Menopause, Low Mood and Irritability: Understanding the Difference from Depression

“I’ve been feeling a little down lately.” “I seem to get irritated more easily than before.” “I just don’t have the energy to do anything.”

When these kinds of changes appear in your 40s or 50s, you may wonder, “Could this be menopause?”

On the other hand, people sometimes casually say, “Maybe it’s menopause?” to a woman who seems irritable or short-tempered.

However, low mood or irritability should not automatically be attributed to menopause.

During menopause, hormonal changes may be accompanied by physical symptoms such as hot flushes, sweating, dizziness and fatigue, as well as emotional and psychological symptoms such as low mood, reduced motivation, irritability, anxiety and difficulty sleeping.

At the same time, similar symptoms can also be associated with many other factors, including significant stress, insufficient sleep, family or work-related problems, physical illness, medication effects and depression.

One particularly important point is that temporary feelings of sadness or low mood are not the same as clinical depression.

This article explains what menopause is, why low mood and irritability may occur during this stage of life, how these symptoms differ from depression, why self-diagnosis can be difficult, everyday factors to consider, and when it may be appropriate to seek medical advice.

What is menopause? Understanding the basics

The word “menopause” can sometimes carry negative associations, such as:

“It means I’m getting old.”
“It is a time when your health starts to decline.”
“Once menstruation stops, you somehow become less feminine.”

However, menopause itself is not a disease.

It is a natural stage of a woman’s life during which ovarian function gradually declines and menstruation eventually stops.

Menopause refers to approximately 10 years around the final menstrual period

In Japan, the Japan Society of Obstetrics and Gynecology defines the menopausal period as approximately five years before and five years after the final menstrual period.

The average age of menopause among Japanese women is around 50, although there is considerable individual variation.

For this reason, menopause cannot be defined strictly by age alone. It is not accurate to assume that every woman enters menopause at 45 or that it necessarily ends at 55.

Menopausal symptoms and menopausal disorder are not the same

Various physical and emotional changes that appear during menopause are generally referred to as menopausal symptoms.

In Japan, when these symptoms become severe enough to significantly interfere with work, household responsibilities, relationships or everyday life, the condition may be described as menopausal disorder.

This means that not every woman who goes through menopause develops severe symptoms.

Some women experience very few noticeable changes, while others experience several symptoms, and some may have symptoms that significantly affect daily life.

What kinds of symptoms can occur during menopause?

Menopausal symptoms vary widely and may involve both physical and emotional changes.

Physical symptoms can include:

• Hot flushes and feeling overheated
• Sweating
• Dizziness
• Palpitations
• Headaches
• Shoulder or lower-back discomfort
• Fatigue

Emotional or psychological symptoms may include:

• Low mood
• Reduced motivation
• Irritability
• Feeling emotionally unsettled
• Anxiety
• Difficulty sleeping

However, experiencing these symptoms does not automatically mean that someone has a menopausal disorder.

Why can low mood and irritability occur during menopause?

During menopause, ovarian function gradually declines and levels of oestrogen, one of the main female sex hormones, fluctuate considerably before decreasing.

These hormonal changes are thought to be associated with various physical and emotional symptoms that may occur during menopause.

However, the process is not as simple as:

“Oestrogen decreases”
↓
“Hormones become unbalanced”
↓
“The autonomic nervous system becomes disrupted”
↓
“Irritability or depression develops”

Menopausal symptoms cannot be explained by one simple chain of events.

Female hormones are not the only factor

Menopausal symptoms may be influenced not only by hormonal changes but also by:

• Age-related physical changes
• Sleep quality
• Existing health conditions
• Psychological factors
• Work-related pressures
• Family circumstances
• Relationships
• Life changes such as caring for ageing parents or children becoming independent

Several of these factors may interact with one another.

The 40s and 50s can also be a stage of life when responsibilities at work increase, family roles change or new pressures such as caring for ageing parents arise.

When several changes occur at once, the overall physical and emotional burden may become greater.

Irritability does not necessarily mean your personality has changed

Some women notice irritability or emotional changes during menopause.

This can lead to thoughts such as:

“I seem much more short-tempered than I used to be.”
“Has my personality changed for the worse?”

However, changes in mood may be influenced by physical health, insufficient sleep, fatigue, psychological stress and life circumstances.

At the same time, family members and others should not dismiss every emotional change as “just menopause”.

