A woman closed her eyes. Then another. Then another, until heads were nodding across the screen, quietly, almost in unison.
To be clear, institutional momentum is finally building around menopause, including some of its mood symptoms. In June, Melinda French Gates announced a $215 million commitment to women’s health research and advocacy. That same month, Washington Governor Bob Ferguson signed an executive order directing state agencies to build menopause accommodations into workplace policy, and Illinois lawmakers advanced the bill that would require employers to provide reasonable accommodations for menopause-related conditions.
Women in my practice describe something sharper than short-temperedness: an emotional intensity disproportionate to the moment. What scares many of them is the loss of predictability, the sense of no longer recognizing their own reactions.
The Study of Women’s Health Across the Nation (SWAN), the largest and longest-running study of the menopause transition, shows women are significantly more likely to report high depressive symptoms during perimenopause than before it. A separate analysis tracked irritability specifically, as one symptom in a four-part anxiety cluster alongside tension or nervousness, feeling fearful for no reason, and a racing or pounding heart, in nearly 3,000 women over 10 years. Women with no prior history of anxiety were significantly more likely to report high levels of that cluster during perimenopause and beyond, even after adjusting for hot flashes, stress, and overall health.
The 2018 Menopause Society consensus guidelines on perimenopausal depression, the most recent dedicated clinical guidance on mood from any major U.S. professional body, direct clinicians to screen for depressive symptoms using validated instruments and treat them with antidepressants or psychotherapy. And in the research that does measure irritability, including the SWAN analysis, it appears as one component inside a composite anxiety measure, studied alongside nervousness, fearfulness, and a racing heart, never examined as its own clinical subject.
I think of a white patient who sat across from me several years ago and stared at the floor. For years she’d been one of the most animated people I knew, full of stories about work travel and her family. That day she barely looked up.
She had stepped back from a leadership role that required frequent travel, not because she couldn't do the work, but because she no longer trusted what she might feel at 30,000 feet. The rage came without warning and without proportion, and what frightened her most was that she couldn't see it coming anymore. She hadn't connected any of it to perimenopause, because no one had ever suggested she should.
But the silence isn’t distributed evenly, and that’s where any policy response built on this moment will either hold up or fall apart.
“I can’t be perceived as angry,” she said. “Ever.”
Washington’s new directive and the Illinois bill focus primarily on accommodations for the physical symptoms of menopause: temperature control of workplaces, flexible scheduling, occupational health access. These are necessary and overdue. But they are not sufficient if another symptom driving significant professional disruption, one with no clinical guideline at all, stays outside of the frame.
Rage deserves to be treated with the same seriousness now finally being extended to other menopause symptoms.
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