One minute you’re screaming at a colleague to get that project done now! The next you’re in tears over a cat food commercial. WTF is going on? Women often hear the word “emotional” used interchangeably with “hormonal,” and it’s not usually a compliment. But there are legitimate reasons why your emotions are in upheaval during the process of menopause.

Stress

“Menopause, itself, is a stressful life event because of the various types of change that occur,” says Dr. Jeff Brown, a professor of psychology at Harvard Medical School

Hot flashes are tightly linked with stress and anxiety, according to a six-year study published inMenopause. Researchers found that anxiety and stress preceded hot flashes among perimenopausal and post-menopausal women.

Stress is your body’s reaction to any kind of demand—good or bad. Acute, or brief stress can make us more efficient and effective (think: deadlines), too much stress or chronic stress, on the other hand, can be harmful to your mental and physical health.

What’s more, chronic stress can compromise our immune systems, making us more prone to illness. Between 50 and 60 percent of all medical issues originate from stress or stress-related events, he says.

So how can you tell the difference between a stressful situation and a real stress rut? Signs that you’ve hit your acute-to-chronic tipping point include changes in appetite and sleeping patterns, headaches, crying, irritability, and even panic attacks, according to Brown.

“When it comes to stress and menopause, it’s crucial to keep your finger on the pulse of physiological, psychological, and relationship aspects of your life. Change is occurring and knowing yourself well is vital,” he says.

Of course, you likely won’t feel the exact same way pre-menopause as you do post-menopause, and some of that is natural. But there’s no need to feel like a totally different woman, especially if that woman is stressed all of that time. You can slash your stress levels. Remember, though, that while your old stress-busting tactics like bubble baths, exercise, and meditating still work, you might have to go above and beyond them to beat stress during menopause, especially when menopause is the actual stressor.

“Each woman who deals with menopause may find that her typical stress-coping strategies need to be adjusted because of the high levels of stress that may be occurring as a result of physical changes during menopause,” Brown says.

Here are three tips for fighting menopause-induced stress:

1. Take charge. Don’t let menopause and its symptoms take control of your day-to-day life, says Brown. Commit to an open and close relationship with a perimenopause and menopause specialist, healthcare provider, or therapist who can help you manage your symptoms and find hormone happiness. “The alliance you have with a physician or therapist can mean the world to you during tough times,” Brown says.
2. Invest in friends. Misery loves company—but so does happiness. Recognize the people in your life who are healthy for you and invest in those relationships. Healthy people are the ones you want to hang out with, and who make you feel better about yourself, Brown says. It is especially helpful spending time with the women in your life who have already traveled the menopausal road you’re currently on. The support, understanding, and even learning opportunities can help make this time in your life a little less stressful, he says.
3. Say no. This is a hard one. While women are famed for multitasking, it takes a huge amount of time and cognitive energy, and adds unneeded stress to an already stress-filled time of our lives, Brown says. And during menopause you may not have the same amount of energy you did in your twenties. For your health’s sake, scale back a bit. Say no from time to time, and don’t feel guilty about it afterward.

Depression

According to Dr. Julia Frank, women are in states of “hormonal flux” at puberty, premenstrually, postpartum, and during perimenopause and menopause. So, from as early as age 10 until our 60s, we’re faced with a seemingly constant wave of hormone fluctuations.

Dr. Frank says that “hormonal flux, loss, and change” are “part of normal experience,” but when you’re living for weeks on end at a 2 instead of a 10 or can’t find the joy in living, there are options that are best evaluated and treated in partnership with a knowledgeable doctor that you trust.

“Hormones are also neuromodulators, so rapid changes can trigger mood symptoms,” says Dr. Frank. “In addition, women who are in the later stages of mid-life face many changes that can lead to depression–loss of the members of the older generation, dealing either with not ever having children or having children leave home, reaching a plateau at work or other workplace stresses, and the sexual changes that may occur in intimate relationships all may trigger depression. All of these factors–hormonal flux, loss and change–are part of normal experience, so the association with depression usually involves either prior personal depression, experiencing more than one stressor or factor, or having one stressor that is unduly severe.

I asked Dr. Frank to weigh in on the top three questions women ask on the subject. Here’s what she had to say:

Do antidepressants help for menopause symptoms? Can you take antidepressants at the same time as hormone therapy?

“Yes. In particular the serotonin reuptake inhibiting antidepressants work as well for depression in menopause as at other times–they also may relieve hot flashes, even in the absence of depression. In some women, the combination of hormones (estradiol in particular) and antidepressants seems to be more effective than antidepressants alone.”

