Why has peri-menopause made me so moody?

A 2019 study examined depressive symptoms in pre- and peri-menopausal women and concluded that 45–68% of peri-menopausal women, versus only 28–31% of peri-menopausal women, report clinically significant elevations in depressive symptoms.

Peri-menopause and menopause bring with it a range of symptoms such as hot flushes and weight gain, but some of the major changes are increased feelings of anxiety, depression, irritability and mood swings.

There are several hormonal triggers through menopause that can disrupt the neuroendocrine balance triggering anxiety, depression, and mood swings.

1.  Oestradiol 2 (E2) fluctuations have been implicated in the development of these symptoms and the increased risk peri-menopausal women have of developing major depressive disorder.

A study on daily hormone levels has confirmed that during perimenopause women face extreme fluctuations of high E2 compared to reproductive years, sometimes reaching levels that are even double those generally seen in the late follicular stage during reproductive years. Furthermore, E2 levels in the early follicular phase have been shown to reach lower levels than typically observed in reproductive-aged women (Gordon et al., 2019).

It is thought that extreme fluctuation in the hypothalamus- pituitary -gland release of follicle stimulating hormone, which controls the development of E2-producing follicles (i.e., eggs) in the ovaries, and greater inconsistency in the number of follicles contribute to these more extreme E2 levels (Gordon et al., 2019).

Repeated rapid extremes between E2 “lows” and E2 “highs” play a key role in the development of perimenopausal depression and mood disorders.

 2.   Another contributing factor is the fluctuations in female sex hormones oestrogen and progesterone during peri-menopause. This can lead to hypothalamic thermoregulatory centre dysregulation resulting in hot flushes and night sweats, but also contribute to dysregulation of the serotonin and noradrenaline systems involved in mood and behaviour.

 3.  Decreased overall levels of oestrogen also plays a major role. Oestrogen is an anti- inflammatory, offers neuroprotective qualities, modulates the limbic processing of memory and emotionally relevant information. So, withdrawal of this from our system results in increased neurological symptoms including mood swings, memory loss, fatigue and mental health disorders (Gordon et al., 2015).

4.   The ratio of testosterone to oestradiol also plays a role. Studies have found that testosterone does not decrease in women at the same rate as oestradiol resulting in a high testosterone to oestradiol ratio. This increases symptom of poor sleep quality and more depressive episodes (Sander et al., 2021).

As you can see the shifts in our neuroendocrine hormones makes women during this period very vulnerable to increased mood disorders and major depressive episodes.

We can’t control the changes in our hormone’s, so we need to control what we can to decrease the risks and smooth the path through menopause. Basically, this is a tipping point like puberty; and we want to rewire our system to operate with the lowered hormone levels moving forward.

So now, more than ever is the time to decrease your sympathetic nervous system and activate our parasympathetic nervous system. The parasympathetic nervous system slows our heart rate, promotes healthy digestion, assist with healing and sleep.

Ways to activate your parasympathetic nervous system are:

• Practice Mindful Breathing

• Do some gentle exercise: yoga, Pilates, walking, or gentle stretching gets your endorphins flowing.

• Spend time with a furry friend: Cuddling that furry friend releases oxytocin, giving you warm, fuzzy feelings.

• Build social connections: regular connections within society also releases oxytocin calming us.

• Spend time in a garden or nature: has been shown to slow heart rates, reduce symptoms of anxiety and depression and improve memory.

• Complete a brainteaser: This focuses your brain and can assist in taking your mind off any worries.

• Listen to music: create a playlist that makes you feel calm.

• Sing or dance: Crank it up and let loose in the lounge room. Dancing is an excellent way to unwind and boost your mood.

Eat a diet that supports your nervous system.

• Remove or limit aggravating food- caffeine, processed foods, trans fats, sugars and alcohol.

• Eat to stabilise your blood sugars by eating a low carbohydrate diet, having protein and healthy fats with each meal.

• Pack your diet full of vitamin B rich food e.g. dark leafy greens, wholegrains and meat, as B vitamins act as cofactors in synthesis and regulation of nervous system hormones.

• Include probiotic rich food in your diet e.g. yoghurt, kimchi and sauerkraut to maintain good gut bacteria. As gut bacteria produces molecules which are involved in the production of serotonin and GABA, which positively influences mood.

• Eat high fibre food e.g wholegrains, nuts, seeds, fruit and vegetables. Fibre feeds your gut bacteria, controls blood sugar levels and assists with clearance of hormones.

• Increase vitamin C intake e.g red capsicum, broccoli, citrus fruit and kiwi fruit. Vitamin C protects the neurons against oxidative stress, decreases inflammation and assist with neurotransmitter regulation.

• Pack your diet full of omega 3 rich food e,g, fatty fish like salmon, walnuts, chai seeds, olive oil, flaxseeds. Omega 3 protects the brain cells and myelin sheaths from oxidation. It also is metabolised into chemicals compounds called resolvins and protectins, which have anti-inflammatory effects.
  

References

Gordon, J. L., Girdler, S. S., Meltzer-Brody, S. E., Stika, C. S., Thurston, R. C., Clark, C. T., … Wisner, K. L. (2015, March 1). Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: A novel heuristic model. American Journal of Psychiatry. American Psychiatric Association. https://doi.org/10.1176/appi.ajp.2014.14070918

Gordon, J. L., Peltier, A., Grummisch, J. A., & Sykes Tottenham, L. (2019). Estradiol fluctuation, sensitivity to stress, and depressive symptoms in the menopause transition: A pilot study. Frontiers in Psychology, 10(JUN). https://doi.org/10.3389/fpsyg.2019.01319

Sander, B., Muftah, A., Sykes Tottenham, L., Grummisch, J. A., & Gordon, J. L. (2021). Testosterone and depressive symptoms during the late menopause transition. Biology of Sex Differences, 12(1). https://doi.org/10.1186/s13293-021-00388-x

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