Irritability and anger

Irritability is a fuse that has got shorter: noise, mess or a question asked twice sets you off when it never used to. Anger is when that tips over into shouting, slammed doors or a fury that surprises you.

The Pakistan Menopause Society's recommendations list irritability among the early symptoms of perimenopause, beside low mood and anxiety, and NHS inform lists it among the common symptoms of the menopause. The NHS website lists mood swings.

In Urdu, women tend to call it chirchirapan about themselves. Ghussa covers everything from annoyance to rage. None of the official Urdu health leaflets Roshara has read has a word for rage as a symptom, which may be one reason it so often gets called a character flaw.

Everyone talking at once and your skin prickling. The television too loud, the WhatsApp group too much, the same question from the children for the fourth time. A flash of heat in your chest that is temper, not a flush, or both at once. Then the quiet afterwards, when you wonder who that was.

The Pakistan Menopause Society groups mood changes with memory, concentration and sleep problems as the neuropsychological symptoms of the menopause (section 1.5.4).

Sleep plays a large part. The NHS website says broken sleep can leave you irritable, stressed and anxious, and the British Menopause Society lists irritability among the daytime effects of long-term insomnia. Waking with night sweats several times a night would shorten anyone's fuse. Sleep disruption has more.

None of this means hormones make women unreasonable. It means a body under strain has less room to absorb ordinary stress.

• The NHS website lists rest, regular exercise and relaxing activities for mood changes around the menopause.
• The Pakistan Menopause Society says reducing stress, better sleep and mindful practices can improve mental health, and describes mindfulness as practical and low-cost (section 4.2.4). Stress management has more.
• The same recommendations say husband and family support plays an important role, and list what helps: honest talk about hormonal changes, respect for personal space, joint stress management, and getting professional help without stigma (section 4.2.6).

No guideline Roshara follows has a treatment aimed at irritability on its own. The PMS recommendations group it with mood symptoms, for which they list CBT, stress management, support groups and education about the menopause. They also say MHT, their word for HRT, may improve mood, sleep and quality of life, especially when hot flushes are part of the picture (section 7.2). Whether any of that fits you is a conversation for your doctor.

See a doctor if your temper is new and is hurting your relationships, your work or how you feel about yourself, or if it comes with low mood, panic or thoughts you cannot shake.

And if the anger at home is coming at you rather than from you, and you do not feel safe, tell your doctor. The PMS recommendations ask doctors to look out for safeguarding concerns (Table 4).

The hardest part is often the label. When the family decides you have become difficult, or that Ammi is always angry now, it is easy to believe them. Showing them this page, and the word chirchirapan beside the word perimenopause, can change the conversation. Partner and family support has more.

Women ask what anger they cannot control means for their sabr, and for their faith. Those are questions for a qualified scholar. They are not a reason to keep quiet with your doctor.