitions, there are changes to the body and mood, but there are big ways in which they differ. 

When adolescents go through puberty, their brains undergo enormous changes that will continue until they reach the age of twenty-five. It is not hormones alone that cause adolescents to be moody. On top of that, they face enormous social change. One interesting connection between puberty and menopause is that during puberty, people have a heightened awareness of how people are looking at them whereas after menopause, some women struggle with the idea that people “see” them less.  

Can you talk a bit about the similarities between premenstrual premenstrual dysphoric disorder (PMDD) and the mood changes many women experience during perimenopause?

Most of us know about PMS, or the physical and mood changes that precede getting a period, whether it’s cramps, acne, sadness, tender breast, or increased irritability. Roughly 7% of women, though, experience a more intense version known as PMDD. Premenstrual dysphoric disorder is a condition where women experience both physical and emotional changes in the week or two before their periods begin. Symptoms interfere with a woman’s daily functioning, whether at work, home, or even socially. It’s common for women who have PMDD to say that they feel the strain most keenly in their closest relationships; for example they may  feel that their partner or maybe their kids are driving them crazy. During the premenstrual phase of the menstrual cycle, women with PMDD often find it more difficult to hold things together that they normally can do with ease. 

PMDD and perimenopause share many of the same inexplicable mood changes such as impatience, difficulty focusing, or feeling sad. They also share some of the same physical changes such as insomnia, fatigue, sore breasts, bloating, and headaches. A notable difference, though, is that with PMDD the timeline is predictable. Symptoms disappear several days after the bleeding begins. Not true for perimenopause when you can feel one way this day and quite another the next. There is not the same predictable timeline. 

For our readers who may be experiencing irritability, what steps do you recommend they take in seeking relief? 

A good first step is to make a few behavioral changes: reduce caffeine and alcohol intake; pay attention to your sleep patterns; and try to fit in daily exercise as it positively impacts endorphins. 

Another helpful practice is acceptance – to recognize that it’s OK to feel irritable, accept that this happens, normalize it. Moods change. It also pays to know what your emotional triggers are so if you know what tends to make you irritable, try to plan around it in a way that works in your favor. We hear a lot about mindfulness for good reason. Things like meditation and yoga do alleviate stress. Lastly, it’s so important for women going through menopause to share what’s going on with the people around them. It alleviates their burden, and it helps the people closest to them understand the uncharacteristic changes in behavior. 

If these changes are not enough, please talk to your doctor as there are medications and treatments available to alleviate your symptoms. For physical symptoms, you may want to start with a risk-benefit analysis with your doctor to see if hormone therapy is a good fit for you. For changes in mood, there are medications such as antidepressants that work well to treat not just depression but anxiety as well. 

If your daily functioning is being impacted, please seek help.

Dr. Lisa Weinstock, MD  

Dr. Weinstock is a reproductive psychiatrist specializing in women’s mental health. She works with women who face emotional and psychiatric difficulties throughout the female lifecycle. Her areas of interest include treatment of psychiatric disorders during pregnancy and the postpartum period, PMDD, mood issues associated with perimenopause, and emotional issues related to infertility treatment. She has a private practice in Mount Kisco NY.

Dr. Weinstock graduated from the University of Pennsylvania College of Arts and Sciences and received her medical degree at the University of Pennsylvania. She did her residency training in adult psychiatry at McLean Hospital followed by a fellowship in perinatal psychiatry at Massachusetts General Hospital. She is a Clinical Assistant Professor of Psychiatry and Behavioral Sciences at NY Medical College and is on the advisory board of Let’s Talk Menopause.