Victoria Keith-Roach: Menopause and mood swings

The perimenopause and menopause years can be a time of upheaval – both physically and mentally.  Mental health symptoms such as anxiety, forgetfulness, irritability, and mood swings are common and can, in fact, be early signs that perimenopause is starting.

It’s important to understand why these emotional changes take place in women to know how to look after their health so employers (and colleagues) can provide helpful and relevant support.

Mood swings are rapid or extreme shifts in an emotional state or mood. Where once you were calm you can quickly become angry, irritated, or frustrated. Increased levels of anxiety or feeling more easily overwhelmed and stressed, low mood, and a lack of confidence are common during this phase of life.

Hormones have played a big role in women’s moods since the beginning of menstruation. As oestrogen and progesterone levels rise and fall through the menstrual cycle, most women experience changes in their emotions. We’re not keen on talking in generalisations but, broadly, more oestrogen helps promote a sense of wellbeing and less oestrogen (in the run up to your period) can cause upset and lower mood (ie. some of the symptoms associated with Premenstrual Syndrome (PMS)).

The mood swings, anxiety and low mood women can experience through menopause are not just linked to changing levels of oestrogen. There are several reasons why women see changes to their mood and motivation and it’s important to understand the bigger picture to best build support that actually helps.

THE BIG THREE SEX HORMONES – OESTROGEN, PROGESTERONE & TESTOSTERONE

All three sex hormones play a part in how women feel. As mentioned above, oestrogen can promote a sense of wellbeing and emotional stability. Oestrogen also helps the growth and development of new neurons in the brain. When levels drop, women can experience mood swings, anxiety, angry and irritability.

Progesterone has a calming effect. It interacts with GABA receptors in the brain and helps to reduce anxiety and promote relaxation. Testosterone can lift confidence and assertiveness both of which support self-confidence.

FEEDING THE BRAIN

While it’s only 2% of your total weight, the brain is responsible for up to 20% of our daily energy needs. It’s important that the brain is ‘fed’ to keep it working optimally and this process can become impaired by metabolic changes linked to lower levels of oestrogen, low iron caused by heavy bleeding, issues with insulin sensitivity and perhaps under functioning thyroid hormones.

A brain with insufficient energy is prone to memory lapses, difficulty focusing and low mood.

THE ROLE OF THE ‘HAPPY’ AND THE ‘PLEASURE’ HORMONES

Serotonin (the ‘happy’ hormone) and dopamine (the ‘pleasure’ hormone) are key neurotransmitters or chemical messengers that impact mood and motivation.

Serotonin is involved in maintaining emotional balance, appetite regulation and a sense of and contentment. It helps to dampen the activity of brain circuits associated with fear and anxiety and assists us with appropriate emotional reactions and improves coping mechanisms. Low levels of serotonin can make us feel unhappy and anxious.

Dopamine is involved in the brain’s reward system, which is responsible for feelings of pleasure and motivation. It helps create a sense of anticipation and drive. Low levels of dopamine can appear as sadness and depressed mood.

Through menopause these chemical messengers can begin to work less well. For some women, lower oestrogen results can reduce serotonin and dopamine levels.

Serotonin and dopamine also require micronutrients such as iron. Many women become anaemic during perimenopause due to heavy periods and low iron in their diet. Magnesium and B-vitamins are also essential.

Chronic stress lowers the levels of these brain chemicals. High levels of cortisol can lead to an increase in the breakdown of serotonin and dopamine, slow the manufacture of new neurotransmitters.

And let’s not forget genetics. There are many genes that impact brain function, but the COMT gene (or the Catechol-O-methyltransferase gene) can have a significant effect. This gene codes for an enzyme that breaks down dopamine. The COMT enzyme affects working memory, emotional regulation and our ability to plan and achieve goals. If your COMT enzyme rate is slow, you’re more likely to become anxious and take longer to recover from stress or shock which impacts mood.