If someone is experiencing significant distress, it is important to consider their overall physical and emotional health rather than treating the issue as a personality problem.

Changes in sleep may also affect mood

During menopause, nighttime symptoms such as hot flushes and sweating can interrupt sleep.

Anxiety or persistent thoughts may also make it more difficult to fall asleep.

When insufficient or disrupted sleep continues, it may contribute to daytime fatigue, difficulty concentrating and feeling less emotionally resilient.

For this reason, when considering emotional changes during menopause, it is helpful to look not only at mood but also at sleep, physical symptoms and everyday circumstances.

Low mood and depression are not the same

Everyone experiences times when they feel sad or discouraged after an unpleasant event, a setback at work or difficulties in a relationship.

This kind of temporary low mood is not the same as clinical depression.

Depression involves more than feeling sad

Important symptoms of depression can include:

• Persistent sadness or low mood
• Loss of interest in activities that were previously enjoyable
• Difficulty experiencing pleasure or enjoyment

Other changes may include:

• Reduced or increased appetite
• Difficulty sleeping or sleeping excessively
• Irritability or restlessness
• Fatigue and reduced energy
• Feeling worthless
• Difficulty concentrating or making decisions
• Feeling that there is little hope for the future

Depression can therefore involve a range of both emotional and physical symptoms.

Two weeks is one guideline for considering professional advice

Japan’s Ministry of Health, Labour and Welfare advises that when symptoms such as persistent sadness or a reduced ability to experience interest or pleasure continue for two weeks or longer, occur together with other symptoms and begin affecting everyday life, it is important to consider the possibility of depression and seek professional advice.

This does not mean that you must wait two weeks before speaking to a healthcare professional.

If symptoms are particularly distressing or are already having a significant impact on work, household responsibilities or everyday functioning, it is appropriate to seek help sooner.

Irritability can also occur with depression

Some people imagine depression only as quietly feeling sad or withdrawn.

However, depression may also involve irritability, becoming more short-tempered or feeling restless.

For this reason, appearances alone cannot tell us that:

“She isn’t crying, so it cannot be depression.”
“She is angry, so it must be menopause.”

Do not try to distinguish menopausal symptoms from depression by yourself

Emotional symptoms associated with menopause and symptoms of depression can overlap.

For example, both may involve:

• Low mood
• Reduced motivation
• Irritability
• Anxiety
• Difficulty sleeping
• Fatigue
• Difficulty concentrating

Because these symptoms may occur in both menopause and mental health conditions such as depression, it can sometimes be difficult to distinguish between them based on symptoms alone.

Do not dismiss symptoms as “just menopause”

When low mood, insomnia or fatigue appears during the 40s or 50s, some people may think:

“It’s probably just my age.”
“I suppose I just have to put up with menopause.”

However, other possible causes may include thyroid conditions, anaemia, sleep disorders, medication effects and depression.

If symptoms persist or begin interfering with daily life, it is important not to rely solely on self-diagnosis.

At the same time, low mood does not automatically mean depression

Feeling temporarily low or irritable does not automatically mean that someone has depression.

Insufficient sleep, fatigue, stress and physical menopausal symptoms can all temporarily affect emotional wellbeing.

Rather than trying to diagnose yourself, it may be helpful to consider:

• When the symptoms first began
• How long they have continued
• Whether you still enjoy activities you previously enjoyed
• Whether your sleep or appetite has changed
• Whether work, household responsibilities or relationships are being affected
• Whether physical symptoms are occurring at the same time

Organising this information can also be useful if you decide to speak with a healthcare professional.

People around you should not automatically label everything as menopause

Family members or colleagues may sometimes say:

“She’s been irritable lately, so it must be menopause.”
“It’s just her age.”

However, assumptions like these can cause someone’s genuine distress to be overlooked.

Understanding menopause is important, but it is equally important not to attribute every emotion or behaviour in a woman to menopause.

If someone feels that they are struggling or that they are no longer feeling like themselves, those changes should be taken seriously and, when appropriate, supported with medical advice.

Everyday habits to consider

When low mood or irritability occurs during menopause, it is natural to wonder:

“What should I eat?”
“Would exercise improve my mood?”
“Should I take a supplement?”

However, emotional changes can be influenced by many different factors, so it is best not to rely on one particular food, nutrient or type of exercise as a single solution.

