Understanding Mood Changes in Perimenopause and Menopause

It is very common for women to experience changes to their mood and emotional wellbeing during the perimenopause and menopause. Subtle changes can emerge slowly and often be one of the first signs of the perimenopause.

Although changes to your mood and emotional wellbeing can be very unsettling at times, there are plenty of ways to minimise these symptoms and treatments (such as HRT) can be effective in helping you feel more like your usual self again.

Hormones and Mood

If you have ever felt down or irritable before starting your period, you will know that hormones can affect your mood and wellbeing.

Estrogen helps regulate several hormones which have mood-boosting properties for example serotonin, norepinephrine and dopamine. It also helps the sharpness of your thinking skills and when levels reduce, the resulting ‘brain fog’ can lower your mood.

Progesterone has a calming effect on your mood, as well as aiding sleep and relaxation. And like estrogen, when progesterone levels drop, it can cause a rise in irritability and mood swings.

Testosterone is thought to have important effects on your mental stamina, quality of sleep, clarity of thought and concentration, and mood stability.

When estrogen, progesterone and testosterone fluctuate and fall during perimenopause, the effects on your mental health and wellbeing can be significant and impact on your daily life and those around you.

Psychological symptoms that can occur due to hormone changes

The most common symptoms affecting mental health and emotional wellbeing are low mood and anxiety. Feeling low can also come with a lack of motivation, feeling ‘flat’ and not experiencing pleasure in things you usually enjoy.

Mood swings and feeling irritable and angry are also common. There can be a loss of confidence in your own abilities, especially at work, and you may find some situations and events more stressful than you previously did. This can affect the way you view your self and how you feel about everyday interactions.

One of the more unsettling symptoms is intrusive thoughts and these may include thoughts of self-harm or suicide. If this is happening to you, it is really important that you tell someone. If you don’t feel you can tell your partner, family member or friend, contact the Samaritans by any phone for free on 116 123.

How do I know what’s normal for me and what’s hormone related?

Many women don’t realise mood changes are related to their hormones at first, and will put it down to stress, tiredness or existing problems at work or in your relationships, for example. During perimenopause, mood symptoms often fluctuate and can leave you feeling awful one day and better the next day.

If you have had a clinical depression in the past, you may be more susceptible to mood changes in perimenopause/menopause. When it is hormone related however, there may not be the same depth of sadness, but other features are more prominent such as irritability and anger, more unwanted thoughts of worthlessness and being worried about what others think of you, frequent feelings of guilt, and more intrusive thoughts that may include suicide.

If you have suffered with premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) or postnatal depression in the past, you may also be more vulnerable to mood changes when your hormones change in the perimenopause/menopause.

How to help your mood and emotions

Keep helpful habits:

Do all you can to sleep well
Keep physically active on a regular basis with activities that you enjoy, especially those outside
Eat a healthy balanced diet
Stay mentally stimulated to keep your mind busy on productive tasks and restart a hobby or learn a new skill
Reduce or cut out alcohol and smoking
Maintain good connections with others
Take regular time out for yourself

Manage your own thoughts

Stay aware and on top of your stress levels. The above habits will help with this too. Have regular check-ins with yourself and adopt some quick breathing and relaxation exercises for times of overwhelm or panic.

Be careful of your self-talk and how you think about yourself. Are you as kind to yourself as you are to your friends? Try not to give yourself a hard time; find compassion and allow yourself to make mistakes and consider if the standards you put on yourself are helpful.

Think about what you’re grateful for, you may find journalling helpful to do this. Reconnecting with your values and helping others or even doing some voluntary work can often bring a new sense of purpose.

Consider taking HRT

Once women are taking the right dose of HRT for a few months, there is usually an improvement in mood, anxiety, irritability and other changes. It can take time however to find the right dose and type of HRT for you and psychological symptoms often take longer to improve than physical symptoms.

You may benefit from taking testosterone. Experienced menopause specialist doctors are observing that testosterone replacement can have particular improvements on mood, as well as estrogen replacement.

Role of Antidepressants

Antidepressants are not usually helpful for menopause related low mood and NICE (National Institute for Health and Care Excellence) guidelines recommend HRT is tried in the first instance.

If you already take antidepressants, you can usually start HRT while still taking antidepressants.

If you have a history of clinical depression or other mood disorders, you can discuss how your menopause is affecting your existing mental health condition with your doctor. HRT can usually be taken alongside most psychiatric medications.

The lifestyle and cognitive measures already described are vitally important alongside HRT or any other medications used to improve your mental health.

Find support from others

It is important to gain support from others when you’re feeling low, worried, unsettled and not like your usual self. You often need to be open and honest about how you are really feeling for this to happen.

If your mood is affecting your work life, try and talk to your manager or a colleague about this and discuss what could be changed to help you.

You may find connecting with other women going through perimenopause and menopause helpful to see that you’re not alone or ‘going mad’ as many often feel. There are plenty of menopause support groups online and on social media.

Psychological or ‘talking’ therapies like psychotherapy, cognitive behavioural therapy (CBT) and counselling can be very helpful for making sense of these changes and challenges common at this time of life. You can find out more about accessing talking therapies here.