THE IMPACT OF STRESS

We all know chronic stress is bad for us. It directly impacts brain function and can change the structure of the brain. Studies show that chronic stress impacts the size of the hippocampus (responsible for memory and learning), the prefrontal cortex (decision making and emotional regulation). Stress prevents us from thinking clearly, reacting to situations appropriately, sleeping well and it depletes key micronutrients.

THE IMPACT OF POOR SLEEP

Nights of disrupted sleep leave us feeling less than ourselves. Lack of sleep impairs the formation of new memories and reduces our ability to learn new information, it reduces attention and concentration and impacts mood, contributing to irritability, anxiety and depression.

In two frustratingly vicious cycles, a lack of sleep can increase cortisol levels, which lowers mood and increases irritability and in turn can cause more sleep issues. Lower levels of serotonin can result in poor sleep which can further reduce serotonin levels.

WHAT CAN EMPLOYERS DO?

How can employers support women at this time and provide them with the right information and structure to feel and work at their best? There is no ‘one size fits all’ policy and whilst not mandatory, failing to put a menopause policy in place can have negative repercussions for both employees and employers.

Much of what women need in this respect comes under the mental well-being umbrella but with some additional specific information. The support needed will vary depending on the type of business. For example, companies that require employees to wear a uniform potentially need to rethink fabric to make it more breathable.

1. Foster a positive work environment:

Cultivate a workplace culture that values open communication, respect and support. For many women, feeling that they are able to voice their concerns is the critical first step. Encourage employees to share their thoughts, concerns or ideas and provide a platform for anonymous feedback to address any issues or concerns.

Encourage private conversations where necessary and consider stepping outside of the formal annual review process.

2. Provide information about lifestyle measures that will help:

This could be via talks and workshops, via educational materials or access to companies who offer personalised advice. WomenWise specialises in a unique combination of at-home tests and questionnaires to help women understand the exact support their bodies need and also provide 12 months of on-going advice and help.

More generally, women can support their mood with:

Sex hormone support: via HRT or natural alternatives.

Getting the right nutrition: Eating a diet rich in fruits, vegetables, essential fats and protein can help provide the brain with the nutrients it needs to function at its best. Targeted supplements can help but it’s key to understand what your body needs vs buying a combination product and hoping for the best.

Get enough sleep: simple and obvious but it can be a game changer. Aim for 7-9 hours of sleep per night and try to establish a regular sleep routine to promote better sleep quality.

Limit caffeine and alcohol: Caffeine and alcohol can significantly contribute to anxiety in some people.

Exercise: Regular exercise can improve blood flow to the brain, promote the growth of new neurons, and reduce stress. This doesn’t have to be an intense work-out at the gym, a half hour walk outside will help.

Practice stress-reduction techniques: Try meditation, mindfulness sessions, controlled breathing, or yoga. Identifying the main stressors or triggers is an important first step and helps find healthy ways to cope with them.

Establish a daily routine: This can provide a sense of stability and predictability and help bring balance to emotions.

Seek professional therapy or counselling: They can provide personalized strategies, support and tools to better understand and manage low mood and / or mood swings. It is good to talk. Menopausemandate offer a FREE 15 minute one-to-one online video appointments with a Menopause Advice Nurse.

3. Provide a structure for social support:

Affinity groups work particularly well in this space where women can share their experiences and feel less isolated. Encourage and facilitate, for example, monthly get togethers via zoom or over coffee or lunch.

4. Consider implementing flexible work arrangements:

These could include remote work options, flexible hours, or compressed workweeks. These arrangements can help employees better manage their work-life balance, reduce stress and accommodate personal needs.

5. Encourage breaks and time off:

Encourage employees to take regular breaks throughout the workday. There are several studies that show the boost to cognitive function and mood from spending time outdoors – particularly in nature (that doesn’t have to be a mountain, the local park also helps). Employers should also have extra support around sick leave.

Supporting your female employees through this phase of life will boost job satisfaction, loyalty and productivity. The options outlined are mostly good common sense – what makes the difference is getting going with them. Women will see and understand that the company appreciates the changes they are experiencing and is there to help.