Mood and Emotions

It is quite common for women to undergo changes in their mood and emotional well-being during the perimenopause and menopause. These changes can often emerge gradually and may be among the initial signs of perimenopause.

Although shifts in mood and emotional well-being during this period can be unsettling, there are numerous ways to minimise these symptoms. Treatments like Hormone Replacement Therapy (HRT) can be effective in helping you regain a sense of normalcy.

How are our hormones and moods linked?

If you’ve ever experienced mood swings or irritability before your menstrual period, you are familiar with the influence of hormones on your mood and overall well-being.

Oestrogen plays a role in regulating hormones that have mood-enhancing properties, such as serotonin, norepinephrine, and dopamine. It also contributes to mental sharpness, and a decrease in oestrogen levels can lead to “brain fog” and lower mood.

Progesterone has a calming effect on mood, promotes sleep and relaxation. When progesterone levels decline, it can result in increased irritability and mood swings.

Testosterone is believed to impact mental stamina, sleep quality, clarity of thought, concentration, and mood stability.

During perimenopause, as oestrogen, progesterone, and testosterone fluctuate and decline, these hormonal changes can significantly affect your mental health and overall well-being, impacting your daily life and relationships.

What psychological symptoms are linked to hormone changes?

Low mood and anxiety are the most common symptoms affecting mental health and emotional well-being. Low mood may also be accompanied by a lack of motivation, feeling emotionally flat, and experiencing reduced pleasure in activities you once enjoyed.

Mood swings, irritability, and anger are also frequent. There can be a loss of confidence in your abilities, especially at work, and you may find some situations more stressful than before. These changes can influence your self-perception and interactions with others.

Intrusive thoughts, including thoughts of self-harm or suicide, can be unsettling symptoms. If you experience such thoughts, it is crucial to confide in someone, whether it’s your partner, family member, friend, or by contacting organisations like the Samaritans at 116 123.

Distinguishing hormone-related changes to mood...

Many women may not initially realise that mood changes are related to their hormones. They might attribute these shifts to stress, fatigue, or existing issues at work or in relationships. Mood symptoms during perimenopause often fluctuate, making it challenging to identify a consistent pattern.

If you’ve experienced clinical depression in the past, you may be more susceptible to mood changes during perimenopause or menopause. However, hormone-related mood changes may differ, with more prominent features like irritability, anger, feelings of worthlessness, guilt, and intrusive thoughts, including suicidal ideation.

If you’ve dealt with premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), or postnatal depression previously, you may also be more vulnerable to mood changes during hormonal transitions in perimenopause and menopause.  See our useful resources section and track your symptoms with an app or paper based trackers.

What ways can you use to improve and best support your mood and emotional wellbeing?

  • Prioritise getting quality sleep.
  • Engage in regular physical activity, especially enjoyable outdoor activities.
  • Adopt a balanced, healthy diet.
  • Stay mentally engaged with productive tasks and consider revisiting old hobbies or exploring new interests.
  • Reduce or eliminate alcohol and smoking.
  • Nurture your social connections.
  • Allocate time for self-care

Stay aware of your stress levels and engage in regular self-check-ins, incorporating quick breathing and relaxation exercises during times of overwhelm or panic.

Be mindful of your self-talk and practice self-compassion. Avoid being overly critical of yourself, allow room for mistakes, and evaluate whether the standards you set for yourself are constructive.

Cultivate gratitude through journaling, reconnect with your values, and consider helping others through volunteering to find a renewed sense of purpose.

HRT, once you’ve found the right dose and type, can often lead to improvements in mood, anxiety, irritability, and other emotional changes. Be patient, as psychological symptoms may take longer to improve compared to physical symptoms.

Testosterone replacement, in addition to oestrogen, is observed by experienced menopause specialists to have positive effects on mood.

While antidepressants are generally not the first-line treatment for menopause-related low mood, if you are already taking them, you can typically begin HRT while continuing antidepressant therapy.

If you have a history of clinical depression or other mood disorders, consult your doctor about managing your menopause’s impact on your mental health alongside your existing psychiatric medications. Combining HRT with psychiatric medications may be appropriate.

When experiencing low mood, anxiety, or feeling unlike yourself, it is vital to seek support from others. Open and honest communication about your feelings is crucial.

If your mood affects your work life, consider discussing your challenges with your manager or a colleague to explore possible accommodations.

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 platforms.

Psychological or “talking” therapies like psychotherapy, cognitive-behavioural therapy (CBT), and counselling can be invaluable in understanding and addressing the changes and challenges common during this life stage.