Menopause & perimenopause

The “bitch factor” — irritability in perimenopause

by Dixie J. Mills, MD

• Irritability and guilt: keeping perspective
• What PMS and menopausal irritability have in common
• Food, sleep, and your emotions
• Breaking the cycle of bitchiness

A good friend of mine called recently to talk about an issue she was having in her relationship. She was in tears, not because of anything her partner had done, but because of her own behavior. Irritable, cranky, crabby, and bitchy were the words she used to describe herself. Deep inside, she felt unhappy and out of sorts because feeling irritable was not her “normal” state and she was embarrassed about it. I was the first person she felt brave enough to talk to about it. She described how she had fallen into a nasty pattern of verbally attacking her loving partner of over 30 years. Nothing seemed to help the situation. She felt guilty and wanted to be able to control her outbursts, but she couldn’t seem to stop herself — what she really wanted was to just be alone!

What’s funny (but not amusing) about my friend’s problem is that she’s not alone, not by a long shot. Irritability and mood swings are unpleasant but common symptoms of perimenopause and hormonal imbalance. For some women with a history of premenstrual syndrome (PMS), it may become increasingly pronounced over the years.

If this sounds familiar, there are some effective ways to bring yourself back from the edge, especially if you take steps to rebalance your hormones. The real opportunity that’s hiding behind your irritability is the chance to pause and say to yourself, Wait — I’m not really mad at this person standing in front of me. So, what am I really upset about?

The “whiplash effect” of irritability

Midlife irritability, though a different circumstance from deep-seated, long-term anger, can still produce lots of misery. Many women are surprised that their irritable episodes are often rooted in the physical changes that occur during perimenopause and can rear its ugly head as impatience, crankiness, or low-grade dissatisfaction with just about everything — and everyone. Even a woman who is normally calm and patient may hit perimenopause and be shocked to find herself morphing into a shrew and furiously questioning the intelligence of an unsuspecting store clerk — perhaps very loudly.

Like my friend, other women tell me that when they snap at family members, co-workers, or even complete strangers, they feel instant regret. Eruptions of crankiness can cause negative fallout — guilt, remorse, and magical thinking when you believe you can rewind the clock and take it all back. But, it’s best to let reality set in, and accept that fact that it happened (not so easy, I know). When you actually let the angry moment pass, your perspective will change and you just might have learned something important about yourself and your life (you may even find it’s funny in retrospect). And at the end of the transition into menopause, a kind of “mellow wisdom” helps light your way, though some times it’s easier to access than others. Just know that your perimenopausal crankiness is likely not a permanent condition.

I have to remind women that, in so many ways, the transition from perimenopause to menopause and postmenopause is a journey for rediscovering who you truly are — physically, emotionally, and spiritually. So even if you thought you had your irritability issue licked long ago, here it is again, popping back up during midlife. Your grumbling may actually be bringing an important nugget of truth to the surface where you can understand it better, and then deal with it more directly.

I once had a patient who told me that her irritability was so intense she felt as if she could chew through steel. When I told her that was a powerful insight, she said, “I don’t see my bitchiness as insightful or helpful — and it certainly isn’t funny.”

And I understand that. But staying angry and feeling ashamed by your outburst may give the episode more power over you and your immediate future than serves your best interests. Forgiving yourself, through contemplation, emotional work with a therapist or program, or doing whatever you need to do to fully process your feelings — and especially if you can have a little chuckle as soon as possible — can help rinse away any embarrassment and shame, and allow you to come to a place of peace with where you are in life.

Connecting perimenopausal irritability to PMS

Even if your periods have become erratic, take a minute to recollect what you can about your own menstrual cycle over the years. If you have always had PMS with irritability, that crankiness could grow stronger near midlife. With PMS and perimenopausal irritability, it’s as if your normal personality does a “180” and turns you into a vitriol-spewing harpy.

Many integrative health practitioners see PMS as exposing how a woman feels all the time. She is able to manage her crankiness most of the month, until physiological changes begin to occur just before her period. These physiological changes are like a door swinging open on all her pent-up frustration, so it’s suddenly released and able to run wild.

Certain hormonal fluctuations, such as a drop-off of progesterone levels, both premenstrually as well as in perimenopause, can certainly be linked to heightened irritability. Research suggests that there are brain changes during a woman’s luteal phase (the latter part) of her menstrual cycle that could predispose her to hear fewer positive words during the premenstrual week. In other words, hormonal changes may make you more vulnerable to interpret whatever you’re hearing as more negative, or more likely to be set off by hot-button words, phrases, or events! The second half of the monthly cycle can also seem “darker” for some women. They may have less energy, less resilience in the face of stress, or react with greater irritability. In addition, chronically high stress can amplify the effects of changing estrogen and progesterone levels in perimenopause and menopause, as well as the delicate balance-ratio between them.

