When we think of women in their 40s and 50s, we imagine women who are confident in their day-to-day lives. Any conflicts that come their way, it just rolls off their back and they keep a cool head in any situation.
Sound completely unfamiliar? Well that’s probably because a lot of women in their 40s and 50s can experience mood changes during perimenopause, including irritability. I’ve heard it described in many ways from “every little thing irritates me even though I know better” and “I take my frustration out on my partner and my kids. I immediately feel guilty but it’s like I have no control anymore.”
Irritability is a common mood change during this second puberty known as perimenopause. If you reflect back to puberty in your teens, those same out-of-control feelings come raging back during this transition and it can affect almost every aspect of your life. It feels like a worsening of PMS symptoms, sometimes staring up to 2 weeks prior to your period so you only have one decent week a month.
Now, because of how our society views things like PMS, periods and women’s hormones, it might seem like these changes are normal. The reality is there’s some other underlying imbalance going on. In my experience, it’s not so much that perimenopause itself is causing the mood changes, rather it’s another underlying issue that is heightened during perimenopause and the hormone changes are exacerbating that underlying imbalance.
As always, we’ve got to think about what the cause is. What can make mood changes more complex is that sometimes the root cause of irritability may be due to another symptom of perimenopause. For example, as we’ve discussed, insomnia is a common issue in perimenopause. We know that poor sleep and fatigue can affect your mood dramatically so if we have deduced that the irritability is due to poor sleep, the treatment would be improving your sleep, which should also improve your mood.
Let’s focus on some other common root causes of irritability in perimenopause by starting with nutrition.
Maintaining a healthy blood sugar is important for a variety of reasons but it’s especially important when it comes to hormone balance. You may already be familiar with blood sugar and its relationship to mood when you feel “hangry”. Skipping meals, going hours without eating, or eating high carbohydrate foods with little protein and fat can be a recipe for disaster. Eating balanced meals and snacks regularly can make a big difference in combatting irritability.
Another frequent food trigger can be unidentified food sensitivities. Food sensitivities create an immune response leading to unwanted inflammation which can cause a host of symptoms, including irritability and other mood changes. Greatly reducing or even eliminating those food sensitivities can have a profound impact on improving your mood. Food sensitivities can be identified via food sensitivity testing or an elimination challenge.
The last common nutritional factor in irritability relates to gut health. We have decades of research demonstrating an association between gut health and mental health. While there can be several factors that can influence gut health, food is a large culprit.
Our standard American diet of processed foods and high fructose corn syrup can be a huge hindrance to good gut health. We need fiber, vitamins and minerals found in whole foods to promote gut health and thereby good mental health.
So what if you’re sleeping well, eating well-balanced meals and snacks regularly but still irritable? It may be due to other hormone changes such as thyroid or cortisol.
As previously discussed, changes in thyroid hormones are extremely common during perimenopause. While hypothyroidism is associated with fatigue, weight gain, and depression, it can also be associated with mood swings and feeling like you have a shorter fuse.
Cortisol can also affect mood, specifically elevated cortisol and irritability. Cortisol is normally released by your adrenal glands in high amounts in the morning to help wake you up and then gradually reduces throughout the day. However, elevated cortisol can occur over a period of time due to chronic stress since cortisol is released in response to any perceived stress, whether it’s life-threatening or not. Our bodies can’t differentiate the stress from a bear chasing you or a mean email from your boss.
With years of chronic stress, higher and higher levels of cortisol are released that can actually contribute to feeling anxious and irritable. Thankfully we can easily check this with a salivary cortisol test with samples taken over the course of 24 hours to see what the pattern looks like.
While there are some targeted treatments that can help reduce elevated levels of cortisol, if the reason cortisol is elevated in the first place is due to chronic stress, then stress management techniques and tools need to be implemented.
Since I could (and plan to) write several lengthy articles about stress and stress management, there are some specific stressors I’ve noticed over the years in my practice that seem to be a factor for women in perimenopause when it comes to irritability.
A common source of stress for women as they age are not setting and enforcing healthy boundaries. If you haven’t heard this term before, according to the American Psychological Association, a boundary is “a psychological demarcation that protects the integrity of an individual or group or that helps the person or group set realistic limits on participation in a relationship or activity.”
I find as women mature into their 40s and 50s and beyond, they start realizing that it’s okay to set boundaries. Maybe the way things have been is not working for them it’s time to make a change.
Sometimes the frustration and irritability can come from feeling not happy with the way things are but not quite realizing it yet. Our days are usually packed from waking until bedtime so it’s important to take a little time out of your day to reflect. Is there some imbalance in your life that might be contributing to the irritability? Do some changes need to happen?
For example, do a lot of the household responsibilities fall on your shoulders when you’re already working full-time? Do you feel like your partner or maybe even your older children could help out?
While it can take time to work on your boundaries, even just taking steps towards creating the life you want can feel empowering. There are many great books written on boundary setting but counseling can help you work on setting boundaries by strengthening your voice so you can stand up for yourself.
Since it can take some time to find the true root cause (or causes) of irritability, there are some herbs and other tools you can implement to help improve your mood.
One of my favorite herbs for irritability during perimenopause is Leonurus cardiaca, commonly known as Motherwort. It’s generally used as a relaxing female tonic, in particular for irritability or nervousness. It can also help with irregular or painful periods and it’s especially indicated for women in a time of transition, such as perimenopause.
Motherwort is considered generally safe except during pregnancy or if you have hypothyroidism. Typical dosing is 1 tsp a day of the tincture.
Another one of my favorite herbs for irritability is Scutellaria lateriflora, known as American Skullcap. There is also a Scutellaria bacalensis that has some different effects so know that I’m specifically talking about the lateriflora species.
American skullcap is great to help restore and relax an overactive nervous system. If you’re feeling irritable, agitated, and restless, skullcap can help calm your system down. As a trophorestorative, it can help heal any damage that’s been done to your nervous system from chronic stress.
American skullcap is generally safe and dosing is 1 tsp of tincture 2-3 times a day in water. It does have a mild sedating effect so I sometimes recommend starting with a lower dose and working up to 1 tsp if you need to.
If you don’t already, creating some kind of journaling practice can be really helpful for mood. One option for journaling for irritability is to just get the entire emotion out. When emotions like irritability are denied or we try to shy away from it, they can become stuck and we repeat the pattern. This is because we’re not letting ourselves fully live out the emotion. You might have heard of the saying, “what you resist persists” and that is true for emotions. Sometimes the act of journaling, of just allowing yourself to fully feel the emotion and write everything that comes with it is the way to move through it.
We know movement or exercise is beneficial as well. It’s great for mood and mental health in addition to all its other health benefits. If you don’t have some kind of practice of moving your body daily, start small. Maybe take a walk around the block or do yoga for 5 minutes. Physically moving can be helpful to release the tension stored in our body from irritability.
Lastly but certainly not least is joy. It’s so important to find little moments of bringing joy into your life. Though it may not feel like it sometimes, you ultimately control your schedule. So if creating moments of joy is not something that’s part of your regular routine or on the schedule, you need to make time. You can’t pour from an empty cup so it’s important fill your own cup regularly.
There’s no right or wrong way to create joy. If there’s something that you remember when you were younger that you loved doing to the point that you lost track of time, bring that back into your life. Even if you just start with five minutes a day, that can add up over time and lead to reduced irritability and increased happiness.
Thankfully we have many tools for helping to reduce irritability. But as I’ve mentioned above, the key is figuring out the underlying root cause. So spend some time to reflect and tap into that irritability to see what it’s trying to tell you.