Mood Changes - Come Sit With Me | A Perimenopause Resource

You snapped at your partner for no reason. Again.

Or you cried at a commercial. Or you felt a darkness settle over you that you can’t explain. Or the anxiety that once stayed in its corner now runs the whole show.

If your mood feels like it’s been hijacked, you’re not imagining things. Depression risk is 40% higher during perimenopause than before. First-time bipolar disorder is twice as likely to emerge during this transition than at other times. This isn’t weakness. It isn’t a character flaw. It’s biology.

Who’s Most at Risk

Some women sail through perimenopause with stable moods. Others struggle profoundly. Risk factors include:

Prior depression or anxiety—your brain may be more sensitive to hormonal shifts
Premenstrual mood sensitivity—if you experienced significant PMS or PMDD, you’re at higher risk
Stressful life circumstances—perimenopause often coincides with aging parents, teenagers, career pressure, relationship strain
Significant vasomotor symptoms—hot flashes and mood have a bidirectional relationship. Each makes the other worse.
Longer perimenopause—the more years of hormonal chaos, the higher the cumulative risk

Why This Happens: The Variability Hypothesis

Here’s something important: mood symptoms may correlate less with how much estrogen you have and more with how much it’s changing.

Researchers call this the “estradiol variability hypothesis.” Your brain adapts to stable estrogen levels—even low ones. What it struggles with is rapid, unpredictable change: up, down, up, down.

This explains why:

Women with premenstrual sensitivity (who experience mood changes with normal monthly fluctuations) struggle more with the wild swings of perimenopause
The chaotic transition is often harder than stable postmenopause
Stabilizing hormone levels—even at lower levels—can help mood

Your brain isn’t failing. It’s trying to adapt to conditions that keep changing.

What This Feels Like

Depression in perimenopause can look different from depression at other times:

More irritability, less obvious sadness
Rage that surprises you
Anxiety that wasn’t there before
Loss of interest in things you loved
Exhaustion that sleep doesn’t fix
Feeling disconnected from yourself
Not recognizing who you’ve become

You might think: This isn’t me. What happened to me?

That’s the hormones talking. You’re still in there.

What Actually Helps

Hormone therapy can be effective for perimenopausal depression, particularly when symptoms are clearly tied to the menstrual cycle or hormonal changes. Stabilizing estrogen levels calms the chaos that’s driving mood symptoms. For some women, this works better than antidepressants.

Antidepressants (SSRIs, SNRIs) help many women. They work through different mechanisms than hormones and can be used alone or together. Some also help with hot flashes. More on this in Beyond Hormones.

Therapy—particularly cognitive-behavioral therapy—provides tools for managing mood that don’t depend on what your hormones are doing.

Addressing sleep is crucial. Chronic sleep deprivation from night sweats mimics depression and makes actual depression worse.

Movement helps, though I know it’s hard to exercise when you feel like this. Even walking makes a difference.

Reducing alcohol—which many women increase during perimenopause as a coping mechanism—can help. Alcohol disrupts sleep and is itself a depressant.

What Doesn’t Help

Telling yourself to just try harder
Assuming this is your fault
White-knuckling through it without support
Expecting your mood to be what it was
Believing you should be able to handle this alone

Getting Care

Mood changes during perimenopause are real, common, and treatable. But getting appropriate care can be a battle.

Many providers don’t recognize perimenopause as a vulnerable period for mood disorders. They may not connect your depression to your hormonal transition. They may offer antidepressants without considering hormones, or dismiss you entirely.

You deserve a provider who:

Takes your symptoms seriously
Understands the hormonal component
Discusses all options, including hormone therapy
Treats you as a partner in your care

Tracking your symptoms can help you see patterns and bring data to appointments. See Finding Care for how to advocate for yourself.

If you’re in crisis or having thoughts of harming yourself, please reach out to a crisis line or go to an emergency room. This is a medical situation, not a personal failure.

The darkness of perimenopause can be profound. But it can also lift. The transition ends. The hormones stabilize. For many women, mood improves on the other side.

You will get through this. Please get support for the journey.