Is This Perimenopause… or Am I Just Losing It? Understanding Mood Changes During Perimenopause
Three Things to Know
Perimenopause doesn't just cause hot flashes. It can also affect your mood, increasing anxiety, irritability, and depression.
You're not imagining it. Fluctuating estrogen levels change brain chemistry, and life stress often piles on during midlife.
You don't have to "just deal with it." Treatment options—including therapy, lifestyle changes, medications, and sometimes hormone therapy—can help.
I sat down to write my blog this week, and while there are approximately 137 topics I could write about, none of them seem to fit my mood.
What is my mood?
Call it depression. Anxiety. Irritability. Low motivation.
I'm going to call it perimenopausal angst.
When I joke that my kids have teenage angst, I find myself explaining that it's completely normal at this stage of their lives.
But when it comes to my own angst?
My first thought is that I should know better. That I'm an adult. That I should be able to control my emotions.
Fuck that.
It's cloudy and muggy outside. I'm questioning every role I have in my life. I'm worried about every single person around me. I'm angry at far too many people to list.
I want to punch something, but at the exact same time I want to crawl under the covers the minute the rain starts.
My skin is crawling. And somehow, I also feel a little dead inside.
Does any of this sound familiar?
Perimenopausal mood changes can range from occasional irritability to full-fledged anxiety and depression.
We've already talked about how the brain has estrogen receptors scattered throughout it (see my Brain Fog post). As estrogen levels fluctuate and eventually decline, so do neurotransmitters like serotonin and norepinephrine—the chemicals that help regulate mood, sleep, and emotional resilience.
And the numbers are surprisingly high.
Studies estimate that 45–70% of women experience depressive symptoms during perimenopause, compared with roughly 25–30% of premenopausal women. One small study even found that the risk of depression was 14 times higher during the two years leading up to menopause than during the preceding three decades.
No wonder so many of us feel like we're losing our minds.
Symptoms of Perimenopausal Mood Changes
One thing I often tell patients is that anxiety and depression like to travel together.
Anxiety may show up as:
Irritability
Nervousness
Racing heart or palpitations
Restlessness
Constant worrying
Depression may look like:
Crying for no obvious reason
Fatigue
Low motivation
Loss of interest in things you normally enjoy
Feeling hopeless or emotionally numb
The tricky part is that these symptoms often overlap. Fatigue could be depression...or insomnia from night sweats. Irritability could be anxiety...or simply the result of sleeping four hours a night because you woke up soaked in sweat for the third time.
It can be hard to tell the difference between hormones, life stress, physical ailments and a mood disorder.
It can also be hard to know when you're just having a bad day versus when it's time to ask for help.
Risk Factors
Some women are at higher risk for anxiety and depression during perimenopause, including those with:
A history of depression or anxiety
Frequent hot flashes
Chronic insomnia
Smoking or a sedentary lifestyle
Significant life stressors (raising teenagers, career changes, aging parents, relationship changes—you know...midlife)
Certain ethnicities (some large studies suggest Hispanic women may be at higher risk)
Treatment Options
The good news?
You don't have to just white-knuckle your way through this.
Treatment options include:
1. Antidepressants
While research specifically in perimenopausal women is still limited, studies have shown benefit from medications such as citalopram, escitalopram, mirtazapine, duloxetine, and venlafaxine.
Some of these medications also help hot flashes. One bird…Two stones.
2. Estrogen
This one deserves a little clarification.
Estrogen has not been shown to directly treat depression.
What it can do is improve hot flashes and sleep quality. Better sleep often means better resilience, improved mood, and a greater ability to cope with life's daily stressors. Some studies also suggest estrogen is more likely to improve mood when started during perimenopause rather than after menopause.
3. Cognitive Behavioral Therapy (CBT)
CBT and other evidence-based therapies can be incredibly effective, especially when anxiety or depression begin interfering with daily life.
4. Exercise and Nutrition
The evidence isn't conclusive, but regular exercise and a balanced diet may be worth trying if they have helped in the past.
5. Omega-3 Fatty Acids
Some evidence suggests that omega-3 supplements with a higher ratio of EPA (eicosapentaenoic acid) to DHA (docosahexaenoic acid) may improve mood and psychological well-being during perimenopause.
So why didn't I write one of the other 137 blog topics this week?
Because this was the one my brain had the energy to write.
Perimenopause has a way of making us question ourselves. It whispers that we're lazy, too emotional, not resilient enough, or somehow failing at adulthood.
But maybe we're not failing.
Maybe our brains are simply responding to changing hormones while we navigate one of the busiest, most stressful decades of our lives.
Some days you'll feel like yourself. Some days you'll feel like sitting in your closet while simultaneously wanting to yell at everyone around you.
Both can be true.
And if those feelings become persistent or start affecting your relationships, your work, or your ability to enjoy life, please talk to someone. You don't have to suffer through it simply because you're "at that age."
Sometimes the strongest thing we can do isn't powering through.
Sometimes its putting your sad song playlist on repeat.
Sometimes, its admitting in a blog that you're not ok today.
And sometimes it's asking for help, because if we don't look out for each other who is going to look out for us.
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