How to control mood swings during perimenopause

If you’re somewhere along the journey to menopause, you may have noticed changes in how you respond emotionally.

Maybe you’ve found yourself getting irritated more quickly, or perhaps your family has pointed it out. Even if you’ve never considered yourself easygoing, you might now feel more reactive — staying in feelings like sadness or anger longer than you used to.

Emotional shifts that can come with perimenopause

One of the most frequent concerns I hear from patients in perimenopause is increased irritability. But mood changes can show up in other ways, too. You might notice:

• Heightened emotional intensity
• Increased sensitivity
• More frequent anxiety or worry
• Feelings of sadness or depression

You may find yourself reacting more strongly to things that once rolled off your back — a comment, a small mistake, a bit of bad luck. Many describe feeling more emotional than they’re used to. Understandably, that can be uncomfortable.

What causes mood changes in perimenopause

These emotional shifts are often linked to the gradual decline in hormones like estrogen, progesterone and testosterone. As you approach menopause (defined as going 12 months without a menstrual period) these hormone levels drop. Estrogen, in particular, plays a role in regulating serotonin and dopamine, two brain chemicals that help support mood and emotional balance.

But it’s not just the hormones themselves — it’s also the symptoms they can trigger that affect how you feel.

Symptoms in perimenopause that can affect your mood

Several common experiences during perimenopause can contribute to emotional ups and downs, including:

• Trouble sleeping or frequent waking
• Hot flashes and night sweats
• Decreased libido
• Stress related to:
  • Changing relationships or friendships
  • Balancing care for children and aging parents
  • Physical changes, such as weight gain

When symptoms like night sweats disrupt your sleep, it can leave you feeling exhausted, and that fatigue can make it harder to stay patient or calm in your daily interactions.

It all adds up

For many people who experience perimenopause, the transition coincides with a particularly demanding stage of life. The combination of hormonal changes, physical symptoms and life stressors can feel overwhelming at times. But understanding what’s happening — and knowing that you’re not alone — can be the first step toward managing it with more confidence and compassion.

Why do mood changes during menopause affect some individuals more than others?

The severity of these mood changes during menopause can vary from person to person. Several factors contribute to increased vulnerability, including:

• Pre-existing psychiatric conditions, such as a history of major depressive disorder or bipolar disorder, can predispose individuals to heightened emotional reactivity during hormonal shifts.
• Biological sensitivity to hormonal fluctuations can amplify the psychological impact of declining estrogen and other reproductive hormones.
• Abrupt onset of menopause, often resulting from surgical interventions including a hysterectomy or medical treatments, such as chemotherapy, can intensify your symptoms due to the sudden hormonal withdrawal.
• Elevated stress, including life events such as divorce or handling caregiving for both children and aging parents, can worsen emotional strain.
• Chronic sleep disturbances are both a symptom and a contributing factor to mood dysregulation.
• Poor overall health or a sedentary lifestyle may reduce resilience to stress and negatively impact emotional well-being.

What you can do to manage the ups and downs of perimenopause

Taking care of ourselves is critical during perimenopause and throughout our lives. Maintaining a healthy body weight may reduce the frequency and intensity of menopausal symptoms.

Lifestyle changes to help your mood

Nutrition: This isn’t news to anyone or unique to perimenopause, but a well-balanced diet is an essential tool during the menopausal transition. Foods rich in calcium and vitamin D support healthy bones, alongside lean protein sources. Eating less sugar and drinking less caffeine may help control hot flashes and improve your energy.

Physical activity: Just as with nutrition, physical activity is good for us. Engaging in at least 150 minutes of moderate-intensity exercise per week, including resistance training twice weekly, has been shown to preserve bone density, support cardiovascular health, and improve mood regulation in premenopausal women.

Stress reduction: Activities like yoga, tai chi, mindfulness meditation, massage therapy, and acupuncture can help you feel less stressed and improve emotional health during menopause.

Sleep: Keeping a regular sleep schedule and making your bedroom comfortable — like keeping it dark and cool, at a temperature around 67 degrees — can improve your sleep. Wearing layers of clothes can help with night sweats.

Substance use: It’s important to quit smoking and limit how much alcohol you drink. Both smoking and drinking can make your symptoms worse and can affect your long-term health.

Medications

Hormone replacement therapy (HRT) usually includes estrogen and sometimes progesterone. It’s the best way to treat hot flashes and dryness in the vaginal area. HRT is available in various forms including oral tablets, transdermal patches and topical sprays.

Antidepressants:

• Selective serotonin reuptake inhibitors (SSRIs): These medications enhance levels of serotonin, a neurotransmitter associated with mood stabilization and emotional regulation.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): These medications help increase two important chemicals in your brain, serotonin and norepinephrine. Serotonin helps stabilize your mood, while norepinephrine contributes to your alertness and energy. These medicines can be helpful for improving mood swings or hot flashes, especially for those who can't use hormone therapy.
• Estrogen and vaginal lubricants: To help with vaginal dryness and discomfort, you can use topical estrogen treatments like creams, suppositories, or vaginal rings. Non-hormonal lubricants are also effective and easy to use.

We often think of perimenopause — and midlife more broadly — as a difficult or even daunting time. This stage of life can carry a certain stigma, often associated with loss or decline. For many, menopause serves as a tangible marker of aging, and a reminder that they’re entering a new chapter.

But it’s important to recognize that this chapter still holds tremendous potential. While transitions can be challenging, they also offer opportunities for reflection, growth and renewed purpose. You have the agency to shape what comes next.