Once your period begins — and during perimenopause, it can be very irregular — additional changes in progesterone and other sex hormones may influence how well your brain integrates information and performs tasks. In thinking about this, you may have noticed or remember a sudden sense of relief come over you as soon as you got your period, or maybe you dropped things a lot, or felt fuzzy-headed or sleepier. But the luteal (2-week premenstrual) phase is when many women experience heightened awareness of their frustration and discontentment with certain aspects of their lives. This may bubble up as irritability and burst forth with gusto! When this happens, try to be kind to yourself and don’t berate yourself. This gentle acceptance can help you carve out a space — an opening to explore your life and, perhaps, what’s not working so well right then. (Hint: Maybe it’s time to pay more attention to YOU.)

Nutrition, emotional health, stress level, and sleep quality

Be the lotus

In the practice of yoga, posture is extremely important, partly because it can affect your mood. As an exercise, imagine you are a lotus flower — a symbol of transformation in yoga. Stand straight — but not rigidly— and imagine that your spine is the trailing lotus stem. Carry your head like a lotus flower floating gently atop of your spine. As you breathe deeply, feel the energy and air in your “central column” circulating freely and releasing tension.

Other factors can compound irritability in perimenopause. If your general nutrition is sub-par, and you’re not getting enough B vitamins and essential fatty acids every day, your “bitch engine” may go into overdrive. If your emotional needs aren’t being met, and you’re pushing yourself too hard, working too many hours, and not getting enough sleep, your grumpiness level will probably skyrocket. If any of these patterns continues for a long period, your tendency to be irritable will likely increase.

I don’t believe there’s a woman anywhere who hasn’t lost her cool at some point, but if you feel you’re getting “triggered” regularly, it may signal a larger issue that’s lurking beneath the surface. Once you acknowledge this, you can construct a method for dealing with it and finding a different way to express it. The most important message is to allow yourself to have more compassion for someone who really needs it — you. If you can figure out what might be really driving your impatience, it will definitely defuse your bitchiness.

Preventing irritable outbursts

Okay, so you’ve barked at someone close to you and, in addition to feeling irritable, you feel guilty, too: I feel awful that I told my son he smelled like a sweat sock… he’s just a kid! I am a terrible person, aren’t I? This thought pattern about something you have said will trap you, allowing the whole incident to make you feel embarrassed, ashamed, and powerless. This negative cascade can continue for days, if you don’t put a stop to it. Try not to dwell on this one moment in time and allow it to define you.

The key is compassion, first of all for yourself, but yes, for anyone else you may have hurt. An apology, along with a short explanation for your crankiness, may help you move forward. If you’re embarrassed by how you acted, say you’re sorry and try to talk about it. You and “your victim” may even be able to laugh about it, but the goal is to move on as quickly as possible.

Creating the conditions in your body for achieving hormonal balance can help you feel less irritated in general. I encourage you to begin intentionally acknowledging and tending to your real needs, both physical and emotional.

Ensuring that you have consistent good nutrition is vitally important for stable moods and to meet the energy demands of your body, though it’s easy to forget it in the rush of a busy lifestyle. And regular physical activity, including contemplative practices such as yoga, is a key component for maintaining hormonal and emotional balance. Try to leave time for your favorite type of exercise as often as possible. Exercise can single-handedly bring you out of nuclear hissy-fit mode. Also, don’t forget the soothing powers of sleep and rest — a little catnap can do wonders for your state of mind.

Lighten up with loving, laughing compassion for yourself and those around you

Most of the women I know in perimenopause have a cranky outburst now and again, and while it doesn’t feel good, it is forgivable. And if you take these events as little lessons, you may be able to speak more clearly about what is really bothering you or what you really want. Understand these episodes for what they are and don’t fixate on them — that can empower you to move on more quickly.

Acknowledge that it feels really crummy when you bitch at someone, and no, it isn’t so funny at the time. But no matter how bad it might seem then, these moments do pass. You don’t have to freeze-frame them for all eternity. My friend broke her pattern of grumpiness by getting away for a solo mini-break. She came back rested and refreshed and says she’s feeling much better, though she is still in the process of making some important changes.

So here’s your homework: contemplate, laugh, learn, forgive — and let go. Then move on with your life. It may take some practice, but trust yourself — you’ll get the hang of it.

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