Perimenopause mood changes: Why your emotions feel all over the place

Menopause is a natural part of women’s health, but did you know there’s a stage before it actually begins?

It's called perimenopause, and it's caused by fluctuating hormone levels, which can lead to both physical and emotional changes. Among the most common are mood swings.

If you’ve been feeling unlike yourself lately and suspect menopause is around the corner, this article is for you.

Read on for everything you need to know about perimenopausal mood changes and what you can do to feel more balanced.

What is perimenopause?

Perimenopause, also known as menopause transition, is the first stage of the gradual end of a woman’s reproductive years. In other words, it's the stage leading up to menopause.

It usually begins during the mid to late 40s, and on average, lasts 3-4 years. However, every woman is different. Some enter perimenopause in their 30s, some only experience it for a few months, and others may not even realise they're going through it.

Perimenopause is a result of hormonal changes—mainly oestrogen and progesterone—which can lead to a range of physical and emotional changes.

Once your periods have stopped for 12 months, you've officially reached early menopause, which means your perimenopause has come to an end.

It’s worth noting that some women experience what’s called premature menopause, when menopause occurs before the age of 40. Although symptoms can be similar, premature menopause isn't the same as perimenopause, and it usually requires earlier medical guidance.

What are the common symptoms of perimenopause?

Perimenopausal symptoms vary widely, and some women may not notice them at all. Having said that, perimenopause is linked to a few common symptoms, including:

• Hot flashes (or hot flushes)
• Irregular periods
• Mood swings
• Brain fog
• Headaches
• Vaginal dryness
• Night sweats
• Fatigue
• Weight gain
• Changes in libido
• Breast tenderness

When it comes to the mental symptoms, some midlife women experience irritability, low mood or other emotional symptoms (similar to premenstrual syndrome but more persistent), as well as difficulty concentrating and loss of motivation or confidence.

In rarer cases, these symptoms can develop into major mood changes.

If any of these symptoms are significantly impacting your well-being, it's important that you speak to a doctor.

Going through the menopausal transition (or menopause, for that matter) doesn't mean you have to accept the discomfort silently.

A healthcare professional can help you manage and reduce your symptoms, so you can take back control of your day-to-day life and feel like yourself again.

Why does perimenopause cause mood changes?

There are a few possible culprits behind those unpredictable mood swings:

Oestrogen and progesterone changes

We've mentioned that hormone fluctuations are behind the changes that happen during perimenopause, and that includes mood symptoms.

Let's go through the 2 key hormones that shift during this life stage and may make you feel emotionally unsteady:

Oestrogen

Oestrogen is one of the main female sex hormones, playing a key role in many bodily functions. One of these functions? Regulating brain chemicals, particularly:

• Serotonin, which makes you feel calm and balanced
• Dopamine, which makes you feel motivated and able to experience pleasure
• Norepinephrine, which affects alertness and focus

When your oestrogen levels swing dramatically, the activity of these chemicals gets disrupted.

You may find your emotional responses are more intense or harder to control, which could lead to mood changes.

Progesterone

Progesterone is a hormone produced by the ovaries. It supports the menstrual cycle and pregnancy by preparing the uterus to receive a fertilised egg.

What you may not know is that progesterone also has a calming effect. It gets converted into allopregnanolone, a chemical that helps ease stress, reduce anxiety, and relax your brain.

Now, as you approach menopause, your cycle becomes less regular, your ovaries produce fewer eggs, and your progesterone levels drop.

This means your brain gets less allopregnanolone, and those calming effects start to fade, contributing to heightened anxiety, irritability, and trouble sleeping.

Studies have actually shown that the hormonal fluctuations of perimenopause are linked with an increased risk of developing mental health disorders, particularly among women who have experienced emotional symptoms before [10][11].

Sleep disruptions

Many people think of hot flashes and night sweats as menopausal symptoms, but the truth is that they can start a little earlier.

That's why, during perimenopause, women may have a hard time falling asleep, wake up several times during the night, or wake up too early unintentionally.

The problem is, sleep is crucial for emotional regulation (well, it's crucial for your overall health, really).

Without proper rest, your brain may find it harder to process emotions, consolidate memory, and balance out those key mood-regulating chemicals we discussed before.

Sleep problems can also raise your cortisol levels. If they stay high for too long, your brain can become more reactive to negative stimuli, amplifying feelings of stress and tension.

