Menopause Mood Swings: What to Do When You Don’t Feel Like You

Feel like you’re riding an emotional roller coaster that just won’t stop? Mood swings are a common complaint during the menopause transition, affecting between one and two-thirds of perimenopausal women. And no, these symptoms are not just in your head.

Let’s discuss all things menopause mood swings: what they are, how hormones can cause them, and what you can do about them.

How menopause affects your mental health

The menopause transition doesn’t just take a toll on your body: it can weigh on your mind, too. Whether it’s increased irritability, anxiety, lack of motivation, or tearfulness, this menopause symptom isn’t just a bad mood.

The truth about mood symptoms

If you’ve ever found yourself googling “mood swing menopause," you’ve probably realized you’re not alone in struggling with your mental health during the menopause transition. Women commonly report experiencing mental health deterioration during perimenopause, and it’s not something to ignore.

Some sobering statistics can tell the story:

People born with ovaries are 2-4 times more likely to experience an episode of clinical depression during perimenopause than they are before or after the menopause transition.
Women’s suicide rates are highest among those aged 45-49, the ages at which most women are likely in the middle of perimenopause.

With these numbers, a few things are clear: we must take mood disorders seriously, and we must support peri- and postmenopausal women as they deal with these symptoms.

What causes mood swings?

Hormonal changes are a driving force behind many menopausal symptoms, and mood swings are no exception. Fluctuating estrogen levels during perimenopause can make you more sensitive to psychological stress.

Hormone sensitivity

If you’ve dealt with mood swings during your menstrual cycle, you may be particularly susceptible to mood changes during perimenopause due to something called hormone sensitivity. Being hormone-sensitive means that you experience a more intense reaction to fluctuations in hormone levels, such as estrogen.

One study followed 101 perimenopausal women for one year to measure their estrogen sensitivity and its impacts. They found that estrogen-sensitive women were more likely to experience significant depressive episodes. This was especially true for those early in perimenopause who had no history of depression.

What are the takeaways from all this? Consider:

If you experience mood swings during your menstrual cycle, pay special attention to depressive symptoms during perimenopause, even if you’ve never had depressive symptoms before.
Having higher hormone sensitivity means you may particularly benefit from treatments that help stabilize your hormones.

Contributing factors

Other factors can increase your risk of perimenopausal depression and mood disorders. These factors include:

Mental health history: A previous history of depression is clearly related to an increased risk of perimenopausal depression.
Physical health: Underlying health conditions, higher body mass index (BMI), smoking, and entering perimenopause early can all increase your risk of mood symptoms.
Demographic factors: Lower education, unemployment, being Black or Hispanic, and a lack of social support also increase your risk of mood symptoms.
Relational factors: One study found that relationship quality and marital status—either married or divorced/no partner—was associated with perimenopausal depression. This data came from a study of Chinese women, but the findings may still be relevant for many American women.

How to treat menopause mood swings

Several treatment options can help relieve the emotional symptoms of menopause. However, there isn’t a one-size-fits-all solution!

Recommended treatments depend entirely on whether you’re perimenopausal or postmenopausal. Consult with your healthcare professional to determine which option best fits your situation and needs.

Not all cases of mood changes and depression are the same. As such, they won’t all respond to the same treatment. Understanding the underlying hormonal cause of your mood swings can help ensure you receive the most individualized treatment.

Antidepressants

Regardless of your menopausal status, antidepressant medications can do what they’re supposed to: fight depression. Studies found that desvenlafaxine, an SNRI antidepressant, significantly improved depressive symptoms in both peri- and postmenopausal women.

Certain other antidepressant medications may help with more than just menopause mood swings. SSRIs and SNRIs have been shown to help relieve:

Hot flashes, night sweats, and heart palpitations
Sleep disturbances
Anxiety
Pain

Keep in mind that these medications might not be a cure-all. While antidepressants may help with some menopause symptoms, they can make others worse. Fatigue, weight gain, and sexual dysfunction are all possible side effects of these medications.

Menopause hormone therapy

Menopause hormone therapy (MHT) is often referred to as hormone replacement therapy (HRT). Whatever you call it, some types of MHT have been shown to have antidepressant effects similar to standard antidepressant medication.

However, these findings only apply to estrogen-only MHT and perimenopausal depression. Estrogen therapy is ineffective at treating low mood and depression in postmenopausal women. If you’re postmenopausal, though, there is still hope: options other than MHT can help with mood disorders.

Other potential benefits of MHT for perimenopausal people include:

Estrogen-only therapy can increase the effectiveness of antidepressant medication.
Estrogen-only therapy can improve mood for perimenopausal people without depression.
MHT—estrogen-only or combination estrogen + progesterone—can have stabilizing mood effects for those who are sensitive to hormonal changes.

If your menopause mood swings are due to estrogen deficiency, the most effective treatment is MHT.

Estrogen isn’t FDA-approved to specifically treat mood symptoms. However, it is a common treatment for other menopause symptoms, such as hot flashes, night sweats, and vaginal dryness, and it appears to help some perimenopausal people with their moods. Talking with your doctor can help you decide if hormone therapy is right for you.

Non-drug options

Mental health is a complex subject, and we still have a lot to learn. Medications aren’t always the best or only options to manage mental health challenges. Fortunately, there are other powerful tools to improve your mental health that don’t require you to take a pill.

Cognitive-behavioral therapy (CBT) is one such tool. CBT is a type of psychotherapy that helps you recognize how automatic thoughts contribute to depression and how you can change them.

One study on 353 perimenopausal women found that CBT improved depressive symptoms for the majority of participants. A smaller study on both peri- and postmenopausal people found similarly positive results. In both of these studies, participants weren’t taking medication to relieve their menopause mood swings.

Mindfulness practices can also help stabilize mood changes. Reducing stress with mindfulness techniques can benefit your mood and mental health, especially if you have a history of depression.

Take control with tracking

Using your smartwatch to track your mental health symptoms won’t make them disappear. However, tracking does help you follow the wise adage: “control what you can control."

When hormonal changes take over your brain chemistry, you can’t always control how you’re feeling. But taking time to track your menopausal mood swings can give you a sense of agency and control. You’re doing what you can to understand your symptoms, notice changes, and take action.

If you start a new intervention, like hormone therapy or a mindfulness practice, it’s important to note how it impacts your symptoms. Tracking will give you and your healthcare professional solid data to determine if the treatment is working as intended or if it’s time to try a different option.

Questions to ask your provider

When it comes to managing menopause symptoms, having open and honest conversations with your healthcare provider is a crucial step. These conversations aren’t always easy, but here are a few questions to help you get started:

I’ve always dealt with mood swings during my menstrual cycle, but really haven’t felt like myself lately. Do you think this pattern could make me more susceptible to low mood or other mental health challenges during perimenopause?
I’ve been tracking my emotional symptoms with my smartwatch for the last few months. Can I get your opinion on the changes I’ve noticed?
I don’t want to brush off my experience with menopausal mood swings any longer. Can we discuss what my treatment options are?

DISCLAIMER

This article is intended for educational purposes only, using publicly available information. It is not medical advice, and it should not be used for the diagnosis, treatment, or prevention of disease. Please consult your licensed medical provider regarding health questions or concerns.