One of the most common concerns midlife women bring to me is mood swings or mood changes. Many women report low motivation, mood swings, irritability, feeling anxious or worried, feeling hopeless, brain fog, forgetfulness, difficulty with focus, tearfulness, and insomnia. Mood changes often manifest during premenopausal, perimenopausal, and menopause transitions. It is a natural tendency to blame hormone changes as the cause for the mood disturbances. I often find myself educating midlife women about the other potential causes of mood disruption.
While it may be easy to assume that hormones are playing a role in mood changes, it is important to identify the root cause or contributing factors to the situation. An accurate diagnosis and identification of contributing factors will direct proper treatment and restore mental health. Mood changes and symptoms can result from a variety of causative or contributing factors. Examples include vitamin, mineral, phytonutrient deficiencies, poor gut health, inflammation, poor sleep, hormone imbalance, nervous system imbalance, stress, and more. The purpose of this blog post is to present some of the more common contributing factors or causes of change in mood during a woman’s middle years.
Depression is a common mental disorder that can manifest as mood swings. The majority of those who suffer from depression are women (you can read about my own personal experience with depression HERE). In a recent survey of middle-aged women that I conducted, 42% reported anxiety and 32% reported depression. According to the American Psychology Association, “Depression is more than just sadness. People with depression may experience a lack of interest and pleasure in daily activities. Additionally, they may report significant weight loss or gain, insomnia or excessive sleeping, lack of energy, inability to concentrate, feelings of worthlessness, excessive guilt and recurrent thoughts of death or suicide”.
Anxiety is more prevalent than ever, since the COVID pandemic. It can present in a variety of forms including generalized anxiety, social anxiety, separation anxiety, obsessive-compulsive symptoms, mood swings, phobias, and panic. According to the American Psychological Association, anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. People with anxiety disorders usually have recurring intrusive thoughts or concerns. They may avoid certain situations out of worry. They may also have physical symptoms such as sweating, trembling, dizziness or a rapid heartbeat.”
I treat many women who have mental health conditions. It never ceases to amaze me how many women with ADHD go undiagnosed until later in life. Medical providers often overlook ADHD in favor of depression and anxiety which can mask or overlap with this diagnosis. I have seen so many women who are living with untreated ADHD. This burden can actually cause depression like symptoms or anxiety and mood swings. The American Psychological Association defines ADHD, or attention-deficit/hyperactivity disorder, as a behavioral condition that makes focusing on everyday requests and routines challenging. People with ADHD typically have trouble getting organized, staying focused, making realistic plans, and thinking before acting. They may be fidgety, noisy, and unable to adapt to changing situations.
The American Psychological Association reports that “Trauma is an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, mood swings, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives.”
PTSD, or posttraumatic stress disorder, is an anxiety problem that develops in some people after extremely traumatic events, such as combat, crime, an accident or natural disaster. People with PTSD may relive the event via intrusive memories, flashbacks and nightmares. They may avoid anything that reminds them of the trauma. And they may have anxious feelings they didn’t have before that are so intense their lives are disrupted.
Perimenopausal, Perimenopausal, Menopausal Hormone Changes
During perimenopause, hormone fluctuations begin to occur. Mood changes can occur as the ovaries begin producing less estrogen and eventually stop production of this hormone. Some women are more sensitive to hormone fluctuations. During the reproductive years this can manifest as premenstrual mood disorders (PMDD), postpartum depression, and mood swings during the perimenopause to post menopause transition. There is some debate in the scientific community as to whether hormone changes are actually directly responsible for mood disturbances during postmenopausal period. In my experience, treating menopausal symptoms such as hot flashes and night sweats often results in improved moods.
Thyroid Dysregulation & Adrenal Dysfunction
The thyroid and adrenal glands produce hormones which interplay with other hormones in our bodies. They are part of a complex regulatory system that begins in the brain and cascades through the thyroid and adrenal glands and down to the reproductive hormones. Dysregulated hormone levels can affect many of our body systems and functions, including moods.
An underactive thyroid (hypothyroid or Hashimoto thyroid) can cause symptoms of depression while an overactive thyroid can cause symptoms of anxiety. Over 16% of middle-aged women have thyroid dysfunction. The prevalence of thyroid disease becomes greater in women over the age of 60. The adrenal glands are powerful players in our body despite their tiny size. The adrenal gland secretes several hormones, the most common being cortisol which is our stress hormone. An overabundance of cortisol circulating in the body over a long period of time, can certainly affect the nervous system and our moods.
Insomnia (trouble falling asleep or staying asleep) or hypersomnia (sleeping too much or excessive daytime sleepiness) can be a sign of mood disorders such as depression. Conversely, sleep deprivation or a lack of adequate sleep quantity or quality can cause symptoms that mimic depression and cause mood changes. Insomnia can be related to anxiety and ADHD as well. Many midlife women have insomnia. This can be due to restless legs syndrome, pain, obstructive sleep apnea, hot flashes or night sweats, stress, anxiety and depression. New research shows that by treating insomnia, depression and anxiety may improve.
Poor Gut Health
There is a huge connection between the health of the gut and the health of the brain. If one is not functioning well, it is often the case the other isn’t either. The gut houses our enteric nervous system (ENS). The ENS is sometimes referred to as our “second brain”. It consists of two thin layers of more than 100 million nerve cells lining the gastrointestinal tract from esophagus to rectum. It’s main role is to control digestion which affects food breakdown, nutrient absorption, and elimination.
The ENS communicates back and forth with the brain. And while we know that the brain helps regulate the gut, there is now evidence showing the powerful impact that the health of the gut has on the brain. This is why so often anxiety and depression can present along with different gastrointestinal disturbances such as IBS. And this is why it is important to identify potential disturbances in the gut that can affect our moods such as bacterial imbalance, SIBO, infection, yeast overgrowth, intestinal wall permeability issues (leaky gut). By identifying and addressing these concerns, and repairing the health of the gut, our brains will benefit big time, and our moods will improve!