This can all create a vicious cycle. You're tired from sleeping poorly, which worsens physical symptoms like hot flashes and headaches, and the night disruptions continue.

That's why it is so important to address your perimenopause symptoms early on, but more on that in just a bit.

Midlife pressures

During this time, responsibilities and expectations are usually high. And while this doesn't cause perimenopausal symptoms, it can amplify them.

Between work stress, family responsibilities, maintaining friendships, and pursuing personal goals, there's a lot to juggle when you're in your 30s, 40s, and 50s.

Add this to the hormonal shifts you're already coping with, and your mental health can take a toll.

And the physical symptoms don't help, either. Between the hot flashes, low energy levels, and potential weight gain, it's easy to feel irritable or overwhelmed.

How to improve your mood during perimenopause

You understand what emotional symptoms perimenopause can cause, and why. Now, let's get to perhaps the most helpful part: what you can do when it all starts to feel like too much.

Lifestyle and self-care strategies

There are some tweaks you can make to your usual routine, particularly if your symptoms are mild and don't require medical attention:

Prioritise sleep

Sleep disruptions are a big culprit for perimenopausal mood swings. So, look at your bedtime routine and see if there's any room for improvement:

• Stick to a consistent sleep schedule
• Keep your bedroom cool and dark to reduce night sweats
• Limit screentime before bed
• Try relaxation techniques like deep breathing or gentle stretching

Exercise

It's been proven that exercising helps improve mental health, lower stress levels, and reduce symptoms of mental illnesses [1].

It does so by increasing feel-good hormones like endorphins and serotonin—the ones that fluctuate during perimenopause.

Even short, 10-minute bursts of exercise can improve your mood, alertness, and focus [2][3].

Whether you prefer running, swimming, practising Yoga, or lifting weights, make time in your day-to-day to move your body.

Eat a balanced, nutrient-rich diet

Your diet can have a major impact on how you feel, both physically and mentally. Make sure you're getting enough:

• Omega-3 fatty acids to help regulate your mood (and potentially decrease the risk of mood disorders) [4]. Good sources include fatty fish like salmon or sardines, chia seeds, and walnuts.
• Protein to stabilise your blood sugar and prevent crashes [5]. Good sources include poultry, tuna, tofu, steak, and edamame.
• Complex carbs to keep your energy levels steady and support serotonin production [6]. Good sources include whole grains, legumes, and starchy vegetables.

Adopt stress management strategies

Managing stress can help reduce mood swings and improve emotional resilience during perimenopause. Different strategies work for different people, but a few ideas include:

• Mindfulness
• Meditation
• Journalling
• Creative hobbies
• Yoga
• High-intensity exercise
• Spending time outdoors
• Social connection with family and/or friends

Treatment and support options

Sometimes, making lifestyle changes isn't enough. In these cases, medical and professional support can make a big difference.

Hormone replacement therapy

Hormone replacement therapy (now more commonly known as menopausal hormone therapy, or MHT) is specifically designed to address the symptoms of menopause by restoring the lower levels of oestrogen and progesterone [7].

MHT comes in different forms, including tablets, patches, gels, and vaginal creams.

A doctor can help you figure out which option is right for you, as well as what dose and duration is safest.

Cognitive behavioural therapy

Cognitive behavioural therapy, or CBT, is a type of talk therapy that helps you identify unhelpful thinking patterns and reframe them into more balanced, realistic ones [8].

It focuses on current problems (rather than past experiences), and teaches actionable coping mechanisms to respond to triggers and stressful life events more calmly.

These may include deep breathing, relaxation exercises, progressive muscle relaxation, and structured problem-solving strategies.

Over time, it helps lower stress levels, improve sleep (there's actually a form of CBT designed specifically for insomnia), and boost your resilience, so day-to-day challenges start to feel less overwhelming.

CBT is also often used for more serious mental health conditions, including depressive thoughts, anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD) [9].

When to speak to a doctor or mental health professional

While mood changes during perimenopause are common, it’s important to recognise when they go beyond the usual ups and downs.

If you've been struggling mentally or emotionally for more than 2 weeks, consider speaking to a professional.

Remember, hormonal changes can increase your risk of affective disorders, even if you've never experienced them before.

A mental health professional can determine whether your symptoms are part of normal perimenopausal mood disturbances or signs of something more serious. From there, they'll guide you toward the most effective treatment.

You don't have to do it all alone, and there's no shame in getting help.

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