Mood Swings

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Mary Jane Minkin, MD

Additional Resources
Mayo Clinic
Menopause Map

You’re laughing with your friends one minute and close to tears a few moments later. You feel tired, overwhelmed, and out of control. You’re not crazy—it’s one of the common symptoms of perimenopause (the first stage of menopause, usually in the early 40s): mood swings. And there are ways to cope.

What causes mood swings?

As a woman ages, estrogen levels are fluctuating from one minute to the next, and erratic. Less progesterone is produced (but stabilizes at low levels in postmenopause, around age 55). Estrogen is related to production of serotonin, a mood-regulating neurotransmitter. Fluctuating estrogen and progesterone levels, plus other factors, cause serotonin production disruption, leading to more mood swings.

What to do about mood swings?

Mood swings are a part of aging for many women, but the good news is that you can take steps to help prevent them and manage them when they occur. Often, a healthy lifestyle is the first step in preventing mood swings.

  • Avoid caffeine, alcohol, and spicy foods
  • Eat a balanced, health diet with fruits, vegetables, and whole grains
  • Talk to a therapist or counselor Get enough sleep; being tired affects your mood
  • Exercise regularly Find healthy ways to deal with stress

Sometimes, however, all of the lifestyle changes you make are not enough. For severe mood swings, especially those that interfere with enjoying everyday life, hormone therapy can help.

  • Hormone therapy: May help severe mood swings; usually lowest dose for shortest amount of time prescribed (there is no increased risk of breast cancer until after three years of therapy; very few women use therapy for any longer)
  • SSRIs (selective serotonin reuptake inhibitors): Can be effective in treating mood swings and other symptoms, such as hot flashes and sleep issues, but have side effects; some doctors suggest effectiveness is increased when a woman is first treated with estrogen
  • Complementary alternative medicines (CAM) such as black cohosh, deep breathing, and soy in some cases; includes treatments such as acupuncture and mind-body therapies such as yoga, tai chi and meditation
  • Low dose birth control pills: Shuts down the ovarian fluctuation that takes place during perimenopause; offers a fixed dose of estrogen and progestin every day

Always talk with your health care provider about medications, hormone therapy, and before using CAM supplements.