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Menopause

Emotions and the menopause: mood swings, anxiety and depression

Women’s emotional symptoms during the menopause vary. Some have no symptoms at all, others have mood swings, anxiety and depression. These symptoms can be frightening and surprise many women, adding to the burden of hot flushes and irregular periods. They talked about these symptoms and how they affected their lives.

A range of emotions
Some women noticed no emotional changes during the menopause, or found their moods levelling out as their periods declined.

 

Cynthia says she ‘got off lightly’ with few emotional symptoms

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Age at interview: 54
Sex: Female
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Some women talk about mood swings and anxiety and loss of confidence. Did you experience anything like that?

Not really. Mood swings but then I’m not sure I’ve always been a little bit had a short fuse so it’s difficult to tell whether it’s just me as a normal short fused person or whether I was. I didn’t feel, I didn’t have tearful times. I didn’t have real highs and lows. I think I got off light with a lot of other symptoms. People have panic attacks and anxiety and I don’t really think that I had any of that. Palpitations, people have said they get. I’ve not my own. I’ve said the only thing really on my list was hot flushes and if I could have not had those I’d have said well, I sailed through the menopause.

Others, however, talked about losing control as symptoms such as mood swings, depression, worsening premenstrual tension (PMT), anxiety, panic attacks, anger, snappiness, short temper, irritation, crying and impatience took over their lives. Women were ‘like a bear with a sore head’, ‘getting very ratty’, or ‘flying off the handle’ at the slightest thing. One woman was so irritable that she ‘just wanted to have a row with someone’; another thought she was snappy because she was tired.
 

Carole feared she was having a nervous breakdown when she felt weepy and couldn’t cope at work...

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Age at interview: 51
Sex: Female
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By the end of the following summer I’d started to notice that I was getting, I wouldn’t say depressed but I was getting quite weepy, I was having trouble concentrating on work.

And I found I just couldn’t cope with things and I started getting a bit tearful. This went on for about another four months towards the end of 2006 and everything got on top of me. I thought I was slightly depressed, then the hot flushes started and they’d been going on for about 3 or 4 months, mainly during the day, not any at night at the time, but then I found I couldn’t concentrate on things, I had no co-ordination, I couldn’t do two things at once. I’d be out in the kitchen thinking I’ve opened the drawer, yes, what am I getting, other times I could do two or three things at once but this was just getting me down.

I think you start to think what the hell’s wrong with me, have I got some disease that, the big C, what is making me like this, am I depressed, am I going to have a nervous breakdown. I thought I was going to have a nervous breakdown until I found the website and I read the forum and I thought Jesus there’s hundreds of women like me, I’m not going bonkers, I’m not going mad, this is quite normal. It’s not abnormal, you’re not mad, you’re not stupid, you’re just going through a stage of your life and you’re not the only one.

Women’s personalities changed as emotions threatened their sense of balance and well-being. Some felt uncharacteristically depressed and even subdued. They used phrases like ‘this isn’t me’, ‘I’m not the way I’d normally be’, ‘it’s not like me’, ‘normally I’m quite a sensible person’ to describe this new, changed identity. One woman found herself ‘crying over things’ which wouldn’t have bothered her before; another felt disconnected from her emotional self, as if she were ‘floating and watching’ herself shouting. Confused by irrational emotions, women understandably wondered ‘what’s happening to me?’. Several were so worried about how they felt and concerned that it might be depression that they consulted their GP (see ‘Consulting the doctor’).
 

Jill’s mood swings left her feeling like ‘Jekyll and Hyde’

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Age at interview: 47
Sex: Female
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And those are the physical sides of it and the other side is the mood swings. I can be up and down, up like that. I don’t know where it comes from. It’s almost like you’re a Jekyll and Hyde and I know it’s me and I know sometimes what I say or what I do but I just I can’t control it. And some things my family, we laugh about, I mean I have been known to fill my bath water up with cold water. And wondering what happened when I try and get in the bath and it’s freezing cold and they just say to me “Mum you’ve put the cold water on instead of the hot.” “Oh.” You see. I’ve mislaid things and nine times out of ten my family find it in the bin, I’ve thrown it away. Lots of silly things but as I say my family are used to it. But the worst thing is if I do go up like a bottle of pop as my family say, I think it’s wrong sometimes how they have to have the brunt of it and my husband stays really supportive and he’s explained to the boys what I’m going through and it’ll pass. And they’re fine yeah.

