You snap at your kids, and then you feel awful about it. You've never thought of yourself as an anxious person, and now your heart races over nothing. Or you've always been a little anxious, and it's so much worse now.
You can't help but wonder what is even happening. It's so not like you.
If that's where you are, I want you to hear this: you are not crazy, and you are not failing at your life. Your hormones may be a big part of what you're feeling, and nobody may have told you.
Quick summary: what you need to know
- Yes, perimenopause can affect your mood. Anxiety, irritability, anger, and mood swings can all be part of it.
- It often starts with falling progesterone. Progesterone is your calming hormone, and when it drops, some of that calm can go with it.
- The pattern matters. Symptoms that come and go with your cycle can be a useful clue.
- Your mental health still deserves real care. Hormones may be one piece, and depression and anxiety disorders need attention too.
- You have options. At AgeWell, a physician-led midlife medicine practice for men and women in Amarillo, Texas, we look at your hormones, sleep, stress, and mental health together.
Can perimenopause cause anxiety?
Yes, perimenopause can cause anxiety or make it worse. Many women come to me with anxiety that's brand new, or anxiety that has suddenly gotten harder to manage, and nobody has connected it to their hormones.
In my experience, it often starts with progesterone. Estrogen tends to be stimulating, and progesterone tends to be calming. When progesterone falls, the usual gap between the two changes, and that can feel like overstimulation or a lack of calm. Your nervous system just doesn't settle the way it used to.
Why am I so angry in perimenopause?
You may feel so angry because you have less calm to draw on, you're sleeping worse, and you're carrying as much as you ever have. Think of it as a shorter fuse. The things that set you off may not be new. Your ability to let them roll off you has changed.
Add a few nights of broken sleep to that, and the people you love most are the ones who feel it. Rage like that can feel really scary, and a lot of women are ashamed to say it out loud. These conversations are normal in my office.
Why do my moods swing so much?
Your moods may swing because your hormones are swinging. Think of progesterone like climate, a slow trend down over the years. Estrogen is like weather, and it can move up and down from one week to the next. You may feel great on Tuesday and like a different person by Friday.
Many women tell me two weeks of the month feel nothing like the other two. If that sounds familiar, write it down. Track your mood, your sleep, and your cycle for a couple of months. A pattern tells us a lot.
Is it perimenopause, depression, or an anxiety disorder?
It can be one of those, or more than one at a time. Research shows the risk of depression goes up during perimenopause, even for women who have never been depressed before, and women who have had depression in the past are more likely to have it come back. So this deserves a careful look from someone who will consider all of it.
Please don't try to sort this out alone if you're feeling hopeless, you've lost interest in the things you love, or you're having panic attacks. If you're having thoughts of harming yourself, call or text 988 or seek emergency care right away.
Should I take an antidepressant or look at hormones?
That depends on what's driving your symptoms, and sometimes both can have a place. Antidepressants help many people, and I'd never tell someone to stop one on their own. I just don't want a new medication to be where the conversation ends.
What I'd want to know is this: when did it start? Did anything else change around the same time? Is your sleep worse? Are your periods different? One pill for sleep and another for anxiety may each help, and nobody has stepped back to ask what's connecting them.
What can help with mood swings in perimenopause?
What helps depends on you, and we have a really big toolbox. These are good places to start:
- Protect your sleep, because everything feels harder without it.
- Look at alcohol and caffeine. Both can make anxiety and sleep worse for many women.
- Lift something heavy and move your body. It helps your mood, and your muscles and bones will thank you.
- Eat protein at every meal, so your blood sugar isn't adding to the roller coaster.
- Talk to someone. A good counselor can be a real gift in this season.
Hormones may be part of the conversation too. For many of my patients, progesterone is the first step. When we bring the gap between progesterone and estrogen closer to where it was, many of them tell me they feel like themselves again. You can read more in the first signs of perimenopause and our guide to hormone therapy for women.
You can expect these changes without having to accept them.
Frequently asked questions
Can perimenopause cause panic attacks?
Many women report new anxiety, and some describe panic. A racing heart can also have other causes, so please get it checked.
Why is my anxiety worse before my period?
Your hormones change through your cycle, and in the days before your period, progesterone is falling. Tracking your symptoms can show whether that's your pattern.
Will this go away after menopause?
For many women, things feel steadier when the swinging stops. Everyone is different, and you don't have to wait it out.
Do men go through this?
Men's hormones change more slowly, and low testosterone can come with irritability and low drive. Our men's hormone health page explains more.
See if AgeWell is right for you
This article is for education and isn't a substitute for personalized medical advice. Talk with your clinician about your own situation. If you have severe or urgent symptoms, seek emergency care.
Sources
- Weber MT, et al. Cognition and mood in perimenopause: A systematic review and meta-analysis. Journal of Steroid Biochemistry and Molecular Biology. 2013.
- Maki PM, Kornstein SG, et al. Guidelines for the Evaluation and Treatment of Perimenopausal Depression. Menopause and Journal of Women's Health. 2018.
- Cleveland Clinic: Perimenopause
- The Menopause Society: Perimenopause
