Menopause and Mood Changes

Colette Dowling, LCSW

Menopause and mood changes are the subjects of the following article by NYC psychotherapist Colette Dowling,LCSW. Colette has written 8 books on women's issues, including Red Hot Mamas: Coming Into Our Own at Fifty and The Cinderella Complex: Women's Hidden Fear of Independence.

Menopause is not unlike menstruation in that no matter what your friends who go through it first tell you, YOUR experience of things like hot flashes, depression, or memory troubles may be different. Most confusing of all may the mood changes, and they can start up as early as perimenopause.

Your unique reproductive system has been manifesting itself all your life. At puberty you and your best buddy discovered that you didn't have the same tampon size, the same length of period, the same cramps, or bloating, or other menstrual or premenstrual symptoms. At perimenopause, too, the "symptoms" differ from woman to woman--for example, the relative severity of the hot flashes, memory troubles, or mood changes. Our hormone levels and brain neurotransmitters differ, and thus, so do our menopausal mood changes.

Generally, estrogen levels begin dropping in our mid-thirties, gradually making pregnancy less likely. In the early forties, menstrual cycles become shorter and FSH (follicle stimulating hormone) may be elevated. By the late forties, cycles become irregular and periods often produce heavy bleeding. Irregularity is a clear sign that you'll soon be leaving perimenopause and entering menopause.

Who gets hit with hot flashes, insomnia, and mood changes such as depression--and when, how severely, and for how long--has to do in part with brain neuerotransmitters like serotonin. A chemical that requires the presence of estrogen for its metabolism in the brain, serotonin regulates sleep, energy, mood, and libido, and is very important to our wellbeing.

Women (like men) vary in the amounts of serotonin their brains process. Researchers have suggested that women with low serotonin (largely a genetic matter) may become more symptomatic when their estrogen levels drop off, during different times in the reproductive cycle, as co mpared to those whose serotonin levels are closer to normal.

The rate at which hormone changes occur, before menopause,is also relevant when it comes to the severity of hot flashes. The relative speed with which our sex hormone levels change could be THE determining factor in how symptomatic we become during perimenopause (and during menstrual cycles too, for that matter). In those whose drop-off is gradual, and who have sufficient serotonin flowing through their brains to begin with, there may be NO overt symptoms. In those whose drop-off is sudden--say, for example, a woman whose ovaries have been removed--symptoms of menopause are likely to be pronounced and dramatic.

Between the two extremes lies the middle ground of the menopause spectrum, which is probably where most women fall. Some in this group may find their symptoms mildy discomforting. Others may be quite symptomatic. The drop in estrogen that begins in perimenopause can disturb sleep, affect sex, alter memory and cognition, and create anxiety and difficulty in concentrating. It can also, as we all know, create hot flashes.

Hot flashes are the notorious outward sign of estrogen drop-off and perimenopause. Researchers at the University of California in Los Angeles found that most hot flashes in a group of women they studied occurred at night, often causing waking. The perimenopausal women awoke three times as often as the premenopausal women, and experienced far less REM sleep--the type necessary for genuine rest. As a result, the UCLA team concluded, perimenopausal women are more likely to be sleep-deprived.

Any woman experiencing hot flashes has one big question: How long is this going to last? For the majority of women (65 percent) hot flashes occur over a period of one to five years. Another 25 percent have them for six to ten years. Ten cent have hot flashes for ten years or more.

The cause of this sudden downward "resetting" of the body's thermostat is unknown. It's assumed that estrogen plays a major role, since hot flashes begin during perimenopause, when estrogen levels drop. Women in menopause used to take estrogen supplements for perimenopausal symptoms such as hot flashes. Far fewer do today, because some breast cancers are estrogen-responsive. Drug companies sell non-estrogenic medications for the treatment of hot flashes and other perimenopausal symptoms. As well, there are many non-pharmaceutical possibilities for improving hot flashes and other symptoms.

Those experiencing significant mood shifts, however, should definitely have a medical evaluation. Women whose serotonin levels are lower than normal to begin with can suffer seriously, as menopause approaches, due to the further lowering of this neurotransmitter that occurs when estrogen levels plummet.

There's no need to suffer from even moderate mood changes during perimenopause. Such mood changes can affect everything, from relationships to a woman's ability to make a living.

There are enough changes--physical, social, emotional--occurring during a woman's perimenopausal years that she sometimes can benefit from psychotherapy. This is not because menopause turns women "crazy", as was thought for centuries, but because therapy can be helpful at any time in a person's life when many changes converge at once, causing a kind of blow to the psyche.

As a therapist who sees many women at various stages of the lifecycle, I would recommend getting the help you need so that you can soften the effects of hormonal changes, even if they are relatively temporary. A long, productive life lies ahead, and you deserve to enjoy it.

* * *

More on menopause, hot flashes, and perimenopause at Colette's website

NYC psychotherapist Colette Dowling, LCSW, has completed advanced training in psychotherapy and psychoanalysis at The Institute for Contemporary Psychotherapy, in New York. She is also trained in EMDR for the treatment of trauma.

Colette has a private practice in Manhattan. Her office in the Flatiron district is convenient to Hoboken, Jersey City, Queens and Brooklyn. You can reach Colette at, or by calling her at 718-594-0201.

To hear Colette speaking on what it's like to begin therapy with a new therapist, click on the auddio button, below.

Colette is best known for uncovering women's psychological conflicts with independence in her best-selling The Cinderella Complex: Women's Hidden Fear of Independence. She has also written on the unique mental health issues of midlife women in her book, Red Hot Mamas: Coming Into Our Own at Fifty. You can find excerpts from her books at

Colette Dowling treats women with menopause-related mood changes. For info on her therapy practice see her profile at Psychology Today.

For articles related to menopause and women's mental health see Colette's website.

Copyright Colette Dowling, 2006-2010