 

Susan describes her anger and emotional outbursts as ‘the shadow side of me’. She felt an ...

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Age at interview: 55
Sex: Female
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But my menopause actually began when I was about 45 and physical symptoms began with hot flushes but the thing that I noticed mostly was the emotional, almost loss of control at times. Anger, emotional outbursts just tapping into things that I felt were a shadow side of me that I hadn’t really felt before and certainly a darkness, a cloud coming over me. But normally, I suppose I would have been prone to mild depressions prior to that I think. I wouldn’t say I was very depressed. I had been prone to mild depression and I always knew there was a light at the end of the tunnel. In this experience I felt as though there was no light at the end of the tunnel. I thought I was in just a very dark place and that I was peculiar. I wasn’t being heard, paranoia, all of these sorts of things. It was that kind of thing that took me aback, a lack of confidence. The invisibility. I mean I suppose I’m somebody, I pride myself on my physical appearance and I would be very confident about my physical appearance and all of that left me as well. So it was that kind of stunning kind of crushing of my sense of myself and the overpowering sense of loss.

How emotions affect family members
Emotional symptoms can also affect relationships with partners and children, adding to the stress of daily life. Family members may become the target of an onslaught of emotions when seemingly innocuous things are ‘blown out of all proportion’. Women highly valued the support of sympathetic partners who tried to understand how they were feeling. One woman, however, attributed her moodiness as much to the lack of support at home as to the menopause. Relationship difficulties, divorce, worries about children, bereavement, moving house, and work pressures may also bring further strain (see ‘What is the menopause?’, ‘Family, health and life events’, ‘Relationships, sex and contraception’).
 

Cheryl talks about the ‘aggro in the household’ and its impact on her husband and teenage sons

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Age at interview: 54
Sex: Female
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Right, I suppose it often happens and other women will find this that it’s as your children perhaps are teenagers, growing up, so obviously there can be sort of underlying aggro in the household anyway. But I felt that it was becoming more obvious that I was not able to cope and I would fly off the handle at the slightest thing. And I’d be more critical, my poor husband suffered I think. I became quite nit picking about things and I think he found that difficult. And before we realised what it was we struggled basically, we felt that something was wrong, what was the matter why was I feeling like this. But we didn’t really connect it with the menopause at all. Just thought it was one of those things and I was just irritable but it was horrible really.

You said “we struggled”. What do you mean?

Well I suppose we argued you see. He said “You’re going on at me” “Oh I don’t mean to” but I’d fly off the handle at something else, so he’d be very critical and I suppose you could get a little bit more distant then because you don’t feel quite so loving, in fact he didn’t feel so loving because I was critical and because I feel critical or I felt critical and cross about things I suppose you don’t feel as loving to your partner either. Yeah, not a good time really.

 

Christina’s unpredictable moods have affected her relationship with her son.

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Age at interview: 52
Sex: Female
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Oh gosh, I can be a screaming banshee one minute, in tears the next and feeling that nobody understands or anything else, and I go very quiet one minute and then something can just trigger it, whether it be driving. Road rage, I’ve never had road rage before and people passing me, overdoing the speed limit, I’m going, “It’s supposed to be thirty miles an hour here.” And I’m thinking, “Nobody is listening to me.”

But my poor son has had to put up with a lot and one minute it’ll be okay and then he’ll just ask something totally different or change a routine or something like that and expect me to drop everything and then go and I’m getting very good because I’m now saying no to him whereas usually I’d have been off like a shot.

