Are you a woman in midlife dealing with sleep disturbances, irregular periods, or mood swings? You might be in perimenopause. This phase is marked by fluctuating hormone levels, especially estrogen and progesterone, and eventually leads to menopause. Physical symptoms like hot flashes, night sweats, and vaginal dryness are discussed regularly, but perimenopause’s emotional symptoms—mood swings, irritability, anxiety, and even depression—can be equally disruptive.
If any number of emotional symptoms are impacting your quality of life, take heart that there are methods to ease or treat them.
About the Experts
Susan B. Trachman, M.D. is a board-certified psychiatrist with over 30 years of clinical experience. She has a special interest in reproductive psychiatry and regularly sees women for premenstrual dysphoric disorder, pregnancy-related mood disorders, and postpartum disorders.
Paul Gittens, M.D., F.A.C.S. is a urologist specializing in the treatment of sexual health for men and women, and a specialist in female menopause and male infertility. He’s the medical director at Rockwell Centers for Sexual Medicine & Wellness in Manhattan, the Philadelphia area, and Allentown, PA.
What Are the Emotional Symptoms of Perimenopause?
During perimenopause, hormonal fluctuations can make women more susceptible to emotional symptoms, which can vary significantly among individuals. Here’s a look at some of the emotional symptoms women may experience:
Irritability: Feeling easily frustrated or on edge
Anger: Sudden, intense feelings of frustration
Anxiety: Increased worry or nervousness
Depression: Feelings of sadness, hopelessness, or lack of interest in things once enjoyed
Sadness: Episodes of unexplained sadness or crying
Lack of Motivation: Difficulty finding the energy to engage in everyday tasks
Difficulty Concentrating: A foggy feeling or trouble focusing
Forgetfulness: Losing track of tasks, appointments, or even simple things (1)
Loss of Confidence: A dip in self-assurance
Loss of Self-Esteem: Feelings of inadequacy or self-doubt (2)
“The most common symptoms I see in my patients are increased anxiety, irritability, and fluctuating moods,” says psychiatrist Susan B. Trachman, M.D.
While these are often linked to perimenopause, they can also signal underlying mental health conditions. In rare cases, hormonal fluctuations may even contribute to psychosis (3).
“Any alterations in behavior that last for more than seven to 10 days and include poor sleep, decreased appetite, increased anxiety or irritability, tearfulness, and loss of interest in usually pleasurable activities should be evaluated by a mental health professional,” Trachman advises.
What Causes Emotional Symptoms?
Fluctuating levels of hormones like estrogen and progesterone can significantly impact neurotransmitters in the brain and contribute to a range of unpleasant emotional symptoms during perimenopause. As Trachman explains, “estrogen is a natural antianxiety hormone but is also involved in regulating mood. Estrogen increases the level of a neurotransmitter called serotonin and modifies endorphins’ production and effects.” The decline in estrogen can disrupt brain chemistry and lower serotonin levels, which is linked to mood disorders like depression and anxiety.
However, emotional symptoms during perimenopause can vary significantly between individuals. So why do some women experience few symptoms while others struggle? “I think some of it’s genetic. But we don’t really know why some people get more anxiety or brain fog than others. It’s hard to tell,” says urologist Paul Gittens, M.D.
While the emotional symptoms of perimenopause can be challenging, there are effective strategies, many of which involve lifestyle changes, to manage them.
Diet is just as important. “Eating a healthy diet, like the Mediterranean diet, rich in fruits, vegetables, whole grains, and lean protein helps to decrease overall inflammation,” notes Trachman. It also includes foods with omega-3 fatty acids, like fish and nuts, which can help regulate mood and stabilize blood sugar levels.
It’s also important to watch your intake of caffeine, sugar, and alcohol. These substances can disrupt hormone balance, increase anxiety, and negatively impact sleep quality, which is already affected by hormonal fluctuations, so cutting back may help prevent mood swings.
Lean on social connections
Staying connected to friends, family, or community groups helps reduce stress and manage emotional symptoms like anxiety and mood swings (4, 5). Research shows that women with strong social ties experience fewer and less intense menopause-related symptoms. Support groups, in particular, have been shown to improve quality of life, reduce hot flashes, and boost mental and physical health. Whether it’s catching up with a friend or joining a local class or organization, meaningful connections can make this transition feel more manageable and less isolating.
Work with a psychiatrist or therapist
If you’re struggling with anxiety, depression, or other emotional symptoms that feel overwhelming, working with a mental health professional can be incredibly helpful. A therapist or psychiatrist can also help you manage stress and offer tools to cope with the emotional changes you’re experiencing. Cognitive-behavioral therapy (CBT) is particularly effective in treating mood swings and anxiety during perimenopause.
In some cases, medication may be necessary, especially for women with a history of mental health issues. “If you’re experiencing low mood or increased anxiety, antidepressants like serotonin reuptake inhibitors (SSRIs) can help by increasing serotonin levels in the brain, which improves mood and reduces anxiety,” says Trachman. A psychiatrist or other doctor can help determine if this is the right option.
Prioritize sleep
“It’s essential to get adequate sleep, which is sometimes disrupted with frequent awakenings during perimenopause,” says Trachman. Doing so can be tricky, however, because hormonal fluctuations during perimenopause lead to sleep disruptions, which in turn worsen both emotional and hormonal symptoms and often create a vicious cycle.
You can help improve sleep by creating a sleep-friendly environment—reduce caffeine late in the day, keep your bedroom cool and dark, and stick to a consistent bedtime routine. If sleep disturbances persist, consult your doctor to explore treatment options.
Consider HRT
Hormone replacement therapy (HRT), sometimes called menopause hormonal therapy (MHT) can ease both physical and emotional symptoms of perimenopause by replenishing estrogen levels. This medication, which comes in forms like pills, patches, gels, creams, and suppositories, can help with mood swings, irritability, and anxiety.
“We’ll start some of our patients on it if they’re complaining of lower libido or vaginal dryness, even during perimenopause. We can still place them on topical estrogens or some topical testosterone to help with their libido and vaginal dryness. It just depends on the patient,” says Gittens. Be sure to consult your doctor to weigh the risks and benefits of HRT and determine if it’s the right fit for you.
The Bottom Line
Emotional symptoms during perimenopause are not in your head—they’re very real and a natural result of the hormonal changes women undergo in the years leading up to menopause. Yes, they can sometimes feel overwhelming, but understanding the root cause and taking steps to manage any emotional distress can make a big difference. Focusing on lifestyle factors like regular exercise, a healthy diet, maintaining social connections, and prioritizing sleep can help ease you through the menopause transition.
Meredith Bethune is a freelance journalist covering health, wellness, food, travel, and the outdoors for publications like New York Times, Outside, Wine Enthusiast, National Geographic, Travel + Leisure, Condé Nast Traveler, CNN, Vogue, and Eater. An avid hiker and adventurer, Bethune holds a degree in history from Tulane University in New Orleans, Louisiana.
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