It was when mum of three Jackie* threw her favourite ceramic platter across the kitchen that she knew she had to do something. She watched it shatter into pieces on the floor, a clear sign the constant anger was threatening to swamp her.
“I really loved that platter – it was a wedding present,” says Jackie, whose rage was ignited on that occasion by her teenagers’ bickering.
“But I was having a total meltdown and, unfortunately, I was holding it at the time.”
Then in her late forties, she had noticed for months that she seemed to be grumpy much of the time.
“Everything p***ed me off, even stupid little stuff,” she recalls.
“I was so annoyed with my kids all the time, and my husband, some of my workmates, every other driver on the road… Pretty much everyone, really.”
She put her irritability down to work stress and a lack of sleep, and hoped it would get better. But the full-on bout of fury that led to the demise of the platter seemed to erupt out of nowhere. It left her seriously concerned.
“I remember picking up all the broken pieces and thinking, ‘What the hell is wrong with me? Why am I so mad at the world?’ “I mentioned it to a friend, and she said, ‘Have you talked to your doctor? It could be perimenopause,’” shares Jackie.
“That was like a lightbulb going on – it hadn’t dawned on me that it could be down to that because I had no other menopause symptoms.”
Jackie, 57, initially put off seeing her GP because of the lack of symptoms. Once her periods became erratic, she booked an appointment.
“My doctor said it was perimenopause and put me on HRT,” she tells.
“What a difference it made. The anger went away. I felt human again.”
Mood swings are a well-known symptom of peri-menopause, which is the time leading up to your periods finishing. They’re due to hormonal fluctuations and affect many women. Yet sometimes, those seesawing hormones don’t just leave women mildly irritable – but feeling fury.
Middle-aged rage due to perimenopause is common, says Dr Wai Tze Cheng of Menopause Care New Zealand.
“Surveys have been done that show 70 percent of women say irritability is one of the main things they’ve noticed in perimenopause,” says Wai Tze, who trained and worked as a menopause specialist in the UK before coming to Aotearoa two years ago.
She tells, “I’ve had a patient who nearly lost her job because she got so angry and answered back to her boss, then stormed out. I’ve spoken to women whose relationships with their partners and their children have really suffered because of this rage they’re feeling. The median age for women to get divorced in New Zealand is 45, right when you’re on the tip of perimenopause. I’ve spoken to people who have said their anger was completely out of proportion to what happened and they don’t understand why they reacted in that way.”
In many cases, the reason for their fury is simple: hormones.
Did you know?
For many women, the rollercoaster of menopause symptoms stops once their periods finish for good. But in other cases, symptoms can continue for another seven years or more.
Why does perimenopause make you so mad?
Fluctuations in hormone levels as you head towards menopause can have an impact on your mood in several ways:
They lower serotonin
Oestrogen plays a key role in regulating mood by influencing other hormones, such as the feel-good hormone serotonin. When oestrogen levels decline, serotonin activity also decreases.
“Serotonin helps you to feel calm and balanced, so when levels are low, you’re more likely to feel irritated and become angry,” explains Wai Tze.
Serotonin levels affect the brain’s response to anger. If those levels fluctuate, it becomes harder for your brain to process emotions, which can trigger mood changes, including rage.
They increase cortisol
As oestrogen and progesterone levels drop during perimenopause, your body struggles to regulate the stress hormone cortisol. As a result, you may have higher levels of cortisol, which could amplify your feelings of irritability and anxiety.
Extra cortisol doesn’t just make you feel angry — it disrupts your sleep. Lack of shut-eye then leaves you even more tired, grumpy and short-tempered.
They diminish another calming brain neurotransmitter
Gamma-aminobutyric acid (GABA) is a chemical messenger in the body that soothes the nervous system and prompts the release of pleasure-creating endorphins. Progesterone stimulates GABA and when it decreases, so too does GABA’s calming effect. As a result, you’re more likely to feel tense and angry.
What can you do to avoid perimenopause rage?
One answer is to take hormone replacement therapy (HRT).
“It’s the gold-standard, most evidence-based treatment,” says Wai Tze.
“You’re having these symptoms because you don’t have enough of these hormones, so HRT is giving you what you don’t have. Just like with diabetes, you don’t have enough insulin, so we give you insulin.”
Some women have put off taking HRT thanks to studies in the early 2000s that reported it increased the risk of breast cancer and other conditions like stroke. But further studies have shown the risks are very low and the benefits – such as relieving menopause symptoms and preventing osteoporosis – outweigh them. However, women with a history of breast cancer are advised not to take it, while others should seek HRT tailored to their individual hormone levels and health needs.
“It’s not a case of one size fits all,” says Wai Tze, who is also a breast physician.
“Treatment is very individualised and dependent on each woman and what they need.”
If you can’t take HRT or prefer not to, lifestyle changes may help.
“People ask me what they can do to have the smoothest perimenopause journey and I say that it’s exactly the same things we’re all told to do to have a healthy life,” says Wai Tze.
“That’s not smoking, not drinking excessively, getting enough exercise, eating well and getting good quality sleep. They all help.”
Cognitive behaviour therapy (CBT) may also make a difference. This kind of approach can help with many of the symptoms of menopause, including low mood and anxiety. It’s a treatment that teaches practical coping skills to identify and challenge negative thought patterns, and change unhelpful behaviours.
“CBT has been shown to be very effective, especially for women who have had breast cancer and can’t have HRT,” says Wai Tze.
“In the UK, they don’t give sleeping tablets for sleep problems any more. CBT is the first-line treatment.”
‘Furious was my default setting’
Michelle* admits she has always had a bit of a short fuse. In her teens, she had a reputation for flying off the handle, but by the time she got to her twenties. She was better at keeping her emotions in check. Then she hit her late forties and became Mrs Angry.
“It felt like being mad with everyone and everything was my default setting,” says Michelle, 54.
“I was pretty much furious from the moment I woke up, often for no real reason.”
The simmering rage that threatened to boil over at any moment could have led to some risky situations. Once, Michelle became so angry with a man who drove the wrong way into a shopping centre through the exit lane she was using. She tried to force him off the road.
She had a feud with the firm next door to the retail business she managed, sparked by their clients parking in spaces clearly marked for her customers. She repeatedly shouted at their staff and visitors. Once, she became so enraged she was on the verge of vandalising a wrongly parked car, until one of her colleagues stopped her.
Michelle finally admitted something was seriously wrong when an argument at a family event escalated. She ended up pushing her 50-year-old sister onto the grass, rolling around, pulling her hair and trying to slap her.
“There were lots of issues from our childhood that hadn’t been dealt with and it all kind of came out that day,” recalls Michelle.
“I totally lost it. I’m not proud of it.”
Her horrified mother persuaded her to have counselling. Her therapist suggested her hormones could be playing a part in her bad moods and volatile temper.
“I had some other symptoms, like hot flushes, but it had never occurred to me that hormones could cause overwhelming anger like that.”
Michelle tried several different treatments, such as CBT, which helped her learn to change negative thoughts. She also tried HRT.
“After a couple of months, I noticed how much calmer I was,” she remembers.
“Now I can just shrug off things that used to make me so mad. And whenever I hear about other women my age behaving irrationally. I know someone who threw her teenager’s phone out of the car window because he was ignoring her. I think, ‘Love, sort out your hormones!’”