I can be extremely short with him and then apologise afterwards because it’s not his fault when he’s in the same room as me when I’m on one of my turns as they say. But friends are coping with it and they know when to leave me alone.

Is there a pattern at all to it or?

No, no it can be anything at all and I can be going quite merrily along my way and then somebody will say something and it will turn, and they’ll say, “Oh, she’s in one of her moods.” But it’s difficult because you can’t really say, “Look, I really am sorry but it’s to do with the menopause, postmenopause and it’s still going on.”

 

Vicky tries to control her temper because her husband ‘doesn’t like people who rant unreasonably’...

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Age at interview: 51
Sex: Female
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I try my best to control myself. I try my best because with my daughters I can but with my husband I can’t because my husband doesn’t like people who rant unreasonably because he doesn’t know what menopause is, he doesn’t understand what menopause is about for women so mostly I don’t take it out on him, mostly it’s my daughters.

So have you tried explaining it to your husband?

Yes, yes, I have told him, so when women get to 50 this is what happens etc etc because I have heard that men get menopause too, is that true?

Yes, because when I heard that men had menopause too I didn’t know if it was true. Because sometimes my husband can lose his temper and find someone to shout at and I thought it might be menopause because he is about the same age as me.

When you told your husband you were menopausal, how did he react?

He said ‘oh, is that what it’s like, I didn’t know’ because he didn’t know.

Trying to keep a lid on emotions at home can itself be exhausting. Women often had to do ‘repair work’ to restore harmony after an emotional outburst by expressing regret and apologising for their behaviour. One woman had felt ‘a failure’ because of her lack of control and spoke of the need to ‘snap out of it’ for the sake of her family.
 

Donna describes how her anxiety affected her young son. She was embarrassed that she could not...

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Age at interview: 47
Sex: Female
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It was really really difficult. With my son I feel really embarrassed, I think he picked up on my anxiety and he became very clingy, he wanted to be with me all the time, he was kind of physically holding onto me and that was the last thing I felt I needed. I didn’t actually want him to see that I was anxious, but he needed reassurance from me that I couldn’t give him, not honestly, because I felt I didn’t know where it was going. And I would just sort of say, “Mummy’s not feeling very well,” and “I need five minutes to myself,” and but no, that made our relationship really really difficult and I was, he’s a very spirited child anyway, and he would get into situations at school, or in the playground that would require my intervention, and I didn’t want to be the focus of attention, so that was really hard for me, I was kind of like forced to deal with situations when I was feeling very vulnerable and shaky. And I was shouting at him a lot, I had no kind of tolerance or patience, or, again I think that was the exhausted part of me felt I couldn’t deal with his demands on top of what I was struggling with.

 

Maria locks herself ‘away for a bit’ in her bedroom to avoid confrontation

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Age at interview: 43
Sex: Female
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So I personally will just make myself go quiet because I’m trying not to. I remember my mum, she used to moan about the silliest things. The cushion wasn’t plumped up properly or and I used to think, “Oh, this woman’s mad.” So me, I try to control it by just not saying anything but the kids will say, “Oh here, here mum’s off again.” So they know, so maybe it’s hereditary. I’m not sure why that happens but I just pick on the silliest things and you’re actually doing it but I still do it even more, it’s sad. So usually in that case, I potter off to my bedroom and just lock myself away for a bit.

Emotions at work
At work women may feel particularly vulnerable and subject to public scrutiny. Anxiety, low self-esteem, loss of confidence and insecurity threaten to undermine women’s status in the workplace (see ‘Work’). One woman’s business was affected as she became increasingly irritated with customers; another felt unable to make decisions; and workmates started to avoid a third because she ‘barked’ at them.
 
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Joyce's uncharacteristic anxiety and loss of confidence led to a panic attack in a meeting while...