Are some antidepressants more effective and/or safer than others?

“The selective serotonin reuptake inhibitors (SSRIS) (fluoxetine (Prozac) and its cousins), and the dual acting antidepressants that inhibit the reuptake of both serotonin and norepinephrine[SNRIs] (venlafaxine (Effexor) and duloxetine (Cymbalta) and desvenlafaxine (Pristiq) are all safer than the older classes of antidepressants (the tricylics (amitriptyline (Elavil) and monoamine oxidase inhibitors (tranylcypromine (Parnate).

“Very few studies directly compare antidepressants to each other, so it is not really possible to say that one group clearly works better than another. However, the SSRIS and dual acting agents both clearly help with depression in menopause. Some women will respond better to one than another, but that has to be determined on an individual basis; it isn’t predictable from large studies.”

What are some natural ways women can fight depression?

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“EXERCISE, EXERCISE, EXERCISE is the best proven “natural method” for fighting depression. Thirty minutes of vigorous aerobic exercise three to four times a week is necessary to experience this effect, but you don’t need to sign up for a marathon or a boot camp; walking, biking, swimming all work fine if you do enough of them. Exercise also helps with sleep, bone health, and even hot flashes.

“Exposure to very bright light in the winter (not tanning, just bright light in the visible spectrum) helps many women, especially those with what’s called Seasonal Affective Disorder, or ‘winter blues.’ The equipment for this is not terribly expensive and does not require a prescription, but you do need to use it correctly for 30-40 minutes every day.

“Psychotherapies of many kinds also help with depression; often just a few sessions are enough to get people back on track. Interpersonal therapy, which involves focusing on important relationships, or cognitive behavioral therapy, which involves changing patterns of thinking and activity, are both well proven methods of relieving depression without medication.

“Attending to spiritual concerns—resolving conflicts with others, looking for meaningful activities and a supportive community—is another important aspect of self-care for depression. Various herbal remedies are much less clearly effective than these methods.”

Dr. Frank’s advice makes perimenopause and menopause sound like an opportunity to learn more about ourselves, improve our relationships, and stay healthy. She may be on to something.

Anxiety

“Calgon, take me away!” – 1970s bubble bath commercial

First and foremost, it’s not your imagination that life is rockier than it used to be. We’re at that time in our lives when caring for ailing parents, raising children, and working full-time are on a collision course.  We’re long past those idyllic pre-internet, pre-cell phone, pre-email, pre-everyone has to be available 24/7 days, when a simple bubble bath was enough to soothe our frayed nerves.  Even the various stages of menopause can affect your mental wellbeing.

Psychiatrist Dr. Harry Croft, principal researcher at Clinical Trials of Texas, says putting yourself first is critical in restoring a healthy mind-body balance.

A study cited by the National Institute of Health uncovered significant differences between peri and post-menopausal women in terms of vitality and quality of life.  Two control groups of each age range were scored on anxiety, depression, and quality of life and the differences between the two groups was dramatic.  Considering you spend one-third of your life in the peri and post-menopausal years, it’s a good time to sit up and take notice.

“Stress and menopause can make for an endless anxiety-riddled loop, requiring women to examine whether their current approach to managing their health is really working.  For example, low estrogen can make you feel crummy and you won’t function as well.  Throw in lack of sleep due to insomnia or waking in the middle of the night and boom—you’re super stressed. Because of that stress women may recognize depression, anxiety, and turn to self-medicating through alcohol consumption.  There is a huge rise of alcohol abuse in older folks because they don’t have to get a prescription to drink.  Many women closet drink and tell themselves it helps them relax, but might not recognize that they’re drinking because of stress.  Also, women build up a tolerance to the effects of liquor and then have to drink more to feel good.  Now, if they go to their doctor complaining they can’t sleep and doc writes a script for a sleeping pill, then that can be a troubling mix,” explained Dr. Croft.

Dr. Croft says a much smarter approach is to have a menopause specialist run a hormonal panel.  Balancing menopausal hormones is an important first step to feeling better. Often, women find that hormone therapy as recommended by their specialist is enough to get them in top shape.  If there is a need for further evaluation by a psychiatrist who might prescribe antidepressants, those meds work more effectively once hormonal levels are closer to normal, especially estrogen.

While a bubble bath and a little peace and quiet away from the demands of your oversubscribed life would probably help, it’s a great relief to know you’ve got a lot of options to quiet the storms brewing inside your head.