Instead, consider your overall routine, including sleep, diet, physical activity, rest and stress.

Review your sleep

Ongoing sleep deprivation or difficulty sleeping may contribute to daytime fatigue, difficulty concentrating and feeling less emotionally resilient.

During menopause, hot flushes or sweating may also cause nighttime awakenings.

Consider whether you have noticed:

• More difficulty falling asleep
• Repeated waking during the night
• Waking much earlier than intended
• Severe daytime sleepiness or fatigue

If sleep difficulties continue, rather than trying to force yourself to sleep, review your sleep environment and daily routine. If difficulty sleeping continues despite these changes, consider seeking medical advice.

Stay active within your own limits

Walking, gentle exercise and regular physical activity are basic components of maintaining overall health.

Exercise does not need to be strenuous.

• Take a walk
• Increase the amount of time you spend walking
• Do gentle stretching
• Reduce long periods of uninterrupted sitting

Choose activities that are appropriate for your health and fitness level and that you can continue comfortably.

However, it is not accurate to assume that “exercise cures depression” or “exercise restores the autonomic nervous system to normal”.

Physical activity is better viewed as one part of a generally healthy lifestyle.

Focus on overall dietary balance rather than one particular nutrient

When researching menopause, you may come across statements such as:

“This nutrient balances your hormones.”
“This food eliminates irritability.”
“This supplement stabilises your mood.”

However, it is not appropriate to assume that one food or nutrient can treat low mood during menopause or depression.

A balanced diet can include a combination of:

• Staple carbohydrate foods
• Foods containing protein
• Vegetables and fruit
• Dairy products and other foods

Similarly, supplements should not be regarded as products that can independently regulate female hormones or treat irritability, depression or menopausal disorders.

Do not try to eliminate all stress

With work, family responsibilities, relationships and caring responsibilities, completely eliminating stress is rarely realistic.

Instead, consider whether:

• Your responsibilities have recently increased
• You are getting enough rest
• You are trying to handle too much alone
• You have less emotional space than before
• Stress is beginning to affect work or family life

Recognising these changes can be an important first step.

Talking with a family member, friend or someone else you trust may also be helpful.

You do not have to turn enjoyable activities into a “treatment”

Music, reading, bathing, walking and hobbies may provide opportunities for relaxation or a change of pace.

However:

“Having a hobby will cure low mood.”
“Thinking positively will prevent depression.”

are not accurate statements.

When you are already struggling, you do not need to place additional pressure on yourself to “be more positive”.

Treatment options may be available for emotional symptoms during menopause

If low mood or irritability during menopause is causing significant distress, you do not have to feel that you must simply cope with it on your own.

There are several approaches that may be considered for menopausal symptoms depending on the individual’s symptoms and overall health.

A healthcare professional will first review the symptoms, their impact on everyday life and whether another medical condition may be involved.

Lifestyle changes and psychological support

Depending on the severity of symptoms, management may begin with reviewing sleep, physical activity and diet, as well as discussing psychological stress or emotional difficulties.

If work or family responsibilities are creating a significant burden, these circumstances may also need to be considered.

However, lifestyle changes alone do not resolve every case.

If symptoms are significant, medical treatment may be considered when appropriate.

Hormone replacement therapy (HRT)

Hormone replacement therapy (HRT) is one treatment option used for menopausal symptoms.

HRT replaces a small amount of declining oestrogen and is particularly used for symptoms such as hot flushes, feeling overheated and sweating.

Whether HRT is appropriate depends on factors including age, symptoms and medical history.

It is not suitable for everyone, and a doctor will consider potential benefits and risks before recommending treatment.

Kampo medicines may also be used

In Japan, Kampo medicines may be considered for menopausal symptoms depending on the individual’s symptoms and overall condition.

However, “herbal” or “natural” does not mean that a medicine has no side effects or is automatically safe for everyone.

If using Kampo medicine, it is important to do so appropriately with advice from a doctor or pharmacist.

Medication may sometimes be used for emotional symptoms

If symptoms such as low mood, reduced motivation, significant anxiety, irritability or insomnia are particularly distressing, treatment may sometimes include:

• Antidepressants
• Anti-anxiety medications
• Sleep medications

Different medications have different effects and precautions, and doctors consider an individual’s symptoms and health before selecting an appropriate treatment.