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Age at interview: 48
Sex: Female
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I remember one day, this was in July of last year, going to a meeting to give a presentation about something, which again I’d been working on for 12 months, this wasn’t new territory to me but I’d got an e-mail from another person who’s a friend and an associate, who said, “You could meet some resistance at this meeting on this particular issue that you’re going to describe. Suggest that you really are prepared for the difficult questions.” Which, he was giving me a heads up it, there was nothing more to it than that, but I really became very very anxious about this to the point where I actually had a panic attack in the meeting. The meeting was being [held] unfortunately in a very big room and as I started to speak people at the top end of the table said, “We can’t hear you, would you stand up?” And so that kind of added to being under a spotlight that not only can I not sit here and say this, I had a presentation and I needed to touch the keys on the laptop to bring it up. Not only could I not do that but now I had to stand up and the words came up, the words were in front of me and I could see the words but I couldn’t read them if that made sense. And I just said, “I’m really sorry, I’m feeling really unwell at the moment, you’re going to have to excuse me,” and I walked out the room. And fortunately a colleague came out and said, “Are you okay?” And I didn’t admit to having a panic attack but I just said, “Look, I just thought I was going to faint and pass out, I think I’ve eaten something, I think I’ve got a stomach upset.”

Fortunately a colleague was with me at that meeting and said, “Actually what [name] wants to tell you is X, Y & Z” and she conveyed the message. So it wasn’t a big problem but I just felt so embarrassed, I wanted the ground to open up and swallow me and I just thought I can’t go on like this.

Maintaining composure in the workplace is difficult. One woman said she ‘silently seethes inside’ and ‘bites her tongue’ when somebody at work says the wrong thing; another ‘bottled up’ her feelings at work while being ‘freer and easier’ with her moods at home.
 

Charlotte’s office was a safe haven when emotional symptoms became too much. She couldn’t talk to...

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Age at interview: 54
Sex: Female
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I’d changed my job and come to work in [place] and my demeanour is generally very happy, I don’t get stressed particularly, I’m not quick to anger, I’m one of those kinds of even people and I’ve found myself in my first year at [place] really quite anxious, quite miserable. I could close the door of my office and come in and cry my eyes out and I didn’t know why I was crying and it would be because I’d said something silly or I felt silly or I felt embarrassed.

I could not tell anybody. There were other women I saw around me of my age but I didn’t feel I could say, “I feel so I don’t know why I’m crying but I’m crying” and all the rest of it.

Coping with emotions
Fearing at times they were ‘going mad’, women found relief by talking to people or consulting internet forums. They could cope with their moods better once they realised that emotional symptoms could be ‘part and parcel of the body clock’ and ‘quite normal’ at this stage in life. Some found homeopathy or over the counter remedies helped (see ‘Complementary therapies’). Keeping healthy by eating well, cutting down on alcohol, and exercise also helped women feel better about themselves (see ‘Changes in the body and keeping healthy’, ‘Non-HRT and lifestyle options’).
 

Susan ‘drank quite a bit’ to relax when she felt angry and frustrated

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Age at interview: 55
Sex: Female
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I remember getting desperately angry and I raged at things. Just feeling that I thought, “God help me if I had kids or was with a family.” I’d give them grief because I know I gave [partner] grief. I know I gave, because you just get angry at and frustrated with things. So I didn’t lash out. I wasn’t physical in that sense but just I certainly would have raised my voice and all the rest. And I can see how you’d get into things like maybe drinking too much or finding that you want to drink, you want to relax. You want to get rid of, so that. I suppose it was a period when I look back when I drank quite a bit. I’m not saying I was anywhere close to alcohol, liquor or anything like that but I certainly would have enjoyed having a few bevies and enjoyed a few drinks partly to relax and I could see you could get into a pattern of that. To such I suppose an extent where I now I don’t drink very much at all. I mean I enjoy wine with meals and things like that but I just began to become conscious of it. And maybe I suppose I enjoyed a little bit of, you need to be careful of self-destructive type behaviours as well. I mean I don’t know if that but just because your mind gets messed up, there’s no doubt about that. And the focus on your life and its meaning, you begin to get into a negative place and a negative way of thinking.

