Biopsychosocial predictors of anger and irritability during the menopause transition: A longitudinal study

There is growing recognition that anger and irritability may increase in the menopause transition (MT). Although sensitivity to ovarian hormone fluctuations may contribute to heightened psychological vulnerability, the potential effects on anger and irritability remain understudied. The aim of the present study was therefore to investigate whether within-person changes of ovarian hormones predict anger and irritability while accounting for inter-individual variability.

Two samples encompassing n = 100 individuals with clinically significant depressive symptoms and n = 101 individuals from a general MT sample provided weekly measures of anger and irritability, subjective sleep quality, subjective hot flashes, and urinary metabolites of estradiol (estrone-3 glucuronide or E1G) and progesterone (pregnanediol glucuronide or PdG) for 15 and 12 weeks, respectively. Multilevel regression models were used to investigate within-person effects, as well as their inter-individual variability.

Anger and irritability were highly prevalent, with 76.7% and 55.1% of depressed and general samples, respectively, reporting having moderate to extreme anger and irritability at least once during the study period. Among depressed individuals, higher-than-usual PdG levels (β=0.05, p = 0.02) and hot flashes (β=0.03, p = 0.008), as well as poorer-than-usual sleep quality (β=-0.14, p = 0.002) were significantly associated with higher anger and irritability. None of these predictors were significant in the general sample (all p > 0.05). Random effects revealed considerable individual variability in both E1G and PdG effects on anger and irritability.

These results suggest that increased hot flashes and poor sleep may predict greater anger and irritability, particularly in those reporting clinically significant depressive symptoms. Ovarian hormones may also contribute to anger and irritability during the MT, but with substantial individual variability in the strength and direction of the effect. Among depressed individuals, higher-than-usual PdG levels (β=0.05, p = 0.02) and hot flashes (β=0.03, p = 0.008), as well as poorer-than-usual sleep quality (β=-0.14, p = 0.002) were significantly associated with higher anger and irritability. None of these predictors were significant in the general sample (all p > 0.05). Random effects revealed considerable individual variability in both E1G and PdG effects on anger and irritability.