Feeling Ragey? It Could Be a Sign of Perimenopause

Photo: Courtesy of HBO

A potent mix of imbalanced hormones, chemical-goings on, and situational factors facing forty- and fifty-something women may be the reason for cascading bouts of rage.

The entire plotline of Netflix’s popular show Beef was rooted in rage: specifically, one epic road rage incident between Ali Wong and Steven Yeun’s characters that quickly spiraled. Displays of rage—specifically female rage—on screen have, in recent years, become more common (see also YellowjacketsI May Destroy You, and Big Little Lies). But while the dramatization of rage for entertainment’s sake is trending, its occurrence—particularly among women who find themselves in perimenopause or the menopause transition—is very real. Julie, a 45-year-old marketing executive in Boston, was intentional about steering clear of Beef during her regular Netflix scrolling. “I was nervous to watch it because I felt like I would see myself on screen,” says Julie, who has been dealing with cascading bouts of rage that her ob-gyn attributed to hormones.

Hormones do indeed play a significant role. “Because of the declining levels of estrogen and progesterone in perimenopause (the years leading up to menopause) and during the menopause transition, our mental health can be impacted,” says Allie Sharma, MD, a psychiatrist and part of Evernow’s women’s health advisory. These hormones can directly impact our brain chemistry, including the production and regulation of brain chemicals called neurotransmitters like serotonin, dopamine, and norepinephrine. These are, says Lisa Mosconi, PhD, a neuroscientist and associate professor of neuroscience, crucial for brain function in general, and mood in particular. “As these levels become imbalanced, women may experience mood swings, increased anxiety, depressive symptoms, and heightened irritability or rage,” says Mosconi.

GABA, the neurotransmitter believed to have a calming effect, is another one that dips along with estrogen loss, adds Leah Millheiser, MD, a clinical professor of obstetrics and gynecology at Stanford and Evernow’s chief medical officer. Hormonal fluctuations can also have a disruptive effect on the hypothalamic-pituitary-adrenal (HPA) axis. “This is a very important system connecting the brain to the ovaries and to the adrenal glands responsible for the body’s stress response,” says Mosconi. “Alterations of the HPA axis can make it more challenging to cope with everyday stressors.” Like, for instance, someone cutting you off in a store parking lot.

But hormonal and chemical goings-on aside, there are also a host of situational factors that accompany the forty- and fifty-something years that could make a person want to, well, rage. Like, say, caring for young children and shepherding them through adolescence; caring also for aging parents; increasing professional demands; and maintaining a longstanding relationship (or forging a new one). They can all, says Mosconi, add fuel to the fire. Not to mention the physical manifestations of the menopause transition like hot flashes, vaginal dryness, sleep and skin changes, fatigue, and insomnia. “Coping with hot flashes throughout the day, abdominal weight gain that seems to come out of nowhere, and changes in sexual function can all be a source of frustration, in general,” says Millheiser. Add to all of the above the hormonal and chemical elements, and you have a mental health pressure cooker. “These circumstances, combined with an already overworked HPA axis, can make it feel as though the universe is conspiring against you, turning everyday irritations into rage-inducing triggers,” adds Mosconi.

While depression and anxiety are widely reported during the years of perimenopause and menopause, clinicians also hear a lot about rage, anger, and mood swings. Because rage is not a clinical symptom, it’s often defined as extreme irritability or anger, says Sharma. Typical irritability can be a perimenopausal symptom for 70 percent of women, with rage occurring less often. “Rage is associated with a greater emotional response than irritability alone,” explains Millheiser. “Most women will describe going from their baseline mood to a more intense level of anger, resentment, and irritability in a matter of moments.” There are some factors that may make an individual more inclined towards rage like, says Sharma, your mental health history, particularly if it includes significant anxiety or depression. And, adds Millheiser, there is some evidence that women who experience PMS symptoms during their lifetime are more likely to experience mood changes during perimenopause, which may include rage.

So, how can it be dealt with? If the rage or mood shifts are specifically due to hormonal changes associated with the menopause transition, hormone therapy—whether it’s perimenopausal birth control pill use, which is what Julie’s doctor prescribed her, or menopausal hormone therapy—can be effective treatments, says Millheiser. Though, she adds, if there are underlying primary depressive or generalized anxiety disorders at play, then, in some cases, an antidepressant can be helpful too. Cognitive behavioral therapy can be an incredible coping tool, as can a regular meditation or mindfulness practice, as well as regular physical activity or exercise to help increase the release of all those endorphins and serotonin. Prioritizing sleep hygiene, all experts agree, whether that’s working on a consistent sleep schedule, minimizing pre-bedtime screen time, or upgrading your sleep environment, is huge. Identify your rage triggers (maybe it’s frustration with memory changes or lack of sleep), says Millheiser, and focus whatever energy you can muster on addressing them. And don’t shy away from asking for help and support from your community. “Nurturing social connections and seeking support from friends, family, or support groups can provide a valuable outlet for sharing experiences and coping strategies,” says Mosconi. “We all need to vent sometimes.”

We also need to understand and accept that this rage often has a time limit: like so many of the other circumstances of this period, it won’t last forever. It’s also not abnormal. “Contrary to popular belief, mood changes around menopause are not a sign of women’s ‘emotional instability,’ but rather often deeply rooted in the complex interplay of hormones and brain chemistry,” says Mosconi. And while we thankfully have tools to deal with them, these mood shifts are often outside of our control and therefore not something to harbor guilt about. Says Mosconi: “Rage during menopause is not a personal failing.”

This article was originally published on Vogue.com

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