Others sought help from their doctor or a counsellor when severe symptoms threatened their quality of life, work and relationships. Some women were treated for depression or prescribed HRT (see ‘Hormone replacement therapy (HRT)’). One woman was given Prostap (leuprorelin) injections to induce a medical menopause when her premenstrual tension became unbearable, but this is an experimental treatment.
 

Rose talks about what made her seek help for her irritability and feelings of anger. The...

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Age at interview: 50
Sex: Female
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I was getting very irritable, very irrational, the hormones were obviously kicking in, and the slightest thing at home, at times I would just blow it all up out of proportion. So I think it was them realising how I was and encouraging me to go back and seek help for that rather than my own realisation that that’s how I was. Because I think that the depression, the feelings of anxiety, the not coping, the feelings of anger that you can go through, because they creep up on you, you don’t necessarily realise how much they’re impacting on yourself and the way that you deal with other people.

It’s very difficult when you’re feeling anxious and you’re feeling angry about things to admit it and go and seek help, it’s much easier to deny it, and say it’s not me it’s you. But

Was there a particular trigger you remember, ‘the straw that broke the camel’s back’, and you thought I’ve just got to go and see about this?

Yes, I can’t remember, we’d had a discussion about something, I can’t even remember what it was, it was something quite innocuous, but I can remember going up into the bedroom and just sitting down on the chair in the bedroom and crying my eyes out. Just sobbing my heart out because I felt very alone. I felt that I’d tried all the HRT things that I could and was still feeling so many of the symptoms, the tiredness, the lack of concentration and everything else and I can just remember sobbing my heart out one day thinking “I don’t know what else do to”. And again, I went back to the doctor and that’s when we tried the natural things. And I think actually they did put me on fluoxetine* for about three months.

[* Note that antidepressants such as fluoxetine and citalopram are sometimes prescribed in the treatment of severe premenstrual syndrome, although they are not licensed for this purpose.]

 

Deborah describes what happened when she took the antidepressant citalopram for unbearable...

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Age at interview: 48
Sex: Female
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I couldn’t cope with the PMS (premenstrual syndrome/tension) so I took my husband along to the GP and I saw a younger GP in that practice, and I think he could understand then the severity of my symptoms, which were heavy periods, and I felt like I was kind of going a bit paranoid, so he prescribed citalopram* at that stage, which I think is kind of like a Prozac type thing. And I took that for a while, and that was quite upsetting, because for a fortnight it made me feel quite zonked out and my husband was not sympathetic. He seemed to think that, well he just didn’t seem to understand, and then what I found, and probably this is more relevant to PMS, and it’s fine if you don’t want to use this bit but, it affected my sex life really, and I felt like I hadn’t been given clear information about that as a side effect.

And you said citalopram had an impact on your sex life, can you say more about that?

Yeah I’ll tell you about that because I would really like other women to, well I’d just like to share some of this really because I think on the packet, the information that comes with them, it talks about, I think it did actually mention, well there was something about sex life. But what it did to me was meant that I couldn’t have orgasm, and so it took a bit of, well I worked this out after so maybe it’s two or three goes at sexual intercourse and I couldn’t come basically, so I went back to the GP and I saw the younger GP and he was fine about it, but it was as though, yes I remember him saying to me, “Well this is unusual”**, so I thought well I wonder if it is actually, and I don’t know.

Fair enough when I was on it, it improved my mood, it did. And if I’d have stayed on it, then I’d have been kind of like happy but I didn’t want that.


[* Note that antidepressants such as fluoxetine and citalopram are sometimes prescribed in the treatment of severe premenstrual syndrome, although they are not licensed for this purpose.
** difficulty reaching orgasm (anorgasmia) can be a side effect of citalopram.]

Some women can suffer debilitating mood swings and anxiety which have a significant effect on quality of life. The postmenopausal period can bring longed-for relief when the symptoms become milder. It’s important to remember, however, that feeling low, angry, irritable and upset, and losing confidence can also be signs of clinical depression. If you are at all concerned, contact your doctor for advice.

 


 

 

Last reviewed July 2018.

 

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