Why menopause can make you angry

Find out what’s happening in your brain that’s bringing on menopause rage

• Up to 70% of women say irritability is their main mood complaint during perimenopause
• Fluctuating levels of oestrogen, progesterone, serotonin and cortisol affect your brain
• You may not be to blame for angry outbursts or simmering rage

Emotions can run high during perimenopause and menopause. Some women find they’re more teary than usual, others fearful, and some can feel full of rage. In a Newson Health survey of almost 6,000 women, an overwhelming 95% of respondents said they’d experienced a negative change in their mood and emotions so if you’ve been feeling angry or irritable, you’re not alone [1].

It’s worth highlighting this as anger is an emotion that many women are uncomfortable feeling. You might be surprised by your outbursts – especially if they’re triggered by something trivial or targeted at loved ones – or feel that you don’t recognise yourself and worry that this is the new you. Anger can also present itself in different ways. You might feel irritable – one piece of research found irritability was the primary mood complaint for up to 70% of women during perimenopause [2] – or experiencing a sudden red mist and loss of control.

Understanding what’s happening in your brain during perimenopause and menopause can help – it can be reassuring to know there are reasons behind your mood instability.

RELATED: Menopause, depression and anxiety

What causes anger during the menopausal period?

There can be very real, legitimate reasons to feel angry at this time of life. However, there are also physiological changes that contribute to an increase in irritability and anger.

Demands of life

Psychotherapist Jennifer Cox says: ‘Women at this point of life have reached peak pressure in terms of the demands expected of them. I see many women grappling with the emotional demands of taking care of teenagers combined with the need to care for the older generation. Working lives too can be fraught with frustration and disappointment at this life stage. Workplaces have typically not provided the most supportive environment for women through their menopause experience. Sadly, many women decide to duck out early, because it’s all just too much to manage. It’s an example of women being told that they are the problem, rather than society figuring out ways of supporting her. Women can begin to view their bodies as somehow failing them, once menopause symptoms kick in.’

The influence of hormones

During perimenopause, levels of the hormones oestradiol, progesterone and testosterone fluctuate, before lowering in menopause and staying low after. The correlation between oestradiol levels and serotonin, which is commonly known as the “feel-good hormone”, is well established [3]. Serotonin helps to regulate mood – when serotonin levels are balanced, you are more emotionally stable, focused and calm. So, when oestradiol and serotonin levels are reduced, you can feel more irritable (or down).

Research has also shown that serotonin levels affect the brain’s response to anger. A study found that fluctuations of serotonin levels affect brain regions that enable you to regulate anger [4].

The amygdala is the emotion centre of your brain – it processes fear, identifies threats, and motivates you to respond to any threat and anger can be a response to a perceived threat. The prefrontal cortex is responsible for executive brain functions such as decision making, judgment and impulse control. The study showed low levels of serotonin made communications between these regions weaker than normal. The hormones oestradiol, progesterone and testosterone all have important roles in the amygdala as well as other areas of the brain.

The amygdala is rich in hormone receptors. Lisa Mosconi, a neuroscientist and author of The Menopause Brain, has described perimenopause – when oestradiol levels fluctuate – as a time when mixed messages are sent to the brain, a sort of misfiring. This can prompt mood changes, including rage, irritability and tearfulness.

RELATED: The menopause brain: why it might be feeling strange and what you can do about it

The effect of cortisol

Cortisol, often referred to as the “stress hormone”, can fluctuate during perimenopause and menopause and can be linked to anger.  These fluctuations in cortisol levels can lead to various emotional changes, including increased irritability and anger. Low hormone levels, especially progesterone, can lead to higher levels of cortisol in the body.

