Mood Swings and Menopause

Yes, menopause causes mood swings, and they are among the first symptoms many women notice, years before hot flashes. About 4 in 10 women report mood symptoms in perimenopause: irritability that flares at nothing, tears at a commercial, a flat patch that lifts by evening. The cause is estrogen and progesterone swinging, not just falling, plus the broken sleep that night sweats bring. They are real, they are hormonal, and they respond to treatment.

Can menopause cause mood swings?

In the years before periods stop, estrogen doesn’t decline smoothly. It spikes and crashes within a cycle, sometimes to levels higher than in your 30s, then lower than ever. Progesterone, which has a calming effect on the brain, becomes unreliable as ovulation becomes erratic. The brain’s mood circuits, which use serotonin and other messengers that estrogen helps regulate, react to the change itself. That is why mood swings track fluctuation: women whose moods always dipped before a period are the ones most likely to feel perimenopause hard.

Two things amplify it. Night sweats and 3 a.m. waking strip away the sleep that steadies mood, so the day after a bad night is the day the rage shows up. And midlife tends to stack teenagers, ageing parents, work and a marriage onto the same months, so there is always a trigger to hand.

Does estrogen make you emotional?

Estrogen shapes how reactive your mood is, more than whether it is high or low. Steady estrogen, whatever the level, tends to mean steady mood; swinging estrogen means feelings arrive faster and larger than the moment deserves. That is why hormone therapy at a steady dose often reduces mood swings in perimenopause, and also why a dose that is too high can produce irritability, anxiety or weepiness of its own. If your mood changed after starting or increasing estradiol, that is a reason to review the dose, not to conclude that hormones are the wrong idea. Our guide to estrogen and anxiety covers how to tell too much from too little.

What menopause mood swings feel like

• Irritability and rage out of proportion to the trigger, often at the people closest to you, followed by guilt.
• Tearfulness at things that never used to move you.
• A low, flat patch that arrives in the afternoon and lifts within hours or by the next day.
• Anxiety or dread with no obvious cause, often early in the morning.
• Feeling like a stranger to yourself. “This isn’t me” is the sentence we hear most.

They cluster in the week before a period while cycles continue, and around poor sleep. If the low mood stops lifting and settles in most days for two weeks, that is depression rather than a swing, and it has its own page: depression and menopause. If the dominant feeling is worry and a racing mind, read hormones and anxiety.

What makes it worse

Poor sleep, alcohol (a depressant that also wrecks sleep), long gaps without food and blood-sugar crashes, too much caffeine, no exercise, and an untreated thyroid problem, which can mimic all of this and is worth a blood test.

What helps

1. Sleep. If night sweats or waking at 3 a.m. are part of the picture, treat them first; mood usually follows. See night sweats and sleep problems.
2. Hormone therapy, in perimenopause. For women whose mood swings travel with hot flashes and poor sleep, estrogen (with progesterone if you have a uterus) steadies the swings that cause them. The evidence is for the perimenopausal years; after menopause, mood symptoms are treated on their own merits.
3. Cognitive behavioural therapy. Good evidence for mood and anxiety, and it also helps hot flashes and sleep. See CBT for menopause.
4. An SSRI or SNRI, when mood symptoms are persistent or severe. Several also reduce hot flashes.
5. The daily basics that genuinely move mood: thirty minutes of movement, daylight in the morning, regular meals with protein, alcohol kept low, caffeine before noon.

Supplements have modest evidence at best; magnesium and omega-3 are the two worth a look. Our supplements guide ranks them.

Getting help

Mood swings are one of the symptoms Golden Leaf’s care team treats most often, usually alongside the sleep and hot-flash symptoms driving them. The first visit is a conversation about the whole pattern, by video, and the plan follows from it. Book a first visit if you’d like yours looked at. If you have thoughts of harming yourself, call or text 988 now.

Sources: ACOG, Mood changes during perimenopause are real; The Menopause Society; Mayo Clinic, Perimenopause.