Broken sleep
Night sweats and waking in the night break up sleep. Poor sleep makes memory, focus and mood worse the next day.
No, You're Not Losing Your Mind - Your Hormones Are Just Off
Often, it's perimenopause. In your 40s, estrogen and progesterone rise and fall unevenly for several years before periods stop. Those swings can affect mood, memory, anxiety and sleep, and these changes can begin before hot flashes do. The symptoms are real, and they can be treated.
How hormones change.
Illustrative, not lab values- Regular cyclesEstrogen and progesterone rise and fall in a steady monthly pattern.
- PerimenopauseOvulation becomes irregular. Progesterone falls first, and estrogen swings higher and lower than before. Mood, sleep and memory changes are most common here.
- After menopauseLevels stay low and steady. For many women, mood and memory symptoms ease.
Six things worth knowing.
- In your 40s, the most common reason hormones feel out of control is perimenopause.
- Progesterone falls first, and estrogen swings higher and lower than before.
- Mood swings, anxiety, brain fog and broken sleep can begin before hot flashes do.
- Women are more likely to have depression in perimenopause than in the years before it.
- Thyroid problems, low iron and PMDD can cause the same symptoms and are worth ruling out.
- Treating sleep, hormone therapy, exercise and CBT can all help.
Why are my hormones going crazy?
The ovaries don't wind down smoothly. For several years before periods stop, hormone levels rise and fall unevenly.
As ovulation becomes irregular, progesterone, which is made after ovulation, falls first. Estrogen can run higher than usual in some cycles and much lower in others. These changes usually start in the 40s and continue until menopause.
The brain has many estrogen and progesterone receptors, including in areas that handle mood, memory and sleep. When levels swing, those systems can work less smoothly for a while. Some women are more sensitive to the changes than others, so two women with similar hormone levels can feel very different.
Signs your hormones may be affecting your mind
Mood
mood swingsirritabilityangeranxietya sense of dreadcrying easilyfeeling flat
Mind
losing wordsforgetting namestrouble focusingfeeling overwhelmed
Body
waking up in the nightirregular periodsheavier periodshot flashesnight sweatsbreast tendernessheadaches
Not sure whether you're in perimenopause? Try the perimenopause checker.
Each symptom has its own guide: mood swings, anxiety, depression, brain fog and sleep problems.
Why it can feel like you're losing your mind
Several changes tend to happen at once, and each makes the others harder.
Mood
Hormone swings can affect mood directly. Women are more likely to have depression in perimenopause than in the years before it, including women who have never been depressed.
Memory
Memory lapses in perimenopause are usually trouble finding a word or a name that comes back later. They usually improve after menopause.
Many women don't connect these changes to their hormones, especially while their periods are still regular. That can lead to worry about early dementia or a serious mental illness. Our brain fog guide explains how to tell the difference.
Other causes to rule out
Some conditions cause the same symptoms and are common at the same age. A clinician may check for these.
Thyroid problems
An underactive or overactive thyroid can affect mood, memory and energy. More on low thyroid.
Iron deficiency
Heavy periods in perimenopause can lower iron and cause tiredness and poor focus.
PMDD
Severe mood symptoms in the week or two before a period, which can get worse in perimenopause. More on PMS and PMDD.
Depression or anxiety
These need treatment whatever the cause.
Sleep apnea, medications, alcohol
Each can cause brain fog and low mood.
Get help now
If you have thoughts of harming yourself, call or text 988 (the 988 Suicide & Crisis Lifeline) any time, day or night. If you are in immediate danger, call 911.
Can a blood test tell?
Blood tests can be helpful in certain situations, such as checking your thyroid or iron.
Hormone levels change so much in perimenopause that a single estrogen or FSH result often can't confirm it. Your symptoms and cycle history usually tell more. Your doctor decides at the first visit whether lab testing is needed.
What helps
Start with sleep. Many women find mood and focus improve once they sleep through the night again.
- 1
Treat sleep.
Treating night sweats and waking in the night often improves mood and focus.
- 2
Hormone therapy.
For many women, hormone therapy eases hot flashes, night sweats and sleep problems. In perimenopause, estrogen can also improve low mood for some women. Your provider reviews your history and risks before recommending it.
- 3
Exercise.
Regular aerobic exercise supports mood, sleep and memory.
- 4
Less alcohol.
Alcohol makes sleep and anxiety worse.
- 5
CBT.
Cognitive behavioral therapy, a type of talk therapy, can ease anxiety and low mood and help you cope with hot flashes.
- 6
Medication for depression or anxiety.
When needed, antidepressants can help. Some also reduce hot flashes.
When to get help
Get help soon if low mood lasts most days for two weeks or more, if anxiety keeps you from daily life, or if these changes are affecting your work or relationships.
Talk.
A one-on-one video visit about your symptoms, your history and what you want to feel like again. Your first visit is $99, refunded if you cancel at least 24 hours ahead.
Test.
If your provider thinks it will help, a hormone blood panel adds lab results to what you’ve told them. Not everyone needs this step.
Treat.
If treatment is right for you, your plan can include hormone prescriptions, non-hormonal options, lifestyle changes and optional supplements. Then two to three follow-up visits with a doctor and text check-ins through HIPAA-compliant messaging, included in membership at $49 a month, which begins one month after your first visit. Prescriptions and labs are priced separately.
FAQ
Why are my hormones going crazy?
In your 40s, the most common reason is perimenopause. Estrogen and progesterone rise and fall unevenly for several years before periods stop. Thyroid problems, pregnancy, stopping birth control and some medications can also change how you feel.
Can hormones make you feel like you're losing your mind?
Yes. Swings in estrogen and progesterone can affect mood, anxiety, memory and sleep, and many women in perimenopause say they don't feel like themselves. These symptoms often improve with treatment and in the years after menopause.
How long does it last?
Perimenopause often lasts several years. Mood and memory symptoms tend to be worst in late perimenopause and often ease after the final period.
Can a blood test show my hormones are off?
Blood tests can be helpful in certain situations, such as checking your thyroid or iron. In perimenopause, estrogen and FSH change from day to day, so a single result often can't confirm it. Your symptoms and cycle history usually tell more.
You don't have to feel like this.
A video visit with a clinician who treats perimenopause and menopause, in 33 states.
