Coping With Emotional and Mental Symptoms

Upset young woman looking to the distanceThe emotional symptoms of premature menopause aren’t as clear-cut as the physical ones. If you don’t know that you’re going through menopause prematurely, you may start wondering just what is going on.

You’re crying about nothing — and it’s not the normal time for PMS. You’re moodier than you ever used to be. You snap at your husband or your children about the littlest thing, then can’t understand why you blew up. And you’re more forgetful than you’ve ever been.

Well, you’re not losing your mind. You’re not necessarily slipping into clinical depression, and you’re not becoming a witch. What you’re experiencing are common emotional signs of menopause.

Many may be related to the physical symptoms you may also be experiencing, such as hot flashes or insomnia. Others may seem to just spring out of nowhere. But they are all a consequence of the changing hormones in your body.

Your Experiences

I remember going to my GP and breaking down crying. I told him that I was so tired of feeling bad. I told him about not sleeping and the panic attacks that would make my heart race like crazy. He was great. The first thing he said was: “You are not going crazy.” He told me that all of these things are very real and not just in my head. He assured me that they are normal symptoms.

— Karen, age 39

When you think about it, it makes sense that you would experience emotional symptoms when you enter menopause. Research has indeed backed the popular notion that many women go through mood swings and depression before their periods.

So if you can get PMS from hormone swings during your normal menstrual cycle, it follows logically that changes in your hormones due to menopause can also cause even more severe emotional symptoms. Add to this the fact that your hormones are making your body go through numerous stressful physical changes, and it’s no wonder you may find yourself being unusually moody, irritable, or forgetful.

Unfortunately, some people — even some doctors — may just shrug off these emotional symptoms and say that they’re a function of daily stress or that you’re exaggerating. But these symptoms are most definitely real for many women when they go through menopause.

Middle aged woman suffering from stress

Recent research indicates that the emotional symptoms of menopause are related to something called MAO (the enzyme monoamine oxidase). When your estrogen levels sink, levels of MAO increase and break down neurotransmitters in your brain, specifically serotonin, which is a mood leveler and elevator.

In other words, then, as your estrogen levels drop and MAO levels rise, your brain becomes more prone to depression and moodiness, among other emotional symptoms.

Your Experiences

The mental/emotional symptoms I’ve had: trouble concentrating (focusing), extremely PMS-y (hated everyone’s guts half the month!), wimpy feeling (shortage of confidence in myself, which I never had!), started crying very easily, depressed feelings and anxiety.

— Bryana, age 38

Mood Swings / Sudden Tears / Depression

Super-sensitivity, crying jags — however you describe the experience, they are a sign of menopause and are often very irritating to deal with. Mood swings are very common for women in menopause. It’s like constantly having PMS. You can feel great one moment, then be crying about nothing the next.

If you don’t know you’re in premature menopause, you wonder what is going on. There seems to be no rhyme or reason to your moods. If you do know you are in premature menopause, often you are so devastated by the diagnosis that you are depressed, to begin with. SO not only do you have a tendency to cry, you feel you have a reason to as well.

The culprits? Lack of sleep due to night sweats, and the draining nature of hot flashes. Also, low estrogen levels contribute to moodiness. For this reason, this symptom is often worse for women in premature menopause due to surgery or cancer therapy, because the estrogen drop is so sudden.

Your Experiences

I remember waking up in the morning, feeling completely normal. Then something would set me off — sometimes it was thinking about the fact that I wouldn’t be able to have a child, but other times it was nothing at all. My husband would say “good morning,” and the tears would start flowing.

— Lynda, age 34

In addition to (or sometimes instead) of mood swings, you may notice that you’re always vaguely depressed. This isn’t necessarily clinical depression but is often a general “blah” feeling. Your energy levels lag, your get-up-and-go is gone, and you can’t shake the blues.

Again, this seems to be connected to low estrogen levels, not to mention a lack of sleep due to night sweats, and the general debilitation of hot flashes. Please note, however, that some women do go into clinical depression, and we’ll look at some of the symptoms below to help distinguish major depression from milder, premature menopause-related mood changes.

The Signs of Major Depression

Mild depression is a common offshoot of premature menopause. But there is a big difference between mild depression and major, clinical depression. Clinical depression is an illness and requires medical treatment. Here are the common signs of clinical depression:

  • You dramatically change your eating habits and eat too much or too little.
  • You begin sleeping much more or much less.
  • You feel elevated levels of anxiety.
  • You are unable to enjoy the things you used to, especially sex.
  • You are always very tired and rarely have any energy.
  • You find yourself slipping into feelings of self-loathing and worthlessness.
  • You can’t concentrate on anything and find yourself unable to make decisions.
  • You think about suicide or death.

