When women go through menopause, many times the focus is on the physical changes that occur: the hot flashes, the night sweats and the loss of sex drive. But there are other shifts that can be just as alarming, says Dr. Christiane Northrup, author of The Wisdom of Menopause. "The emotional changes can feel much bigger and dramatic than even the physical changes," she says. "Women think they’re going crazy, they think that they’re getting a short fuse, they think that their life as they know it is over. It feels like a death in many ways."

Dr. Northrup covers three of the emotional responses to menopause that many women encounter:

Menopausal memory

"Maybe you leave the cell phone in the refrigerator, and you think you’re losing your mind," Dr. Northrup says, "but you’re not! Your attention is turning inward. However, memories from the past will actually come up; people may remember abuse memories or times they were sad or whatever. It’s because it’s a time when the brain is being affected by the change in hormonal levels. So old memories come up to upgrade your self concept for the second half of your life - you’re 'rebooting.'

"For most women, this lasts a couple of years. It can be anywhere from six to 13 years; the ovaries change function slowly, but if you’ve had a hysterectomy it can be almost overnight. But it’s usually a gradual process so that you can integrate this new self that’s coming up and being born. It’s like a snake shedding its skin and you’re remembering the best part of who you were. You know how girls are when they’re nine and 10? They’re mouthy and tell you who they are. This is happening again, only in a good way - you have skills now."

Dr. Northrup explains the physiological causes for these changes. "The first thing that happens is you get a decrease in progesterone when you stop ovulating or skip ovulations. Progesterone binds in the same places in the brain as Valium, so it’s a very calming hormone; when women are pregnant they’re very calm and they glow. But [older women] don’t have that one so much anymore. And so you have relatively increased levels of estrogen and even androgen, a testosterone, because the inner part of the ovary grows, especially in the face of stress hormones. That estrogen is converted into another stress hormone and it knocks on three places in the brain where old memories are stored: The basal forebrain, the hippocampus, and the amygdala. These are sort of ancient centers in the brain that store memories. And so those increasing and changing levels knock on that area and say, 'Hey! There’s some stuff that needs up dating in there!'"

Rachael asks if hormone therapy can be of some comfort. "You’re still going to have to update your software," Dr. Northrup responds. "You’re going to have to do it anyway but you don’t need to suffer. So a little dusting of hormones can help - progesterone - and if you’re not sleeping for instance and you’re becoming depressed because you’re not sleeping, then this will really help because you can really become depressed just from not sleeping."

Menopausal Meanness

"What that is about is this excess estrogen relative to progesterone," Dr. Northrup says, "and the fact that it’s pounding on those ancient areas of the brain that make you impatient with people that, say, haven't been folding the towels for the last 20 years. Stuff you would put up with before that wasn't so good for you anyway, now you really can't put up with it. You're saying, 'I’m irritable because I have a need that is not being met.' What is your need? Maybe a need for support, need for rest, need for sleep, need for someone to say, 'Gosh, you're doing a good job mom! I notice you've been doing it thanklessly for 20 years.' These are real needs and that’s why the emotions come up."

Menopausal depression

"Often times, this is a cliché in psychiatry, except that it's based on the truth, which is depression is anger turned inward," Dr. Northrup explains. "And anger is jet fuel; it allows you to change something because you can't stand it. It's like you become immobilized for a while, it’s kind of like being in a shell that you need to break out of, and so you start with doing one thing at a time that is toward change. However, what I really want to get across is that depression and menopause are not synonymous. They’re not associated with each other in particular. The women with the most depression are in their 30s or early 40s. Women in their 50s and 60s are much happier, so it’s not related to the hormone changes per se.

"You know, it's interesting [to hear about] the days before hormone replacement. One of my friends is 90 and she’s a doctor. She said women [she saw with menopausal depression], she said some would go to bed for two years and the rest of the family would do everything and then they’d wake up, they'd finally get it together and then they'd emerge as a new person. So you might be in a kind of cocoon right now. Now, you could try a little estrogen, a little progesterone, see if it helps you, but I would go with vitamin D, sunlight, that stuff first. Just know that you will come out of it, but you’re in a cocoon right now."

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Dr. Christiane Northrup