July 24, 2025
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Dear perimenopausal friend, are mood changes making you feel out of control? Do your emotions shift so often that you no longer recognize yourself? Tears, fear, giddiness, anger, self-doubt, sadness, irritability. It’s like you’re a dozen people wrapped into one. Dinner reservation for a party of 12, please!
In your childbearing years, these fluctuating mood symptoms are called PMS, and they pop up before your period starts. As you transition into perimenopause, the mood issues continue, but they stop occurring in relation to your menstrual cycle.
This new emotional rollercoaster of mood issues has a name, too—perimenopausal mood instability. And while these mood challenges don’t follow a pattern, they affect 4 in 10 perimenopausal women and can go on for years.
Perimenopause is a bit hard to define, but it begins when your periods start becoming irregular and ends when you go 12 straight months without a period. The perimenopausal transition lasts 4 to 8 years, on average, but can be shorter or longer. No matter how long you’re in perimenopause, the mood fluctuations are very real and can affect every aspect of your life, from family relationships to work performance.
What causes perimenopausal mood instability?
A combination of factors that occur during perimenopause can contribute to mood alterations, including hormonal shifts, sleep disturbances, and life pressures. You may be affected by just one issue or be bombarded by several at the same time.
Hormonal shifts
Remember back to puberty when your hormones (and emotions) were all over the place? Puberty is a transition where hormonal changes slowly transform a girl into a young woman. It takes time, and is filled with the out-of-control mood swings that were part of being a teenager.
Well, guess what? Perimenopause is a transition, too, so it’s no wonder it’s full of ups and downs and curves. As the transition progresses, estrogen—the main female sex hormone—drops. Estrogen helps regulate many mood-stabilizing chemicals, including serotonin. So, as estrogen declines, decreases in serotonin may lead to moodiness. Low estrogen can also contribute to insomnia and fatigue, which may affect mood.
Sleep disturbances
The other key female sex hormone is progesterone, which promotes calmness to help induce sleep. When progesterone falls during perimenopause, it may cause anxiety or sleep disturbances. In addition, nighttime secretion of the sleep hormone, melatonin, decreases during perimenopause.
Being sleep-deprived for even one night can make anyone cranky! When insomnia or night sweats during perimenopause lead to sleep deprivation night after night, unpleasant emotions are bound to follow.
Life pressures
Midlife is a stressful ride for many women. It’s a time of parenting children and college students or having a newly empty nest as young adult children move on. On top of possible career and financial challenges, caring for aging parents may become a new responsibility. Plus, changes in body shape and increasing wrinkles can add to the emotional challenges and cause a plunge in self-confidence. It can all add up to mood swings and strains on relationships.
One study of 300 women showed that perimenopausal women experience the highest level of stress, and they were the most bothered by feelings of anxiety and depression. They also had the poorest self-reported psychosocial quality of life.
Smoothing out your mood issues with lifestyle hacks
If you’re ready to get off the mood swings carnival ride, you may be wondering how to do it. You’ve heard all the advice about stress management, eating nutritious foods and ways to get quality sleep, right? Those things are critical aspects of self-care, but they’re probably not enough. Finding time for a daily morning exercise routine—even just a vigorous walk—is also a great lifestyle hack because it increases the feel-good endorphins that can boost mood for the rest of the day.
But here’s the thing: Getting to the root cause of the mood issues is probably what you need to level out the emotional twists and turns. And that root cause is most likely hormonal imbalances.
Addressing the root cause of mood issues
Compounded bioidentical hormones, as prescribed by your provider, may help address perimenopausal mood instability. Since estrogen fluctuations during perimenopause can be associated with depressed mood, achieving individualized estrogen balance is often a goal of hormone therapy.
Progesterone may be a component of your prescription too. In a study of almost 300 women, compounded bioidentical progesterone was linked to decreases in irritability, anxiety, and emotional instability.
Bioidentical estrogen, progesterone, and testosterone can be tailored to the dosage and form that’s right for you. Compounded bioidentical hormone therapies that include testosterone have also been associated with significant improvements in mood.
You don’t have to start each day wondering which version of yourself will rule the day. Decide which of these steps might work for your mental wellbeing and start making changes. And when you talk with your provider about BHRT, consider Belmar Pharmacy. We’ve been expertly compounding hormone therapies since 1985.
Cheers to getting back to your confident, steady, wonderful self as a party of one.