Moody Bitches: The Truth about the Drugs You’re Taking, the Sleep You’re Missing, the Sex You’re Not Having and What’s Really Making You Crazy.... Julie Holland
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prevalence of depression is highest in women aged forty to forty-nine and lowest in women older than sixty; hence, the storm before the calm.
When you remove a female rat’s ovaries, depleting her of estrogen, she shows increased anxious and depressive behaviors, which can be reversed by administering estrogen. Lower estrogen levels will lower overall serotonin activity. Remember, if you’re prone to reproductive depressions—if you get significant PMS or if you’ve had postpartum depression—you’re more likely to have mood complaints with your perimenopause. Reproductive depressions are responsive to hormones. Once you’re past menopause, major depressions need to be treated with antidepressants because hormones won’t work as well.
Insomnia and Anxiety
I was on the phone with a therapist talking about our mutual patient. The conversation quickly turned to the therapist’s own issues and struggles. She’s fifty and miserable, not depressed so much as she is agitated. She gets anxious during the day, and then her sleep is interrupted by frequent panicked awakenings.
The estrogen-dominant phase of perimenopause can be an anxious, depressed time for a couple of reasons. High estrogen, when it tamps down the thyroid function, ends up inhibiting the activity of a calming neurotransmitter, GABA. Lower progesterone levels also lead to lower GABA activity and therefore more anxiety. In the later transition, when estrogen levels fade, anxiety can become even more of a problem. There are estrogen receptors on the amygdala (the brain’s fear and panic center) as well as the hippocampus (memory) and limbic system (emotional control). When the brain’s hormone control center, the hypothalamus, sees lower levels of estrogen, it seems to panic, decreasing production of serotonin and dopamine but ramping up norepinephrine. The end result: low mood, insomnia, and fatigue, but with a touch of anxiety and agitation thrown in. It’s not an anxious fear so much as it is irritation, often aimed at partners. Any little thing can set you off and make you angry. This is “ roid rage,” truly: agitation brought about by a change in steroid hormones.
Insomnia is a biggie during perimenopause. Throughout their lives, women experience insomnia more than men do, but it jumps from 36 percent of women at age thirty to 50 percent at age fifty-four. A few issues are at play here. Cortisol helps to establish circadian rhythms (your body knowing when it’s day and night), so when cortisol levels drop during perimenopause, not only is your ability to cope with stress severely limited but also your sleep cycle is a mess. High estrogen levels in early perimenopause can deplete magnesium. For many women, magnesium supplementation can treat insomnia and anxiety, and it’s also great for restless leg syndrome. While progesterone is calming on the brain, estrogen is more excitatory. Estrogen dominance exacerbates insomnia; progesterone replacement can help restore sleep. In early perimenopause, supplementing with natural progesterone can help with insomnia. Once you hit the waning estrogen phase of the transition, you’ll probably see better effects on sleep by using estrogen.
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