Symptoms are essentially excessive anger and a lack of patience, with the key element being that they come out of very minor things, very quickly, and are hard to control. Estimates suggest that 70% of women experience some form of perimenopausal rage or excessive irritability.

It should be noted, if you are unable to control perimenopause rage resulting in hitting or otherwise physically harming those around you, this would be beyond normal perimenopause rage and you should see a healthcare provider and/or a mental health specialist to see if there are other neurological elements that need care.

How are Mood and Menopause Linked?

There is a direct relationship between estrogen (the hormone that is declining to the point where we start to notice it in (later) perimenopause and serotonin. Serotonin is the neurotransmitter responsible for regulating your mood - meaning if it declines, you get mood swings and feelings of instability.

To better understand this - let's look at some definitions:

• Neurotransmitters are the chemical messengers that our brain needs to get signals from the outside environment into our brain.
• Synthesis is the chemical reactions between different neurotransmitters and hormones.
• Degradation is the decline in the quality of chemicals in your body.
• Inhibiting re-uptake refers to the fact that, if a neurotransmitter cannot be taken back up by the cell that created it, then more of that neurotransmitter is available to pass further messages between nearby nerve cells - and more messages are better! (to a point)

Estrogen promotes the synthesis (good chemical reaction), prevents degradation (quality decline), and inhibits reuptake of serotonin; it also promotes the expression of serotonin receptors. Plus, estrogen increases dopamine synthesis and decreases its degradation and reuptake too.

Dopamine is the neurotransmitter responsible for acting on areas of the brain to give feelings of pleasure, satisfaction and motivation. Dopamine also has a role to play in controlling memory, mood, sleep, learning, concentration, movement and other body functions.

So, estrogen declines, which in turn means serotonin and dopamine (those 'feel good' chemicals in our brain) also take a pretty big hit in various different ways. You can take a more indepth look at hormones and mood in our blogs on Hormones and the Brain, and The Chemicals of Calm.

It's Not All Science...

And, it's not all in your head.

In perimenopause, we are starting to see a bigger gap open up between the levels of estrogen and progesterone, which can lead to some really unpleasant (and often painful) symptoms such as hot flashes, painful sex, vaginal dryness, weight gain, brain fog, and many more. These are enough to drive anyone a little bit crazy, but it doesn't stop there…

It is the drop in progesterone that is most at the root of the intense mood swings. Progesterone increases GABA which is an inhibitory NT, essential for balancing glutamate, the excitatory neurotransmitter. Glutamate is the most abundant neurotransmitter in the brain and, unchecked can cause bursts of aggression. Low progesterone frequently results in poor sleep, and poor sleep leads to reduced ability to manage stressors in a calm way. Estrogen doesn't really drop until late in perimenopause and after the menopausal transition. Often, at this time, a woman is progesterone deficient (not estrogen dominant), before estrogen eventually starts to fall, and this is the place where it all goes to hell in a hand basket for many of us. Add in oxidative stress from toxins in food/environment, working and parenting and doing more than 50% of household management etc... well, you might have guessed what the outcome will be!

As we move into perimenopause many women report a combination of sociocultural factors starting to hit - with complaints of being ignored, dismissed, or starting to feel old. Women with careers might find they are being overlooked as they need more support during perimenopause, women with children leaving home might start feeling a little rootless, we all start to notice the lack of representation of older women... Well, everywhere, and maybe... we get a little frustrated and angry by it all.

Couple that with a partner who has no idea what you're going through and a doctor who tells you to get over it, or that it's all in your head…? Well, it's a testament to female willpower that there isn't a True Crime Podcast dedicated to Menopausal Murderers.

I’m Not Mad, I’m Sad or Stressed!

Whilst some women experience rage, many others find they just have fleeting irritability, but rather, they are plagued with feelings of stress and anxiety, or even depressive symptoms. Interestingly, these stem from the same issues - the dysregulation of serotonin and dopamine.

Everyone’s unique brain chemistry is slightly different, so whilst this dysregulation for some women can result in rage, for another it can manifest as anxiety, and another can find themselves feeling very blue. Ultimately, the root causes are still the same.

The Toll on Careers and Personal Relationships

Studies indicate that perimenopause can signal the onset of mood disorders - but, are we treating the symptom rather than the cause? In reality, many of the issues women face in menopause DO have treatment (such as hormone replacement therapies) but women are not able to access it, or are not well educated about it, leaving them with confusion and fear around something that could significantly help. Instead, they are left feeling the need to treat mental health issues that, in reality, stem from physiological ones.

And, for many women, these mental health changes impact careers and personal relationships, causing strain between husband and wife, or mother and children, leading to a domino effect. Consider the woman who is experiencing these mood shifts and is constantly snapping at her husband and children, leaving her with less of their love and support - in turn making her feel more isolated, and so on.

So, What Can I Do About It?

Many of the things that help perimenopause in general, also help with perimenopause rage, and many are great lifestyle changes that can help our overall health and longevity:

1. Exercise - This is because regular exercise floods your body with endorphin hormones, serotonin, and dopamine, which gives you a boost when menopause has your hormone levels depressed.
2. Eat Well - From phytoestrogen rich foods to foods that can potentially help boost neurotransmitters, what you eat matters! You can read more about that on our blogs on best menopause foods and foods for mood!
3. Drink Water - Estrogen helps a woman’s body tissues retain water, so when estrogen levels decrease, it becomes harder for those tissues to hold on to moisture. Dehydration has a number of adverse side effects, including irritability and confusion.
4. Sleep - we all know lack of sleep can make us grouchy, but it also makes it harder to concentrate, makes repair harder for our bodies, and increases the likelihood we will reach for sugary snacks or caffeine - which can then increase anxiety and make it harder to sleep... and a vicious cycle begins.
5. Meditate - even if you're not into deep breathing or yoga, simply spending time away from screens and outdoors can help. Many mindfulness practices can be found online, from muscle relaxation to breath work that can help you feel more grounded, calm, and in control.
6. Get Support - from besties to family to a professional - support in menopause matters. Studies indicate that 66.7% of women reported feeling negative about menopause, but this figure was strongly correlated with the support systems they had (friends, family, social network, etc.). Shared experience and care can mitigate our menopause symptoms, and boost those feel good chemicals. To learn more about this, you can read our blog on menopause and social factors.
   
   

How Hormone Replacement Can Help

Whilst those six tips are all great ways to boost your overall health and mood - they are by no means the only way to do so. Hormone replacement therapy can help top up the hormones that are being depleted, and balance out the gaps between estrogen and progesterone.

As our hormones become stabilized, our neurotransmitters are also better regulated - and many other symptoms are also alleviated, thus creating a significant change in how we experience perimenopause.

When tension mounts and you need a little break/help - that’s where Chaos Calmer comes in…. It helps you take that deep, calming breath and calm the chaotic neurotransmission in your head that makes it want to explode!