Mood swings and menopause

Q: I am concerned about my mom. She is in her mid-40s and I am not sure if she is experiencing menopause or not. She seems depressed a lot and run down at the end of the day. She also has big mood swings, sometimes to the point where the family is afraid to talk to her. After only a few minutes she is fine and joking around again. The smallest thing can set her off. Could this be menopause? Is there anything we can do to help her through this and make her feel better?

A: The question you are asking – are your mom’s emotional problems the result of menopause, or something else? – is one of the toughest faced by any physician.

Women in their 40s are often dealing with tremendous stresses, what with kids going off or returning home, caring for aging parents and in-laws, the stresses of job retraining or reentering the work force, and more. And some women do develop problems with depression, which can happen at any age.

If her periods are still very regular, her moods are less likely related to menopause. Some physicians would recommend a blood test to measure her estrogen levels, although I don’t find them terribly helpful. Oftentimes, I will try a brief trial of estrogen replacement therapy – in a matter of a few weeks, you will know if she is feeling better or not.

If estrogen levels are high, or replacement therapy doesn’t work, you must consider other diagnoses. If her mood swings are clearly premenstrual, some very simple PMS measures might help. I would have her try vitamin B6 (100 mg daily), evening primrose oil (2 capsules daily), and strongly encourage her to get involved in a good aerobic exercise regimen. If you and she note no cyclic variations, consider the possibility of depression. Serotonin reuptake inhibitors are usually well tolerated, with minimal side effects, and can be helpful in the treatment of PMS as well. And, again, you will know within a matter of weeks if she is getting relief.

Your mom is lucky that her family cares how she is doing, and I am sure that will be helpful in making her feel better.

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