If you suffer from four or more of these symptoms for two weeks or more, you may be clinically depressed and should seek professional help.

If you don’t know that you’re entering premature menopause, it’s easy to assume that you’re falling into clinical depression even when you’re not, and in many cases, a doctor may prescribe an antidepressant. This is often more medication than you need, since your emotional symptoms may have their roots in your fluctuating hormone levels.

Contrary to past belief, menopause, premature or otherwise, probably doesn’t cause clinical depression in and of itself. Yes, you may get depressed because you are suddenly plunged into menopause years before you expected it, but menopause itself doesn’t automatically mean you will be sent into a tailspin of chronic depression.

For this reason, it’s important that you determine the cause of your low mood. If you’re feeling just a little down, estrogen will probably be enough to pull you out of your slump. If you’re feeling very depressed, and it seems to be completely unrelated to insomnia or hot flashes, then you may consider exploring other treatments with your doctor.

How To Cope

Middle aged woman lifts dumbbells at park

Low mood and irritability is never a simple thing to deal with, but there are some things you can try that may help. As you would expect, both hormone replacement therapy (HRT) and supplements can help you level out your mood swings, as can diet and exercise. In addition, you may try the following:

Keep your diagnosis in perspective

Of course, your feelings of sadness and loss are justifiable but remember all the things in life still capable of bringing you joy. What you’re enduring right now won’t last forever but many positive and uplifting things in life will.

Analyze what sets you off

If you can identify the specific situations or triggers that bring about your negative thoughts, it may be easier to avoid feelings of sadness and hopelessness in the first place.

Incorporating certain cognitive behavioral therapy (CBT) techniques can help you defeat flawed and unhelpful patterns of thought. Seeking out professional help is also an option.

Don’t fight your feelings (go with the flow)

It sounds trite, but it does help to relax. Talking with others — friends, a support group, even a therapist if you feel it necessary — may help.


It’s a natural way of burning off stress and lifting your spirits. When you train, your body releases feel-good chemicals, which can offer a natural means of elevating your low mood.

Also, exercise can help you feel better about your appearance and can potentially help with other menopausal symptoms such as insomnia.

Cut back on caffeine and sugar

Both are stimulants and can make your mood swings more intense. Yes, you’ll feel up for a while, but you’ll crash when their effects wear off.

The herb St. John’s Wort may ease depression and level your mood swings

If your quality of life is severely impaired by your low mood, ask your doctor about prescription antidepressants such as Prozac, Paxil or Zoloft.

Antidepressants are strong drugs so, of course, it makes sense to use them only if truly necessary. Discuss your different options with your doctor if you feel that you are unable to function well due to depression.

“Brain Fog” — Memory Lapses and Loss of Concentration

It sounds odd, but it’s a little frightening: you suddenly can’t remember the simplest things. You walk into another room to get something and stand there wondering just what it was you were supposed to get. You forget appointments, phone numbers, names. You generally feel “out of it.”

It’s easy to think something is drastically wrong with you when this happens. You’re in your twenties or thirties, and you feel as though you’re suffering from memory loss already. Again, though, what you’re experiencing is often a sign of menopause.

Your Experiences

I buy Post-it notes by the case, and now every room in my house and my car has them stuck everywhere, but then I forget what they all mean if I don’t write down every little detail!

— Marianne, age 40

Some women blame this “brain fog” on their premature menopause but high-quality studies are sadly lacking in this area. The good news? First, early menopause appears to have no effect on long-term memory. Second, any short-term memory loss tends to disappear after menopause even without HRT, and in the meantime treatment can often help.

Brain fog and memory loss can also be related to insufficient or poor quality sleep, so if you’re having night sweats and suffering from insomnia, chances are you’ll also periodically suffers from bouts of them.

Here are some things you can try:

  • Don’t panic — nervousness about forgetting things can exacerbate the problem.
  • Become a list-maker — it sounds simple, but it does work. Make a list of things to accomplish, stick to it, and tick them off as you finish.
  • Try to get better sleep — this can be tough to achieve if you’re suffering from night sweats and hot flashes. However, better sleep will help your concentration and memory.

Moving Forward

The emotional fallout of early menopause can be immediate and severe. You can read more about one woman’s experience. Often, simply knowing that you’re not the only one suffering from these consequences can be reassuring in itself. In our next article on coping with the emotional and mental effects of early menopause, we’ll explore anger, acceptance and how support groups can be a vital and helpful mechanism for moving on with your life positively.

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