Mood changes

Mood changes means your mood shifting more, or faster, than it used to: up and down within a day, or settling lower or sharper than you are used to. The NHS website calls them mood swings and lists them among the symptoms of perimenopause, along with low mood, depression, and problems with memory and concentration.

NICE NG23 asks doctors to explain to women that the menopause can bring "effects on mood (for example, depressive symptoms)". So it is written into the guideline.

The Asia-Pacific Menopause Federation adds that for Asian women, symptoms that affect mental health are more common than hot flushes. So if your mood is what changed first, with few flushes or none, you are far from alone.

Mood changes usually have a main flavour. If yours is mostly:

• a short fuse, read irritability and anger
• heaviness and flatness, read low mood
• worry, nerves or panic, read anxiety
• tears that come at every little thing, read crying easily
• losing words and the thread of things, read brain fog

Laughing with your sister on the phone, then crying in the bathroom ten minutes later. A good morning undone by one remark. Feeling like a passenger in your own moods. Watching the family tiptoe round you and hating it.

In Urdu, mood ghari ghari badalta hai: my mood changes from moment to moment.

The Pakistan Menopause Society's recommendations say declining estrogen may cause psychological as well as physical symptoms, from mild to severe.

Sleep makes it worse. The NHS website says mood symptoms may feel worse when you are not sleeping and are very tired, which is why sleep disruption and mood changes so often arrive together.

The same PMS recommendations also warn doctors not to blame estrogen for everything in midlife, because age, lifestyle and other health conditions play a part. Both can be true at once.

• The NHS website lists getting as much rest as you can, regular exercise and relaxing activities, and says CBT, a talking therapy, can help with low mood and anxiety.
• It also suggests talking to other people going through the same thing, such as family, friends or colleagues.
• The Pakistan Menopause Society asks for honest talk at home about hormonal changes and for the family to share the stress (section 4.2.6).

For the low end of mood changes, NICE NG23 tells doctors to consider HRT for depressive symptoms that start around the same time as other menopause symptoms, and CBT when they come with hot flushes or night sweats (1.5.21 and 1.5.22). The PMS recommendations say MHT, their word for HRT, may improve mood, sleep and quality of life, especially alongside hot flushes, and list CBT, stress management and support groups (section 7.2). Which fits you is your doctor's call.

See a doctor if your moods are affecting your work, your relationships or how you get through the day, or if they are new and you cannot explain them. Bring your symptom score if you have taken it, since it puts your mood on the same page as your sleep and your flushes.

If the low days are winning, the low mood page covers when to see a doctor.

When your mood changes, the people you live with feel it first. They may not have a word for it either. A shared word, mood mein tabdeeli, and the knowledge that guidelines list it, can turn "what is wrong with you" into "what can we do". Partner and family support has more.