When we think of the perimenopause (or premenopause)we think of periods that become irregular, changes in the cycle, the first hot flashes… But we think less of mood swings.
And yet this whole period of gradual transition to menopause, which begins around the age of 40 (or even before) has effects on hormones and therefore on the menstrual cycle, but also on mood.
There perimenopause thus refers to “the period from which these signs are first observed and ends one year after the last menstrual cycle”, explains the WHO. It can last for several years and “impact physical, emotional, mental and social well-being”.
Anxiety, crying spells… and even memory loss
There perimenopause period is marked by a long hormonal fluctuation, with a decrease in estrogen and progesterone levels. Testosterone – the “male” hormone – also drops slowly. Menopause occurs when the ovaries stop producing estrogen and progesterone. Menopause is considered confirmed “after 12 consecutive months without periods, in the absence of other obvious physiological or pathological causes and clinical interventions”, according to the WHO.
“It’s usually a confusing time that surprises many of us, largely because the symptoms of perimenopause can be extremely unpredictable,” obstetrician-gynecologist Dr. Anna Barbieri told HuffPost in an article dedicated to the effects of perimenopause on the psychic state. “Hormonal changes and how symptoms manifest are anything but linear.”
These hormonal changes, in particular the decrease in estrogencan thus trigger worsening of symptoms of premenstrual syndrome (breast tenderness, acne breakouts), irregular periods (heavier and more frequent or lighter and shorter), insomnia (especially in the two weeks before menstruation), hot flashes and sweating nocturnal. All to varying degrees and frequencies. They can also cause mental symptoms, such as depression, anxiety, irritability, brain fog, crying spells and mood swings. But also of mild cognitive impairment (loss of memory or concentration) themselves sources of concern for women.
Why does perimenopause affect mental health?
“There is growing evidence that estrogen – and estrogen signaling pathways – are involved in a wide range of brain functions, including mood, cognition and memory,” explained to HuffPost, Dr. Juliet Nevins, gynecologist.
When estrogen levels decrease, brain receptors receive fewer hormones, which can potentially impact body and mental health. So low estrogen plays on the hypothalamus (the body’s thermostat) so that it becomes more sensitive to slight changes in body temperature, triggering exaggerated hot flashes and night sweats to cool the body down. . And the consequence of night sweats is that it plays on sleep, which becomes more fragmented, therefore less restful and a source of stress, irritability or even a drop in concentration and memory difficulties or even decision.
There drop in progesterone can also lead to a decrease in the activity of a neurotransmitter called GABA, known for its “calming” effect. Consequence: perimenopause can result in a potential increase in anxiety and sleep problems, such as difficulty falling asleep.
There testosterone can also play an important role: “When out of balance, testosterone levels can cause emotional fluctuations that lead to depression and irritability”explains Anna Barbieri.
Do not hesitate to talk about it and adapt your lifestyle
Beyond the effects of hormones on the body, perimenopause also coincides with a time in life when women can ask themselves more questions. Thus an increase in stress will not be explained solely by the decrease in estrogen: difficulties related to professional career or private life can also play a role. Also, it is important to talk about it as much as possible with the medical entourage, as well as with family or friends. According to an OpinionWay survey “The French and menopause”, carried out in January 2023, menopause remains taboo for 22% of French people and the first reason given is that “it’s a big shock in a woman’s personal life”.
Faced with the symptoms, here are the tips to keep in mind:
- Do not hesitate to talk about to their doctor, gynecologist or midwife. This already allows you to confide, but also to rule out any other pathology (thyroid disorders for example) and possibly to set up a treatment.
- Adopt a healthy lifestyle, either a balanced diet, particularly close to the Mediterranean diet. “The Mediterranean diet is linked to a reduction in hot flashes, symptoms of depression and cognitive decline”, said Dr. Suzanne Fenske, gynecologist.
- Adopt regular physical activity. “Light to moderate aerobic activities, such as brisk walking and Tai Chi, are thought to increase brain volume and improve executive function”said Dr. Fenske.
- get enough sleep. “Having a set sleep schedule, where you fall asleep and wake up at the same time each day, trains your body and mind to sleep.”
Sources:
- How Perimenopause Affects Your Mental Health, HuffPost, February 27, 2023.
- Menopause sheet, WHO.
- OpinionWay survey “The French and menopause”, conducted in January 2023.
