Perimenopause can cause a range of symptoms, some more common than others. Irritability and anger are two symptoms that some women in perimenopause will experience. Dr Aoife Dáibhis, Vhi clinical psychologist, gives us the rundown on what causes these emotions, what triggers to avoid, how they can be treated and how family can be a helping hand.    

What is perimenopause and at what stage of life does it occur?

Perimenopause is the transition period before menopause, and can last anywhere from two to ten years, but generally it will last around four years. During perimenopause, your ovaries start to release fluctuating levels of hormones and also begin to stop producing eggs, causing your menstrual cycle to become irregular. Perimenopause also causes physical and psychological symptoms that can vary from woman to woman. 

What are the psychological symptoms of perimenopause?

There are a range of psychological symptoms of perimenopause due in part to the hormonal changes that happen. The hormone fluctuations can cause low mood, anxiety, irritability, anger, brain fog and difficulty concentrating. Changes in body image and your sense of self are also common for some women. Dr Dáibhis highlights that while the potential symptoms of perimenopause sound overwhelming, and most definitely can be difficult, women should remember that there is lots of help, support and treatments available, and you will get through it.

What is perimenopause anger?

Perimenopause anger is experienced by some women, and how it’s felt and experienced will differ from woman to woman. For some, the anger won’t feel any different to what they typically experience, but for some, the anger will feel unpredictable, more frequent and more extreme than the anger they’re used to feeling. This can be distressing, especially if it starts to negatively impact mood or relationships. Dr Dáibhis reminds us that anger is a very natural and oftentimes helpful emotion, so it’s about distinguishing between anger that is healthy and anger that is less so.

Healthy anger:

• Alerts us to something that is wrong, such as being unfairly treated in the workplace or at home
• It signals to us that we may be overwhelmed and need to look out for ourselves or take action
• It doesn’t result in bad or extreme behaviour. Instead, it evokes us to take action, such as arranging a meeting with your boss to explain how you’re being unfairly treated or sitting down with your partner to discuss how you’re feeling

Less healthy anger:

• Causes tension or problems in the workplace, potentially damaging your reputation or earning you a disciplinary warning
• Starts lots of arguments at home 
• Damages relationships with others

How common is it to feel like this? What actually causes these feelings of anger?

There are a whole host of changes that happen to a woman’s body during perimenopause that can contribute to increased feelings of anger. Fluctuations in hormones such as progesterone and oestrogen, can trigger irritability and anger. One of our ‘happy’ chemicals, serotonin, can also decrease. Dr Dáibhis likens it to adolescence and puberty, because it isn’t a steady decline in hormones, but a fluctuating decline, so women can feel like they can handle things one minute and like they can’t cope the next. External factors and what’s going on in your day-to-day life can add to this and make things more difficult. If you’re struggling to sleep because of perimenopause symptoms like hot flushes, or you have deadlines at work, a cranky teenager at home, or an ever-growing ‘to do’ list at home, these factors will make your anger or irritability worse―understandably!

How do women in perimenopause describe the anger?

Experiencing new and different anger due to perimenopause is quite distressing for women, with Dr Dáibhis explaining how some women may even feel shame as a result of angry outbursts or ongoing irritability. Some women relate it to a sense of lack of control, while others feel like they shouldn’t be feeling this anger and that it’s not justified – though in fact, there are very real hormone fluctuations and external stresses that are contributing to their experience of anger. This guilt or shame can cause women to shy away from addressing their anger and finding solutions that might help alleviate it, such as speaking to your manager and having some of your workload delegated if you have an unfair amount.

Is there anything that partners can do to help?

There are plenty of things your partner can do to help you feel less irritable. Providing emotional support during this period, and practical help that includes taking tasks off your plate, particularly if you’ve been doing the lion’s share of the housework or meal preparation in the home, would be helpful. Other helpful things include agreeing to lighter duvets and a cooler temperature in the bedroom at night to ease your night sweats and poor sleep. If you have children, your partner can also help you explain to them what you’re experiencing.

What’s the best way to approach the conversation with family?