For this reason, avoid replacing medical treatment on your own based on assumptions such as:

“Medication is frightening, so I’ll only use health foods.”
“Natural products must be safer than medication.”

If you are already taking prescription medication, do not suddenly stop it or change the dose without discussing it with your doctor or pharmacist.

Menopausal symptoms and depression do not necessarily require the same treatment

Depressive symptoms associated with menopause and clinical depression can overlap.

However, even when both involve “feeling low”, the underlying situation and appropriate treatment may not be the same.

Rather than deciding for yourself that “it is menopause, so I need HRT” or “I feel depressed, so I need antidepressants”, it is important to receive an appropriate medical assessment.

Where should you seek help? Gynaecology, psychosomatic medicine or psychiatry

If low mood or irritability continues, you may wonder:

“Should I see a gynaecologist?”
“Would a psychosomatic medicine clinic or psychiatrist be more appropriate?”

There is not always one single correct place to start.

If you also have physical menopausal symptoms, consider a gynaecologist or menopause clinic

For women in their 40s or 50s who experience a combination of:

• Changes in the menstrual cycle
• Hot flushes or feeling overheated
• Sweating
• Palpitations
• Other physical symptoms that may be associated with menopause
• Low mood or irritability

a gynaecologist or menopause clinic can be one possible place to seek advice.

A gynaecologist can consider whether symptoms may be associated with menopause while also considering other possible medical causes when necessary.

If low mood or loss of motivation is significant, mental health care may also be appropriate

Consider speaking with a mental health professional if symptoms include:

• Persistent and significant low mood
• Being unable to enjoy activities you previously enjoyed
• Having very little motivation to do anything
• Being largely unable to manage work or household responsibilities
• Persistent severe anxiety
• Ongoing difficulty sleeping

In these circumstances, a psychosomatic medicine clinic, mental health clinic or psychiatrist may also be appropriate.

Some people first speak with a gynaecologist and are then referred to psychiatry or another specialist if necessary.

Conversely, a mental health professional may recommend discussing possible menopausal changes with a gynaecologist.

If you are thinking “I want to die” or “I want to disappear”

Particular attention is needed if you are experiencing thoughts such as:

• Wanting to die
• Wanting to disappear
• Feeling that others would be better off without you
• Thinking about harming yourself

If you are experiencing these thoughts, do not dismiss them as “just menopause” or decide to wait and see on your own. Seek support promptly from a healthcare professional or an appropriate crisis or mental health service.

If you are unable to keep yourself safe or believe you may harm yourself, do not remain alone. Tell a trusted person and seek emergency medical assistance.

If you are unsure where to go

You do not need to know whether the problem is menopause or a mental health condition before asking for help.

A gynaecologist, GP, general physician, psychosomatic medicine clinic or psychiatrist can be an appropriate starting point, and you can be referred to another specialist when necessary.

The important thing is not to diagnose yourself before seeking care, but to explain the symptoms that are causing you difficulty.

Summary: Do not assume it is “just menopause” or “just personality”

Menopause refers to approximately the five years before and five years after the final menstrual period.

Menopause itself is not a disease, but hormonal and other changes during this stage of life may be associated with various physical and emotional symptoms.

Low mood, irritability, anxiety, reduced motivation and difficulty sleeping can all occur during menopause.

However, these symptoms are not unique to menopause.

Important points to remember include:

• Menopause itself is not a disease
• Menopausal symptoms and menopausal disorder are not the same
• Menopausal symptoms are not determined by female hormones alone
• Low mood or irritability should not simply be treated as a personality problem
• Temporary low mood and depression are not the same
• Do not dismiss every symptom as “just menopause”
• Do not try to treat emotional symptoms with one particular food or supplement alone
• If symptoms persist or interfere with everyday life, consider seeking medical advice

Menopause is a stage of life experienced by many women, but the type and severity of symptoms vary considerably from person to person.

You do not have to assume that you simply need to endure symptoms because “everyone goes through menopause”, and people around you should not dismiss genuine distress as “just menopause”.

Reviewing sleep, rest, diet and physical activity can be useful, but you do not need to rely on lifestyle changes alone when symptoms are causing significant difficulty.

If low mood, anxiety, irritability or sleep problems continue, consider speaking with a gynaecologist, GP, psychosomatic medicine clinic, mental health professional or psychiatrist depending on your symptoms and circumstances.