Questions This Article Answers: What causes mood swings during menopause? Can menopause cause depression? What treatment is available for emotional symptoms during menopause? You’ve always thought of yourself as a pretty even-keel person. But since you’ve hit your late 40s, you’ve been struck by uncharacteristic bouts of the weepies, alternating with cranky, snapping bursts of irritability. What’s going on? In a word: menopause. While hot flashes are the symptom you most often associate with The Change, emotional difficulties can crop up during this transitional time, too. These can range from brief periods of tension, weepiness and mood swings to more prolonged episodes of anxiety, despair and even, for some women, clinical depression. Why do these emotional difficulties strike? What can you expect if you are entering menopause, and are there things you can do to help prevent or make these symptoms less pronounced? Reasons for Your Mood Swings About 1.3 million women reach menopause in the United States each year, but the symptoms of menopause can start years before this happens. That’s because your estrogen levels start fluctuating–often wildly–as your body prepares for menopause. This transition stage, called perimenopause, usually starts around age 47 and can take about 4 to 8 years. Menopause itself usually happens around age 51 (though some women experience it earlier and some later), and is marked by having had no periods for 12 months. Experts point to several reasons you may be feeling more tense, restless, tearful or angry during your perimenopausal or menopausal years. Shifting levels of estrogen: Estrogen is linked to neurotransmitters that affect emotional pathways in your brain. Rapid changes in estrogen levels can result in anxiety, mood swings and depression. Lack of sleep: Menopausal symptoms such as hot flashes can interfere with your sleep, which can then affect your mood. Life changes: You’re going through a new stage in your life. You will never give birth again; for some women, this change in maternal identity is troubling. Your adult children may have left the nest or may be having children of their own. Or you may have aging parents who need your care. These and other changes can impact your emotional health. Your Risk of Depression Rises During Perimenopause Just being in perimenopause increases your risk of depressive symptoms. Researchers suspect this is because estrogen levels during this time are shifting frequently. After menopause, your estrogen levels may be low, but they’ll be stable, which appears to ease emotional disturbances. Most women don’t experience clinical depression or anxiety during menopause, though you may have short-lived or mild to moderate symptoms. However, if you have symptoms most of each day for more than two weeks, you have developed major depression and should seek help with a health professional. Women who have a history of clinical depression are up to five times as likely as women who haven’t been depressed before to experience a recurrence, especially during perimenopause. Other risk factors for depression during perimenopause and menopause include having had a surgical menopause, such as removal of your ovaries; being highly stressed or in poor physical health; smoking; having a negative attitude toward aging and menopause; having had PMS in the past; and having hot flashes. (Women with hot flashes have four times the risk of depression as women who don’t have them.) Ways to Deal With Your Emotional Symptoms There are a variety of approaches you can take to help yourself, depending on the level of problem you are experiencing. Medication: Options include antidepressants, which can relieve not only depression and mood swings but also ease hot flashes; short-term hormone replacement therapy; low-dose oral contraceptives if you are in perimenopause; and herbal supplements, such as St. John’s Wort. Talk to your physician about any medications–including supplements--to determine what is best for you. Support: Talk to other women who have experienced menopause-related emotional issues. Or find a support group for women who can relate to what you’re going through. Counseling can help, too. Lifestyle changes: Reducing stress can help relieve your symptoms, so it’s important you find ways to do this. Try to find classes, videos or books to teach you relaxation techniques. Explore hobbies or other enjoyable activities, such as reading a good book, doing brain-stimulating puzzles, and going outdoors. Exercise at least 30 minutes most days and try to get enough sleep, with regular wake and bed times. Be kind to yourself: Learn to adjust your goals at this time in your life. Don’t be hypercritical; cut yourself some slack, and do what you can do, without stressing over what you can’t manage. Research shows most women with emotional issues will see improvement as estrogen levels stabilize and most will have moved beyond their disruptive symptoms within 5 to 10 years after menopause. Your even-keel self will likely soon be restored.