Why Am I Crying!?

Crying can be a therapy within itself.

It’s no longer viewed as a sign of weakness or embarrassment. Or at least in theory it isn’t. When you’re the one crying, especially in public, it can be a turmoil of emotions, unfortunately including weakness and embarrassment. It’s a tough battle to embrace, but like I said earlier, it can be oh so very therapeutic.

We all know crying is a natural response humans have to a range of emotions, including sadness, grief, joy and frustration (yes, only humans shed emotional tears). It’s not unusual to cry, and apparently, we cry a lot more than people assume – women cry an average of 3.5 times a month, and men cry on average 1.9 times a month.

However, menopause makes things different (menopause makes everything different!).

Menopause (also perimenopause) can mean that you start crying for no known reason. It can mean that your threshold for sad ads, difficult situations and easy decisions is terrible, and you may find yourself crying so much more than what you are used to. Unfortunately, it’s normal in menopause and perimenopause. I once had a patient tell me she started to cry because she looked out the window and saw a bird land. Not only was this a out of character for her, but it concerned her. Yes, it is unusual. Yes, it’s a little different. Yes, I believe it can help to know that you are not alone, and to know that this too shall pass.

Let’s delve into the world of hormones.

Menopause marks the time that your ovaries retire. When they retire, they are essentially shutting down the ‘oestrogen making factory’ and cancelling the production of progesterone (it’s not quite that extreme, but it’s almost that extreme). Without the hormones that your body has been used to working with, a few things start to change. Hot flushes and night sweats are some of the most talked about menopause changes, but your moods and your brain function are also quite noticeable and concerning parts of that change.

Oestrogen deficiency is thought to be the instigator of tears, cognitive decline, depression and almost everything bad in menopause (or at least it feels that way). Too much oestrogen can have a negative effect too (anger and irritability), but unless you are crying because you feel guilty about the anger outburst, it is likely menopause tears are tears of oestrogen deficiency.

There are a few factors at play. One of the factors is serotonin[1]. Serotonin is a chemical that sends signals between nerve cells. It is believed to regulate mood and social behaviour (hence the involvement in tears), as well as regulate appetite, digestion, sleep, memory and sexual desire and function.

Earlier this year, a group of researchers examined the scientific literature surrounding the link between serotonin and oestrogen[2]. After examining the literature, the team hypothesised that oestrogen plays a role in regulating the serotonergic system, providing a protective effect towards serotonin linked diseases. Another team who examined the research on this link have also consistently found that oestrogen increases serotonin availability by altering markers and decreasing breakdown[3].

During menopause, and the decline of oestrogen that comes with it, you are left without the protective or regulating effect that oestrogen has over serotonin. This lack of benefit can leave you vulnerable to erratic changes in mood and social behaviour (plus the rest). Thus, this can result in the tears and the reduced threshold to tears that I mentioned earlier. Serotonin is a key factor.

Another factor involved in the tears in menopause involves something called MAO-A.

MAO-A (monoamine oxidase A) is an enzyme that is involved in removing certain brain chemicals from action, including serotonin and dopamine. It is a key regulator for healthy brain function and is heavily involved in mood, feelings and behaviour. A 2014 study[4] has examined the changes in perimenopause and discovered a relationship between oestrogen and MAO-A. The team was able to identify a 34% increase in MAO-A during perimenopause, suggesting it plays a significant role in the removing of serotonin, and the tears and moods seen during this time. This increase in MAO-A improved (decreased) in menopause, but it was still higher than those in their reproductive years. The switching off of serotonin (or the removal of serotonin) that MAO-A does, heavily impacts the fragile balance of happiness, mood, anxiety and depression. This research team concluded that the strong oestrogen decline was implicated in elevating MAO-A levels. This means that it’s not just the hot flushes or night sweats that can influence your moods, but the hormones and hormonal changes themselves directly impact your brain function.

Summing it up, not only does the decrease in oestrogen mean that you lose your protective effect over serotonin, but it accelerates the break-down, or removal of serotonin. It’s a double whammy – no wonder the tears are fragile.

Don’t fret. Your hormones change, and your body eventually catches up to this change.

Menopause generally marks the time for consistency regarding your sex hormones – yes, they are consistently low, but that consistency is key.

Purely and simply, hormones are messengers that need to connect with a hormone receptor to create a response. Generally speaking, when your ovaries start to malfunction, then retire (perimenopause, then menopause) it takes a little longer for your receptors to respond to the changes, and then down-regulate, or turn off themselves. Eventually, your hormone receptors equal your hormone levels and a harmonious (and comfortable) balance arrives. Until that time, symptoms are present.

My advice for now, be gentle with yourself.

If you find yourself feeling a little vulnerable, teary or emotional, take some time out. Breathe through it, take a seat, feel the emotions (use the tears as a therapy). Once you’re better, move on and don’t fret about the tears. Definitely don’t hold grudges.

If you’re overwhelmed, consider support from the team at the Australian Menopause Centre. The transition time can be challenging, but once you are through and the receptors match the hormones, smooth sailing entails and the next adventure begins.

[1] Lokuge, S., et al. (2011). “Depression in women: windows of vulnerability and new insights into the link between estrogen and serotonin.” J Clin Psychiatry 72(11): e1563-1569.

[2] Hudon Thibeault, A. A., et al. (2019). “Serotonin-estrogen interactions: What can we learn from pregnancy?” Biochimie 161: 88-108.

[3] Lokuge, S., et al. (2011). “Depression in women: windows of vulnerability and new insights into the link between estrogen and serotonin.” J Clin Psychiatry 72(11): e1563-1569.

[4] Rekkas, P. V., et al. (2014). “Greater monoamine oxidase a binding in perimenopausal age as measured with carbon 11-labeled harmine positron emission tomography.” JAMA Psychiatry 71(8): 873-879.