Mood, Anxiety & Irritability

Menopause doesn’t arrive overnight. For many women, the first signs aren’t hot flashes but emotional shifts, mood swings, irritability, or anxiety. These can feel like a stronger, more unpredictable version of PMS.

Around 1 in 4 women experience noticeable mood changes, though some studies suggest it may affect up to 3 in 4. For some, it’s minor irritability or tearfulness; for others, it may feel heavier, with sadness, worry, or loss of motivation.

These shifts are often linked to fluctuating hormones, especially estrogen and progesterone, and may start in early perimenopause. While they can be unsettling, you are not alone, and there are many ways to restore balance. 

Emotional changes vary, but many women describe:

• Sudden or frequent mood changes

• Feeling overwhelmed, tearful, or anxious

• Irritability or lower patience

• Low mood, sadness, or lack of interest in usual activities

• Heightened stress or worry

• Reduced self-confidence or mental energy

Some find these changes manageable, while others struggle with new or stronger feelings of depression or anxiety.

Hormonal shifts play a big role in how mood is regulated:

• Estrogen supports serotonin and norepinephrine, which influence mood and emotional stability. Drops in estrogen can increase sensitivity, worry, and low mood.

• Progesterone has natural calming effects. When levels fall, women may feel more anxious, irritable, or struggle with sleep.

• Testosterone also contributes to energy and mood; low levels may cause fatigue and emotional changes.

Beyond hormones, weight changes, sleep disruptions, and stress can all add to emotional ups and downs.
 

Menopause is a time when body chemistry, brain signaling, and life stressors often collide:

• Sleep problems (from night sweats or insomnia) can worsen irritability and low mood.

• Neurotransmitter changes linked to hormone loss affect serotonin, dopamine, and norepinephrine, brain chemicals that regulate mood and focus.

• Life stage pressures - Caregiving, work demands, or relationship changes - can intensify emotional strain.

Not every mood change is “just hormones,” but perimenopause can magnify underlying stress or vulnerability. 

Talk with a menopause-informed clinician if: 

• Mood swings or anxiety are persistent or intense

• Emotional changes interfere with daily life, work, or relationships

• Symptoms feel like more than “just hormones”

Support is available; you don’t have to manage this alone.