Who Have I Become? When Anger and Irritability Show Up In Perimenopause

Who Have I Become?

When Anger and Irritability Show Up in Perimenopause
A deeper look at Liver Qi Stagnation and how Traditional Chinese Medicine looks for patterns.

Recently, I was speaking at The Warm Room about hormones and mental health in perimenopause, and I told a story that I have told many times before.

A woman was driving when another driver did something that made her furious. Her knuckles were white on the steering wheel, her foot was heavy on the gas, and she followed the other car into a parking lot. She pulled in front of them, got out of her car and started screaming.

When she finally got back into her car, she looked over at her daughter in the passenger seat. Her daughter was slumped down, pulling the brim of her baseball cap over her eyes, trying to disappear.

“Mom. You terrified me.”

And just like that, the rage was gone and the guilt rushed in.

When this woman eventually sat across from me in clinic and told me what had happened, she said something I hear a lot:

“I don’t know who I am anymore.”

She wasn’t only talking about what happened in the car. Her husband’s chewing made her want to scream. She was losing her temper with her kid. Things she used to be able to brush off suddenly felt unbearable. Then she would hide away and cry because she felt so guilty about how she had reacted.

She thought she had become an angry person.

At The Warm Room, after I told this story, a woman in the audience stood up and said, “That story you told? I actually just did that.”

The whole room broke into laughter.

What struck me about that moment was the immediate recognition in the room. Maybe not everyone had chased someone into a parking lot, but a lot of people understood the feeling behind it.

So I wanted to go a little deeper into something I only had time to touch on that night.

When I hear a story like this in my clinic, I don’t simply hear “anger.” I’m listening for what else is happening.

I’m looking for a pattern.

And one of the patterns I saw in this particular woman was something we call Liver Qi Stagnation.

How did I know to look at the Liver?

To explain that, I need to take you a little further into Traditional Chinese Medicine.

There is a beautiful framework in Traditional Chinese Medicine called Five Element Theory. The Five Elements are Wood, Fire, Earth, Metal and Water. They aren’t simply five separate categories. They describe relationships—how different systems support, influence and interact with one another.

We’ll come back to that idea.

For now, I want to start with Wood.

The Wood element includes the Liver and Gallbladder. The Liver is considered the Yin organ and the Gallbladder the Yang organ. Yin and Yang are a much bigger conversation, so we’ll save that one for another day.

For this story, we’re going to stay mostly with the Liver.

And when I say Liver, I’m not talking only about the anatomical liver.

This is one of the places where Traditional Chinese Medicine can be confusing when you’re first introduced to it. An organ system in Traditional Chinese Medicine has a much broader set of functions and relationships than the physical organ that shares its name.

Those relationships give me clues.

When I start hearing about changes in several areas associated with the same system, I start wondering whether those things might be connected. One symptom by itself may not tell me very much. When several pieces begin pointing in the same direction, however, a pattern can start to emerge.

So what am I looking for?

One of the Liver’s important responsibilities in Traditional Chinese Medicine is helping maintain the smooth flow of Qi.

Qi is one of those Traditional Chinese Medicine words that doesn’t translate neatly into English. You’ll often hear it translated as “energy,” but that doesn’t really capture it. Qi is involved in movement, function, transformation and the things the body actually does.

There is much more to Qi than that, and we’ll get there.

For now, the important part is movement.

The Liver wants Qi to move freely. When that movement becomes constrained, we call it stagnation.

Think about traffic.

When traffic is moving, you don’t really think about it. You’re just driving. Then something blocks the road. Cars start backing up. More cars arrive. The pressure builds.

That feeling of constraint and building pressure is something I’m listening for when I’m considering Liver Qi Stagnation.

The woman in my story described feeling wound incredibly tightly. Things that used to roll off her back suddenly didn’t. Her tolerance was disappearing. She could feel everything building and building until something relatively small tipped her over.

But anger alone would never be enough for me to decide this was Liver Qi Stagnation.

I need more information.

This is where the pattern starts to appear

This is one of the things that comes with practicing Traditional Chinese Medicine for a long time. When someone starts telling me their story, there are certain things that make my ears perk up.

If you tell me you’ve suddenly become incredibly irritable, that’s interesting. But it isn’t enough for me to decide you have Liver Qi Stagnation.

Then you tell me your breasts are painfully tender before your period.

Okay.

Your neck and shoulders are constantly tight.

Interesting.

Your headaches are worse when you’re stressed. Your digestion changes during stressful weeks. You feel noticeably better after you go for a walk. And all of it seems to ramp up before your period.

Now I’m seeing something.

Those symptoms may have felt completely unrelated to you. From a Traditional Chinese Medicine perspective, several of them can fall within the same landscape.

That’s when a pattern starts to emerge.

