Verified by 
Perimenopause is defined as the time “around menopause” and essentially means the few years in the run-up to menopause. On average, perimenopause lasts for four years, but some women experience symptoms for up to 10 years. For many women, perimenopause starts in their early forties, and, for some women, this transitional phase may start earlier. “Menopause” is diagnosed when a woman has not had a menstrual period for 12 months or longer.
Research has shown that about 23 percent of women will experience mood swings during menopause.1 When we talk about menopausal mood swings, we’re often talking about the mood swings which occur during perimenopause. During this time, women may suffer severe mood swings and may experience anxiety and depression for the first time in their lives.
The mood swings experienced at this time can be extreme. They seem to come out of the blue and may be far more severe than anything experienced in the past. Many of my perimenopausal clients report that they feel out of control or as if they’re "going mad." It can be difficult to keep doing the things they’ve always done as they find themselves exhausted, emotional, and even forgetful at times. Changes at this time in life affect almost every part of a woman’s life, with some finding the mood swings the hardest thing to cope with.
So, what causes perimenopausal mood swings?
Estrogen reduction. Estrogen—the main female sex hormone which is responsible for sexual development and for regulating a woman’s menstrual cycle and reproductive system—is produced in the ovaries. Estrogen has a major impact on mood, primarily by affecting levels of serotonin in the body. Serotonin is a mood-balancing chemical that is sometimes called the “happiness hormone." During perimenopause, as estrogen levels start to drop, so do our levels of serotonin. This is one of the reasons why we may feel more depressed and are more likely to cry at the drop of a hat than we would have been in the past.
Progesterone reduction. The other significant sex hormone in a woman’s body is progesterone. Similarly to estrogen, levels of progesterone begin to drop during perimenopause. As progesterone levels fall, estrogen may become the dominant hormone, leading to irritability and depression. Progesterone is responsible for calming the brain and promoting sleep; a reduction in progesterone can have the opposite effect. Low levels of progesterone are associated with a range of symptoms including sleep disturbances, migraines, hot flashes, and unexplained anxiety. The combination of these symptoms can have a major impact on mood.
Hormonal fluctuations. Hormones are complex entities, as is the human mind and body. Estrogen doesn’t just gradually decline. Instead, the production of estrogen becomes unstable and unpredictable. During the process of overall decrease, the ovaries may start to overcompensate in producing estrogen, resulting in a hormonal surge. At other times, there will be a marked drop in estrogen and these fluctuating levels may be particularly noticeable in the second half of a woman’s cycle, following ovulation. These fluctuations can have a very destabilising impact on your moods.
Hormonal imbalance. When we’re thinking about the impact of hormones on mood, we can’t isolate one hormone at a time. Instead, we need to think about how these hormones work in combination with each other. During perimenopause, the delicate balance of hormones is affected by the reductions and fluctuations mentioned above. For instance, when progesterone decreases, women can end up being “estrogen dominant” which can cause a range of physical symptoms—such as bloating, decreased libido, and fatigue—as well as mental symptoms, including anxiety and depression.
Sleep disturbances. We all know the impact that poor sleep has on our mood (just think about how irritable and even easily upset you were the last time you slept badly!). Many women experience severe sleep disturbances during perimenopause, even if they have never had problems sleeping before. Changes in estrogen and progesterone affect the action of other hormones that are responsible for regulating bodily temperature. Hot flashes which are experienced at night—called night sweats—can severely impact women’s sleep patterns, with some women reporting waking up drenched in sweat. The hormonal fluctuations mentioned above, which can cause anxiety, mean that it can be difficult for women to fall asleep and can mean that they are sometimes very abruptly woken up in an anxious or panicked state.
Hot flashes. Sudden surges of heat, sometimes accompanied by uncontrollable sweating, are known as hot flashes. A typical hot flash will last between 30 seconds and 10 minutes. Sometimes, they can be very noticeable to others, as the face reddens and many women feel embarrassed and anxious about having a flash, which can stop them in their tracks. The difficulty in dealing with hot flashes can cause anxiety and depression in some women.
Other menopausal symptoms. Menopause is accompanied by a whole host of symptoms, some of which women find very upsetting to deal with. These symptoms can include weight gain, reduced libido, vaginal dryness, tender breasts, extreme bloating, loss of breast fullness, thinning hair, and dry skin—in addition to the hot flashes, insomnia, and hormonal mood swings! Coping with a changing body, a changing sexual relationship, and everything else which is going on during perimenopause can be quite overwhelming and can have a major impact on mood.
Pressured time of life. For many women, this midpoint in life also coincides with a high degree of pressure. The “sandwich generation” refers to people who are responsible for caring for children and their parents. Even if you don’t have kids, you may find yourself faced with responsibilities for caring for older parents, holding down a job, and dealing with a myriad of other pressures.
Difficult transitions. Whether or not you have ever wanted children, or have had all the children you ever desired, menopause brings into sharp focus that your childbearing years are coming to an end. This can be a difficult realisation for some women and perhaps more so for women who have experienced fertility issues in their life or have “unfinished business” with regard to having children, perhaps because they never had a relationship in which they wanted to bring a child into the world. In those cases where women have had children, the “empty nest” can cause great distress and anxiety. I’ve had several clients—including women whose focus was certainly not exclusively directed towards childrearing and the home—who have felt far more upset than they expected as their children leave home. Any life transitions can be hard, and this is a transition that goes to the core identity and may involve a significant change in day-to-day life.
Existential panic. Many women face aging with a sense of dread which is exacerbated by the fact that we live in a culture that values youth. Both women and men can face a sense of fear at this stage in their life. There’s something about realising that, realistically, you’re midway through your life. It makes you sit up and take stock. Some people might look over what they’ve done so far and feel a sense of regret. Some might take this as an opportunity to reassess what’s working and what isn’t. Some might feel overwhelmed at the thought of aging and of having failed to achieve what they might have desired in their youth.
Menopausal mood swings can be severe, but it is important that there are very real physical changes that are happening in your body which are impacting how you feel and behave. If you are finding it hard to cope on your own, therapeutic approaches including CBT and hypnotherapy have a proven track record in helping manage symptoms and provide a complementary, or alternative, approach to conventional, bio-medical menopausal treatments.