It’s a good idea to have conversations with your family about perimenopause. People tend to be more understanding when they have context and information about a situation, so Dr Dáibhis believes providing this insight is important. If your family don’t know anything about perimenopause or the fact you’re even in perimenopause, their tolerance levels for your fluctuating moods might be lower. Being as appropriately open and honest as you can about your experience will help your family to understand perimenopause and to understand that low moods or outbursts of anger don’t necessarily have anything to do with them. It’s also an opportunity to have them show you comfort and care and help out where they can.

What are some ways to manage your anger?

There are two main themes of addressing anger that Dr Dáibhis references: preventative and dealing with the anger in the moment.

Preventative strategies are usually focused on lifestyle, and include:

• Regular eating. We should be eating every three to four hours, and breakfast is extremely important. Eating something nutritious, even if your start small, within the first hour after waking is likely to be beneficial.
• Exercise is a great way to burn off energy and feelings of irritability or anger. Aside from that, it makes us feel more empowered and confident and exercise like walking has been found to help us to think more clearly. Using our bodies for any kind of movement, be it yoga, running, or dancing, will make us feel better, calmer, and in control.
• Sleep hygiene refers to the environment in which we sleep and our behaviours in this space. Good sleep hygiene habits are things like avoiding screens in the hour before bed, a comfortable temperature in your room, keeping a fairly consistent sleep and wake time, not sleeping in after 9am no matter when you fall asleep, and avoiding alcohol or caffeine in the hours before bed.
• Cut down on coffee consumption and avoid smoking. Both caffeine and nicotine are stimulants and won’t help with trying to remain calm when you feel yourself getting irritable.

For managing anger in the moment it’s starting, Dr Dáibhis recommends:

• Breathing exercises
• Stretching
• Grounding exercise using your senses, such as the 5-4-3-2-1 technique. Pause and think about 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell and 1 thing you can taste
• Getting up and taking a short walk
• Removing yourself from a situation when you can feel the anger rising, even go to the bathroom for a short break

Are outlets like meditation, mindfulness, art or gardening useful?

Outlets that work as self-care or bring you joy can most definitely be useful for dealing with perimenopause anger. Dr Dáibhis explains how important self-care is during perimenopause, to put yourself first and carve out time and space to do things that make you happy. It doesn’t matter if it’s meditation, gardening, painting, or anything else, if you enjoy doing it, it’s a useful outlet for your fluctuating emotions during perimenopause.

What other treatments can women access to help with perimenopause anger?

If you don’t know where to begin or your anger is at a level where you feel you cannot manage it the way you want to, your healthcare provider can help you understand the options available and what might work for you. There are many evidence-based therapies for anger and anxiety, which can give good structure and strategies on how to manage both.

Is it likely that perimenopause rage will continue into menopause? Do post-menopausal women find their anger settles down?

Though it depends on the woman, generally women will find that their anger dissipates as they move into menopause, though some others may find it stays fairly consistent with perimenopause levels. Typically, post-menopausal women will find their anger passes as their hormone fluctuations and poor sleep also pass. If you feel your anger isn’t dissipating post-menopause, you should seek advice from your healthcare provider.

When is it time to see a healthcare professional when feeling increased anger during perimenopause?

As soon as you start to experience general symptoms of perimenopause, Dr Dáibhis recommends visiting your GP to discuss your options and ways to treat uncomfortable symptoms like hot flushes, poor sleep and vaginal dryness. When it comes to mental health symptoms, Dr Dáibhis says once they begin to interfere with your life, relationships and work, it’s time to get support. She highlights the bar for intervention should be relatively low―don’t wait until things becoming totally unmanageable, get help as soon as you feel you could do with some support. 

Dealing with increased anger can be overwhelming and stressful, but the guidance above can help you find ways to alleviate it. Remember, as soon as you feel lifestyle changes aren’t helping, speak to your healthcare provider so both your physical and mental symptoms can be looked after.

This content is for information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment. Always seek advice from your GP or an appropriate medical professional if you have concerns about your health, or before commencing a new healthcare regime. If you believe that you are experiencing a medical emergency call 999 / 112 or seek emergency assistance immediately. 

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