The Liver has a close relationship with Blood in Traditional Chinese Medicine. We say that the Liver stores Blood, so menstruation is something I’m interested in when I’m looking at this system. I want to know what your periods are doing, whether they’ve changed, whether they’re painful and whether other symptoms change around your cycle.

The Liver is also associated with the sinews, so physical tension is another clue. That person who feels like their shoulders are permanently attached to their ears, who clenches their jaw or describes feeling physically wound up gets my attention.

And in Five Element Theory, the emotion associated with Wood is anger.

That does not mean anger equals Liver Qi Stagnation.

It means anger is another piece of information.

Put the irritability beside the menstrual changes. Put those beside the tension. Add the stress headaches. Add the digestion that changes when life becomes overwhelming. Add the fact that movement makes you feel different.

Now I have something very different from a list of random symptoms.

I have a pattern to investigate.

But aren’t these symptoms hormonal?

Yes. They absolutely can be.

Perimenopause involves significant changes in ovarian hormone patterns. Ovulation can become less predictable, progesterone exposure changes, and estrogen can fluctuate considerably. Those physiological changes can contribute to many of the things we’ve just been talking about—irritability and other mood changes, breast tenderness, headaches, changes in sleep and changes in the menstrual cycle.

So if you’re reading this thinking, “But couldn’t hormones explain all of this?”—yes. They can be an important part of the explanation.

I don’t need to choose between that explanation and Traditional Chinese Medicine.

The hormonal changes help us understand part of why this is happening physiologically.

Traditional Chinese Medicine gives me another question to ask:

How is this particular person’s body responding to that changing physiology?

Because not everyone going through perimenopause has the same experience. One person may find irritability becomes one of the biggest changes they notice. Someone else may barely experience it. Even among people who are irritable, the other things happening alongside that irritability won’t necessarily be the same.

That’s where pattern differentiation becomes useful to me.

I’m not looking at Liver Qi Stagnation as an alternative explanation for perimenopause, and I’m not suggesting that hormones somehow aren’t involved.

I’m looking at the hormonal transition and asking what pattern is showing up in the person sitting in front of me.

This is pattern differentiation

This is probably one of the most important things I want people to understand about Traditional Chinese Medicine.

I don’t take every symptom and put it into its own separate box. I’m interested in what happens when I put all of those symptoms beside each other.

The irritability matters, but so does the headache. So does the timing of your period. So does the tension in your body. So does your sleep. So does the fact that your digestion changes when you’re stressed. So does what makes you feel better and what makes you feel worse.

I’m looking for the relationship between them.

We call this pattern differentiation, and it’s central to the way I practice.

That’s why I ask so many questions.

If you’ve ever been treated by me, you know this. You may come in because you’re suddenly furious all the time, and before long I’m asking about your period, your sleep, your digestion, where you hold tension and what was happening in your body six months ago.

There is a reason for all of it.

I’m looking for connections.

And this is where perimenopause changes the landscape

You don’t arrive at perimenopause as a blank slate.

You arrive with the body you’ve been living in for decades. Your menstrual history, your sleep, your stress, pregnancies and births if you’ve had them, illnesses, work, relationships, responsibilities and all the ways you’ve learned to cope with life come with you.

And then something important happens.

Your physiology begins to change.

This is where I want to bring you back to Five Element Theory, because the Liver doesn’t exist in isolation.

Remember that the Liver belongs to Wood.

Another of the Five Elements is Water, which includes the Kidney system.

In Five Element Theory, Water nourishes Wood. This is sometimes described as a mother-child relationship: the Kidney is the mother and the Liver is the child.

And that relationship becomes particularly interesting when we start talking about perimenopause.

In Traditional Chinese Medicine, the Kidney system is deeply connected with growth, reproduction and aging. It is also where we begin talking about Jing, or Essence, one of the foundational substances in Traditional Chinese Medicine.

Jing deserves a much bigger conversation than I can give it here.

It’s also closely connected to another beautiful TCM framework called the Seven-Year Cycles, which describes stages of growth, reproductive development and aging throughout a woman’s life.

I’m going to take you much deeper into both Jing and the Seven-Year Cycles in The Menopause Map and in future articles because they are an important part of understanding this transition.

For now, there is one piece I want you to hold onto.

In Traditional Chinese Medicine, Jing gradually declines as we move through life. This is not something going wrong. It is part of the natural progression of aging described within this medical system.

And this is where I think the map becomes really interesting.

If the Kidney system is changing, and the Kidney and Liver have this close relationship, then I can’t look at what is happening with the Liver as though nothing else around it has changed.

The whole dynamic is changing.

That doesn’t mean changes in the Kidney automatically cause Liver Qi Stagnation. Bodies aren’t that simple, and neither is Traditional Chinese Medicine.

But it does mean that the internal landscape in which that Liver pattern is happening has changed.

