'I'm Angry and Feeling Destructive'

Q:  I am 54-year-old woman undergoing menopause. I have been experiencing very angry and destructive thoughts. Could these thoughts be related to menopause? If so, is this common?

A:  If you feel that you might act on your anger or destructive thoughts, talk to a doctor or other professional right away.

Yes, such thoughts and feelings could be related to menopause. Many women describe an uncomfortable change in mood as they move through the menopausal transition. And when women have a worsening of mood, they frequently feel "irritable," which may mean being more prone to anger.

This irritability can have multiple causes. It may be a direct result of the hormone changes of menopause. Insomnia is also very common for women in this stage of life, and sleep deprivation can cause irritability too.

JoAnn E. Manson, MD, writing in her 2007 book, Hot Flashes, Hormones & Your Health, described this time of life as follows: "Stressful life circumstances, rather than hormonal changes, seem to be the major drivers of mood symptoms during the menopausal transition." She identifies, as possible causes, the "multiple challenges that can arise in midlife." These include:

• Medical illnesses
• Relationship troubles with parents, spouses, and children
• Financial stresses
• Creeping thoughts about mortality

Are such symptoms common? A significant percentage of women report mood problems, insomnia and irritability. But as far as I know, there are no reliable statistics on the specific kinds of thoughts you're having.

I may be reading too much into the short description in your question, but "very angry and destructive thoughts" is a phrase that hints at a greater intensity of feeling than the irritability that experts in this area refer to. If your symptoms are entirely new, and only started as you entered menopause, then menopause could be the primary cause of your symptoms.

I would not make that assumption, however, because it is possible that menopause is aggravating a separate problem that should be evaluated and treated.

It would be best to review your situation with your primary care doctor, who may refer you to a mental health professional. Once you and your doctor have evaluated all the possible causes for your change in mood, you can figure out the best way to treat it.In short, you have a very low, and temporary, risk of MRSA from the person in the next cubicle. And a few smart actions can protect you further. Hopefully treatment will cure the person's MRSA infection soon. That'll be good news for both of you.

Michael Craig Miller, M.D., is editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 25 years.