Inflammation can cause all kinds of problems in the body, and it can most certainly contribute to the state of our moods. As a natural defense, inflammation is triggered in the body when a threat is recognized. When this occurs, the body responds by gathering resources to create an inflammatory response in hopes of addressing the threat. The inflammatory response is a requirement for survival.
The body responds with inflammation to a wide variety of threats, including not only infections, but also irritants, stress and physical trauma. When exposed to any of these triggers, the body produces small protein cells called cytokines. These small cells facilitate the response of the body to threat. Cytokines can be measured, and as a result, they can be used to assess inflammation levels in the body.
There is growing evidence that inflammation affects our moods. This influence is exerted through many systems, including the immune system, metabolism, sleep, stress responses, cognitive thinking, memory, expression, impulse control, mood, clarity, and more. Common causes of inflammation are infection, poor diet, stress, lack of sleep, autoimmune disorders, injury, exposure to toxins, excessive alcohol, obesity, sedentary lifestyle, smoking.
Developmental Transitions & Aging
Midlife women go through a variety of transitions which can be exceedingly overwhelming. Middle age is a time when careers often change, children transition to adulthood and leave the home, relationships with spouses transition or change, aging parents become a concern. On top of these transitions, our bodies begin to show changes related to aging and our health may begin to change as well. Each one of these transitions presents its own set of challenges, and it is most commonly the case that women are going through several of these passages all at once. This can certainly take a toll on moods.
Lack of Connection, Meaningful Activity, or Purpose
Loneliness can contribute to higher rates of depression, anxiety, and suicide. In a recent survey I conducted of middle-aged women, over 20% reported feeling lonely. The COVID pandemic obviously challenges our ability to stay connected, however, there are other factors besides the pandemic that can contribute to a feeling of loneliness. Our rising use of social media can contribute to loneliness or feeling disconnected or “left out”. An absence of meaningful activity or purpose in our lives, often due to changes in our careers or in our roles as mothers, spouses, and daughters, can result in a sense of disconnection or loneliness. Women experiencing these things often feel a lonely void and a sense of isolation can develop. This can culminate in a higher risk for depression and anxiety.
Poor nutrition and certain nutritional deficiencies can contribute to poor brain and nervous system health and therefore impact our mental health. A diet high in processed foods and highly refined grains or sugars can contribute negatively to our moods. Dehydration can also have a negative impact. Deficiencies in the B vitamins and vitamin D can cause symptoms of depression. The brain is comprised of mostly fatty tissue. Therefore, consuming inadequate amounts of healthy fats can contribute to poor brain health and depression/anxiety. Poor gut (intestinal) health and a microbiome that is lacking appropriate beneficial bacteria and prebiotics can also contribute to mood problems due to the very strong brain gut connection.
When mood swings occur, it may be one way that the body signals it needs more water. Dehydration can disrupt the delicate balance between dopamine and serotonin. Even mild dehydration can contribute to a shift in moods. Our body is more than 50% water. For this reason, it is critical to maintain adequate hydration for optimal functioning of the body, including the brain.
Sedentary lifestyle is a huge problem in this country. Adults who engage in lower levels of physical activity are at higher risk for depression and anxiety. Activity can promote better circulation to the brain. As a result, the brain responds to physical activity by producing mood boosting hormones and better overall health. Movement can be soothing for the nervous system which helps to support mental health.
Nervous System Dysregulation
Our autonomic nervous system is comprised from the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system encourages the “fight or flight” mode. It helps us to produce an adrenal type effect when needed to respond to a threat or to stress. In our stress ridden society where we are multitasking much of the time. For this reason, our sympathetic nervous system tends to be overworked and this can result in adrenal fatigue. The parasympathetic nervous system encourages a “rest and digest” response. It contains the vagus nerve which, if activated, can help us achieve a relaxed and restful state. It is optimal to strike a balance between the two systems over time. If there is imbalance or more influence by the sympathetic nervous system, then our mental health can be affected. As a result, depression or anxiety can occur.
Lack of Spiritual Connection
Spirituality is an important aspect of mental health. Spirituality is a belief that there is a connection with something we understand as all powerful or a greater power than ourselves. In other words, something more than being human… a greater good. This belief can foster a sense of connection, purpose, and meaning in ones life. Spiritual connection can provide support during stressful times. Spirituality is an accepted concept in psychiatry. Research has shown that spirituality is beneficial in both lowering risk of mental illness and also helping to cope with the stress of mental illness.
The WHOLE Picture
In summary, women often attribute mood swings to hormone fluctuations or imbalance. Mood changes, however, can be a symptom of a variety of different health conditions. Likewise, a variety of factors can contribute to or influence our moods. To be honest, most of the time it is a combination of the above rather than a single factor that influences our moods. For this reason, it is important to have a thorough evaluation of the WHOLE body, mind, spirit to determine the root causes contributing to mood changes. A functional medicine approach is well suited for this. From this approach, an individualized health plan can be utilized to correct the situation and restore mental health.
At Valencia & Sage, LLC, I offer women a functional medicine approach designed to reveal the root cause of symptoms, including mood swings or mood changes. Utilizing this approach allows me to develop an individualized holistic health plan to restore wholeness and create vibrant health! Consider working with me. It’s easy to set up a FREE telephone consultation to find out more about how my approach might benefit you. Or, plunge right in and schedule your initial 90 minute visit with me, and we’ll get started on creating YOUR vibrance! See you soon! Have a glorious day! Kimberly
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