Maybe someone has always had some tendency toward Liver Qi Stagnation. Maybe she has always been a little irritable before her period. Maybe stress has gone straight into her shoulders since her twenties. Maybe PMS isn’t remotely new to her.

And then she reaches perimenopause and says:

“I’ve always had PMS, but not like this.”

Or:

“I’ve always been impatient, but I’ve never felt rage like this.”

Or simply:

“I used to be able to handle all of this.”

That’s interesting to me.

Because maybe we aren’t looking at an entirely new person, or even an entirely new pattern.

We may be looking at a familiar tendency showing up in a body whose underlying physiology is changing.

The landscape has changed, so the pattern can look different too.

This is also one of the reasons there isn’t one Traditional Chinese Medicine pattern for perimenopause. Changes associated with the Kidney system may be part of the picture, but those changes are interacting with everything else that is already happening in that particular person.

That’s why I need to know your story.

And I don’t want to take your anger away

There is another part of this conversation that matters to me.

If anger is part of your pattern, my goal isn’t to make you stop being angry.

Anger can be information.

This stage of life can make some things incredibly clear. Maybe you’ve spent decades taking care of everybody else. Maybe you’ve kept the peace. Maybe you’ve said yes when you wanted to say no. Maybe things you’ve tolerated for years suddenly feel completely intolerable.

I don’t necessarily want to treat that out of you.

What I want is for you to feel steady enough that you get to decide what to do with the emotion.

There is a difference between recognizing, “I’m angry because this isn’t okay with me anymore,” and feeling as though the rage has taken over and you no longer recognize yourself.

That’s the difference I’m interested in.

What changed for the woman in my story?

When she first came to see me, she wasn’t convinced that any of this could change. I remember thinking, The proof is going to have to be in the pudding. We could talk about Traditional Chinese Medicine theory all day, but ultimately she needed to experience something different in her own body.

And she did.

Months later, she came into my treatment room grinning. She told me that she had felt that familiar rage beginning to bubble up, and her first thought was essentially, Oh my God. I hate this feeling.

But then something different happened. Instead of immediately believing that the rage was who she was, she recognized it. She knew the feeling. She knew it would pass, and she knew what she could do.

That was the part that mattered to me. At the beginning, the story had been, This is who I am now. Later, it became, This is something I’m experiencing.

She didn’t become a person who never got angry. She became someone who understood what was happening in her body and had more agency in what happened next.

I don’t want you to diagnose yourself

As I share more of these patterns, I want to be really clear about this.

The point isn’t to read an article about Liver Qi Stagnation, count your symptoms and decide, “That’s me.”

I’d rather you start noticing.

If your irritability has suddenly become much worse, what else changed around the same time?

What’s happening with your sleep? Your period? Your digestion? Are you getting headaches? Where do you hold tension? Does stress make things worse? Does movement change how you feel? Is there a time in your cycle when everything becomes louder?

You don’t have to know what those things mean.

Just notice them.

That’s where I start too.

This is part of The Menopause Map

When that woman first sat across from me and told me she didn’t know who she was anymore, she was looking at what had happened as evidence that she had changed as a person.

I was looking at it differently.

I wanted to know what had changed in her body, what else was happening and whether those things were connected.

For her, one piece of that picture was Liver Qi Stagnation.

But as you’ve probably gathered by now, the Liver doesn’t exist by itself. Neither does the Kidney. Neither does your period, your sleep, your digestion, your mood or the tension you carry in your shoulders.

They’re part of a landscape.

This is the part of Traditional Chinese Medicine that I wish more people understood. It isn’t really about memorizing that anger belongs to the Liver, that the Kidney belongs to Water or that Water nourishes Wood in the Five Element cycle.

It’s about learning to see relationships.

I’ve been practicing acupuncture and Traditional Chinese Medicine since 2010, and I’m in perimenopause now myself. Even with everything I know about Traditional Chinese Medicine, there have still been moments when I’ve thought, “What the hell is happening to me?”

But I had a map.

That doesn’t mean I’ve sailed through perimenopause. I haven’t.

It means I’ve had another way of looking at what is happening in my own body and another set of questions I can ask.

And that’s a big part of why I’m writing The Menopause Map.

As I write it, I’m going to take you deeper into Qi and Blood, Yin and Yang, Jing, the Seven-Year Cycles, Five Element Theory and the different patterns I see in my treatment room. I’ll also be sharing pieces of the book and some of the things I’m thinking about and learning along the way.

You don’t need to become your own Traditional Chinese Medicine practitioner.

I want to give you enough of the map that you can begin to notice your own landscape.

So that when you have one of those moments when you think:

Who have I become?

Maybe you know to ask another question too:

What’s changed?

The Menopause Map is being written now.

If you’d like to follow along as I write it, join me.

Follow The Menopause Map