Perimenopause and Moods

Menopause is defined as the period in life when you have had no menstrual periods for one year. Perimenopause is the time that leads to menopause when the reproductive hormones begin to fluctuate more widely. During this time the dialogue between your brain and your ovaries slows, develops gaps, and changes it’s conversational pattern. Perimenopause may last 7-10 years or longer or last only a year or two. Women in perimenopause rank insomnia, irritability, and depressed mood among the most common complaints. Mental health is the most prevalent difficulty and not hot flashes.

During perimenopause, there are wide fluctuations in estrogen, testosterone, FSH, LH, and progesterone. Perimenopause is not simply a time when estrogen diminishes. It is a time when you don’t have enough estrogen and then you have too much estrogen. Perimenopause is a time of wide fluctuations in hormone levels. These fluctuations result in the mood disturbances associated with perimenopause.

Blood tests may be used to measure hormone levels during perimenopause. But due to the many fluctuations in the ovary-brain dialogue during this time, blood tests can be unreliable in indicating exactly where you stand with your hormone levels.

The more definitive way to know if you are close to menopause is to know how many months it has been since your last period. If it has been six months or more since your last period it is likely that you are close to the end of the perimenopause process.

Eventually you will have no more eggs but the brain still attempts to make the ovaries respond by stimulating the secretion of FSH and LH. FSH and LH hormone levels increase at menopause and remain high thereafter. When there has been no response from the ovaries and your periods have ceased for one year, perimenopause is over and menopause has arrived.

Your brain, your hormones and your mood

The relationship between your hormones and your brain chemistry is critical because this relationship is very vulnerable to the hormonal fluctuations of perimenopause and menopause.

Estrogen is integral to your health and brain function. It influences the way your serotonin and other neurotransmitter pathways react to normal hormonal shifts. It is easy and common to experience mood variations related to these reproductive hormone fluctuations across your cycle and over the changing years.

Many women will develop mood and sleep difficulties during perimenopause. Women who have had mood disturbances before in the form of anxiety or depression are especially vulnerable to the hormone brain dialogue changes during perimenopause. The loss of estrogen can significantly worsen anxiety, depression, and other mood disorders. Some women are especially sensitive to the loss of estrogen and its effect on the brain.

You do not need to have hot flashes, night sweats, or significant changes in your menstrual periods to be in perimenopause. Your brain may the first and the only manifestation of the changing hormonal levels in the form of mood or cognitive changes.

Hormone fluctuations and mood changes

Estrogen fluctuations can alter neurotransmitter levels in the brain and may result in mood disturbances. The hormonal fluctuations in perimenopause and its effects on the brain result in fatigue, loss of the feeling of subjective well being, difficulty sleeping, mood alterations, anxiety, poor concentration, depression, changes in thinking patterns and abilities, and problems with memory. Hormone replacement therapy will relieve night sweats and the loss of well being associated with perimenopause but often it will not alleviate the symptoms that arise from depression.

It is not unusual for women with a history of mood disturbances to find that their moods become harder to manage as they enter perimenopause. They may find it difficult to find a regime – medication or otherwise - that stabilizes their moods and restores coping abilities. Women who have been taking antidepressants may find that when they enter perimenopause these medications may not work as well and their symptoms may worsen. Those with mood disorders may destabilize despite adequate medication.

A woman’s mild or severe life long or occasional depression may worsen significantly under the influence of peri-menopausal hormonal fluctuations. A history of mood disturbances and depression indicates that a woman’s brain already requires precise management in self-regulation. Due to hormonal fluctuations, perimenopause may further compromise the brain’s ability to self-regulate.

When a woman notices that "this feels hormonal," it is appropriate and advisable to look to management of the reproductive hormones to destabilize mood disturbances. Peri-menopausal hormonal fluctuations can greatly influence the brain and may cause something in the brain to shift thus overwhelming a woman’s normal coping mechanisms.

Women with bipolar disorder are particularly subject to the hormonal fluctuations of perimenopause.

Hormone replacement and mood stabilization

Normal hormonal fluctuations during this time can destabilize moods. Taking progesterone may worsen your depressive symptoms and adding estrogen may make you fluctuate rapidly between mood states.

The addition of estrogen replacement by itself during perimenopause is not capable of resolving the mood symptoms in women with a history of depression and other mood disorders. Once the neuroreceptors and pathways in the brain have sustained the biochemical changes of depression, estrogen alone is ineffective in treating the symptoms of depression. Estrogen can, however, help antidepressants to work more effectively during perimenopause and menopause.

Some women, when placed on hormone replacement therapy, may actually worsen in their depressive symptoms because progesterone tends to affect moods negatively.

Women with a history of mood problems often can not tolerate the use of progesterone during perimenopause. Progesterone acts against estrogen in the brain and acts as a dysphoric hormone causing mood and anxiety changes. Various forms, dosages, and regimes, however, may be better tolerated than others.

Hormone fluctuations and cognitive changes

The hormonal fluctuations of perimenopause may also affect your memory and learning. Estrogen is involved in maintaining specific cells in your hippocampus that are responsible for detailed communication between nerve cells. Estrogen is also related to supporting your acetylcholine levels. When estrogen levels fluctuate or decline, acetylcholine levels fluctuate or decline. Acetycholine is the neurotransmitter that is responsible for memory, creative pursuits, and retrieval of words.

Estrogen is involved in maintaining verbal memory (the recall of spoken material) and enhances the capacity for new learning in women. (Estrogen does not seem to affect what is learned visually.)

Estrogen changes in perimenopause may also affect other cognitive functions such as recognition, interpretation, decision-making, and eye-hand coordination. Compensating for the changes in estrogen is important for maintaining peak cognitive functioning.

You can take steps to move more smoothly through perimenopause and into the new life patterns of menopause by following a program that focuses on:

Proper nutrition for perimenopause
Adequate dietary supplementation
Increasing your understanding of the hormonal changes occurring and how these affect your neurotransmitters, neurons and brain chemistry
Paying attention to your sleep patterns and ensuring adequate rest and recovery during the day
Taking time for yourself
Increasing your self-awareness

Use the following checklist to find out if you might be peri-menopausal and need to take special care to manage your moods and retain your memory and learning skills.

Do you have these symptoms?

Hot flashes, night sweats, perspiration and/ or chilly sensations

Sensations of numbness and/ or tingling of skin

Insomnia, sleeplessness, and/or restless, fragmented sleep

Fatigue, feeling of weariness of mind and body with desire for rest; disinclination to make further effort

Vaginal dryness

Irregular menstrual bleeding

Changes in frequency of menstrual cycle
Irritability, feelings of anxiety or apprehension

Feeling of depression, sadness, unhappiness and / or being miserable without any obvious reason

Pain affecting joints and/or muscles

Headaches of any kind

Dry skin

Urinary problems

Digestive problems

Sexual / desire changes

Quickening or acceleration of heartbeat or a fluttering/pounding heartbeat in a sitting or resting position

Sensation of "crawly skin"

Forgetful, scattered and/or suddenly disorganized

Clumsiness and /or uncoordination

Difficulty remembering past events and/or learning new material

Slow to recall a name or to find the right word

The more symptoms that you have experienced the more likely it is that you are entering perimenopause. It may be time for you to take some steps to shift your health and self-care focus to provide adequately for your new hormonal and well-being needs.

At Evenstar, we are dedicated to helping you make your Perimenopause Passage the best time of your life. we offer Functional Health Tests, Personal Coaching and integral Mood and Energy Wellness Programs that are specific to the Perimenopause passage.

Find out more at www.evenstaronline.com/perimenopause.html
or you can give me a call at 434-263-4996 or email me.