Studies have looked at what happens to cortisol during menopause, and findings include:

• Cortisol levels increase 20 minutes after vasomotor symptoms (hot flushes and night sweats) [5]
• Cortisol levels rise among some women during the late stage of the menopausal transition [6]
• Cortisol levels increase overnight as women through perimenopause and menopause. [7]

Our hormones are closely linked, the fall in oestradiol, progesterone and testosterone levels during menopause can lead to higher cortisol levels, which may exacerbate stress and mood swings. Lack of sleep, poor diet, chronic stress and certain medical conditions can also cause cortisol imbalances, which then further exacerbate feelings of anger and aggression [8].

RELATED: Why is the menopause so stressful?

What about GABA?

Gamma-aminobutyric acid (GABA) is a neurotransmitter (a chemical messenger) that soothes the nervous system. It has a calming effect and promotes the release of endorphins. Progesterone’s interaction with GABA receptors play a significant role in mood regulation.

What can I do about my anger?

Realising that your hormonal fluctuations can have such a disruptive effect on your brain can be reassuring. HRT, often with testosterone, the first-line treatment for menopausal symptoms, can help to even out these big fluctuations by replacing the missing hormones and improve mood symptoms.

Jennifer says it’s important to take your feelings seriously – to explore them rather than internalising and burying them. ‘There are several ways of doing this. You can begin with the absolute basics: Are you tired? Hungry? Did you say yes when you meant no? Do you have any time for just yourself? What do you enjoy doing anyway (at this point in our lives, we’ve often forgotten)?

Practice self-compassion and look after your wellbeing. Take time to discover what relaxation techniques work best for you – some women find mindfulness helpful, or you might prefer yoga or Pilates.

Jennifer recommends walking: ‘It’s great for processing and working through your feelings, and you can probably factor it into your day more easily than other forms of exercise. Get used to saying, ‘I’m going for a walk to clear my head.’ Ringfence your walking time as the space you allow yourself – whether something’s just happened to anger you, or whether you need to think about a wider area of your life which might need to change.’

A healthy, well balanced diet, regular exercise and getting enough rest can all help to manage your physical and mental health.

Jennifer Cox is a psychotherapist and author of Women Are Angry, available now (Lagom).

References

1. Experiences of the perimenopause and menopause, December 2022
2. Born L., Koren G., Lin E., Steiner M. (2008), ‘A new, female-specific irritability rating scale’, J Psychiatry Neurosci, 33(4) pp344-54.
3. Bendis P.C., Zimmerman S., Onisiforou A., Zanos P., Georgiou P. (2024), ‘The impact of estradiol on serotonin, glutamate, and dopamine systems’, Front. Neurosci., 18, https://doi.org/10.3389/fnins.2024.1348551
4. Passamonti L., Crockett M.J., Apergis-Schoute A.M., Clark L., Rowe J.B., Calder A.J., Robbins T.W.. (2012), ‘Effects of Acute Tryptophan Depletion on Prefrontal-Amygdala Connectivity While Viewing Facial Signals of Aggression, Biological Psychiatry, 71 (1) pp36-43, https://doi.org/10.1016/j.biopsych.2011.07.033
5. Meldrum DR, Defazio JD, Erlik Y, Lu JK, Wolfsen AF, Carlson HE, et al.. Pituitary hormones during the menopausal hot flash. Obstet Gynecol. (1984) 64:752–6.
6. Woods NF, Mitchell ES, Smith-Dijulio K. Cortisol levels during the menopausal transition and early postmenopause: observations from the Seattle Midlife Women’s Health Study. Menopause. 2009 Jul-Aug;16(4):708-18. doi: 10.1097/gme.0b013e318198d6b2.
7. Woods N, Carr MC, Tao EY, Taylor HJ, Mitchell ES. Increased urinary cortisol levels during the menopausal transition. Menopause. 2006;13:212–221. DOI: 10.1097/01.gme.0000198490.57242.2e
8. Kajantie, E., & Phillips, D. I. (2006). The effects of sex and hormonal status on the physiological response to acute psychosocial stress. Psychoneuroendocrinology, 31(2), 151-178. https://doi.org/10.1016/j.psyneuen.2005.07.002