Are the mental effects of menopause weighing on your mind? Women often experience irritability, anxiety, difficulty concentrating and mood swings as they go through this phase of life. The reason: The decline in levels of estrogen and other hormones that occurs during perimenopause directly affect the neurotransmitters in your brain, explains Holly Thacker, MD, FACP, CCD, director of the Cleveland Clinic Center for Specialized Women’s Health.

It’s important to note that the mood swings of menopause and depression are two separate things. Menopause does not cause depression, nor are there higher rates of depression among menopausal women, Dr. Thacker says. However, she points out that women with prolonged perimenopause are more likely to report having depression.

And while menopause may not cause depression, according to a report issued by the Harvard Study of Moods and Cycles, a history of depression may bring on earlier menopause. If you are experiencing a prolonged low mood or deep anxiety, you should speak with your physician and seek treatment specifically for this condition.

QUIZ: How Happy Are You?

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If you are perimenopausal and experiencing mood swings, ask your doctor about taking a low-dose oral contraceptive (OC) — even if you are not seeking contraception. By continuously providing stable hormone levels, the pills may control your fluctuating frame of mind. Women over 35 who smoke should not take OCs.

“There are multiple ways to address mental changes during menopause,” says Elizabeth Ricanati, MD, medical director of Cleveland Clinic’s Lifestyle 180 program. “Your physician should address you as a whole person and try whatever works best for you. Exercise and stress management are key, and certain medications can be really helpful.”

To manage the everyday moodiness that comes with midlife, take the following positive steps — you’ll have a better outlook and feel calmer.

Get a move on. There’s very little in our lives that doesn’t benefit from regular exercise, especially for menopausal women. Not only does it help manage or prevent physical health issues that become more prevalent once estrogen levels drop, such as cardiovascular disease and osteoporosis, but experts point to a growing body of research that shows exercise improves mood as well.

“When you exercise, your body releases stimulating chemicals in the brain that promote relaxation and enhance a person’s sense of well-being,” says Lori Gemma, DO, a family medicine physician affiliated with South Pointe Hospital, a Cleveland Clinic hospital. “Since regular physical activity makes you look and feel better, it can improve your self-esteem and confidence, while reducing anxiety and depression.”

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Stretch it out. Yoga is often recommended for relaxation, and research indicates that it specifically helps menopausal moodiness. In a study published in the journal Menopause, researchers found that perimenopausal and menopausal women following an eight-week program of basic yoga poses, breathing exercises and meditation had decreases in both perceived stress and the tendency to experience negative emotions. (Other studies, by the way, have shown this mind-body exercise to have positive effects on hot flashes and sleep disturbances during menopause.) Multiple yoga-for-menopause routines are available on DVD; or see if your gym or community center offers a program. 

Bond with your buddies. If you’re feeling too cranky to see anyone, seeing friends may be just what you need. The reason: It will boost your oxytocin levels. This chemical, explains Scott Bea, PsyD, a clinical psychologist in the Department of Psychiatry and Psychology at the Cleveland Clinic, is involved in feelings of connectedness and compassion; according to research published in the Journal of Neuroscience, oxytocin may also reduce anxiety. It appears to decline during menopause — but, on the bright side, engaging with others can help raise levels.

“There is mounting evidence from both animal and human studies that social behavior produces a neurochemical effect that helps us feel better, more connected and less fearful,” Dr. Bea says. ”In many ways, this evidence lends scientific credence to the wisdom of the ages. Indeed, being with and caring for one another has beneficial effects.” Invite friends over (chances are some of them are going through the same thing) for a game night, expand your circle by joining a club or get involved in a volunteer activity.

Jog your memory. Feeling fuzzy-headed or forgetful? It may just be in your head — literally. Your brain has estrogen receptors in the hippocampus, the area of the brain responsible for memory formation, leading scientists to believe the hormone has a direct impact on our mental acuteness.

While the hormonal fluctuations of menopause are not the only cause of declining cognition, says Michael Parsons, PhD, a neuropsychologist at the Cleveland Clinic’s Center for Brain Health, “it can be one variable.” But even if your midlife transition is affecting your memory, it’s likely only temporary: A report published in the journal Neurology suggests that while the ability to learn may decrease in perimenopause, it rebounds to former levels after menopause.

The best way to stay sharp in midlife and beyond? “Physical exercise,” Dr. Parsons says. A recent study in the Journal of the American Medical Association is just the latest to show that regular aerobic activity is a key contributor to maintaining your brain.  

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Get balanced. Many physicians believe that some psychological changes that take place during menopause are caused by hormonal imbalances. Talk with your physician about your symptoms, the appropriateness of hormone therapy for you and how to achieve the right balance of hormones in your body. You and your doctor should work together to develop a plan that may include estrogen creams, a full regimen of hormone replacement therapy or other treatments.

by Anne Gallagher