How Does Perimenopause Affect Mood? The Science Behind Perimenopause Mood Changes

Feeling less patient than usual? Crying at something that normally wouldn’t bother you? Suddenly feeling anxious, overwhelmed or as though your emotions are much harder to keep on an even keel? It’s easy to put it down to stress, work, family life or simply having too much on your plate. But if you’ve also started noticing changes to your periods, sleep or energy, there could be another piece of the puzzle: perimenopause. Understanding how hormonal change can influence your brain and mood may help you start joining the dots - and, importantly, start finding the support that feels right for you.

Mood changes are a recognised symptom of perimenopause. The NHS lists mood swings, low mood and depression among common symptoms, while Women’s Health Concern describes anxiety, irritability, anger, crying spells and loss of confidence among the emotional changes women may experience.¹ ²

Yet these symptoms can be much easier to overlook than a hot flush or a changing menstrual cycle.

You might simply find yourself thinking:

Why am I snapping at everyone? Why does everything suddenly feel like too much? Why don’t I feel like myself?

For some women, perimenopause mood changes can be one of the first clues that their hormones are shifting.

How does perimenopause affect mood?

Perimenopause is the transition leading up to menopause, when the hormones produced by your ovaries begin to change.

And importantly, they do not simply decline in one smooth, predictable line.

Levels of oestrogen and progesterone can rise and fall considerably throughout the transition. Research suggests that this hormonal variability may be particularly important when it comes to mood, with some women appearing more sensitive to reproductive hormone changes than others.³ ⁴

That matters because oestrogen and progesterone do far more than regulate your menstrual cycle.

They also interact with the brain.

Hormone receptors are found throughout areas involved in mood, cognition, sleep and our response to stress. So when those hormones begin behaving differently, it makes sense that the effects may sometimes be felt emotionally as well as physically.

This is one reason perimenopause moods can feel surprisingly unpredictable. You may feel completely like yourself one week, then more anxious, irritable or emotionally vulnerable the next.

Oestrogen and serotonin: why changing levels can affect how you feel

One of the most important relationships is between oestrogen and serotonin.

Serotonin is sometimes nicknamed our “happy hormone”, although technically it is a neurotransmitter: a chemical messenger used by the brain. It has a role in regulating mood, as well as sleep, appetite and other functions.

Oestradiol - the main form of oestrogen during the reproductive years - interacts with the brain’s serotonin system in several ways. Research suggests it can influence serotonin synthesis, its availability in the brain and the way serotonin receptors and transporters work.⁵

During perimenopause, oestradiol becomes increasingly variable before eventually settling at a lower level after menopause.

That does not mean every fall in oestrogen causes an equivalent fall in serotonin. The relationship is much more complex than that.

But changes in oestrogen can alter serotonin signalling, and this is one of the mechanisms thought to help explain why some women become more vulnerable to low mood, irritability or emotional changes during the menopause transition.³ ⁵

Research also suggests that it may be sensitivity to hormonal fluctuations, rather than simply having a particular hormone level, that matters. In one study, greater variability in oestradiol was associated with greater depressive symptoms in women who were also experiencing significant stressful life events.⁴

In other words, hormones and everyday stress do not exist separately.

Hormonal change may alter how resilient you feel to a stressful week, a difficult conversation or a long list of demands that you might previously have taken in your stride.

Suddenly, your usual coping capacity may feel smaller.

That experience of thinking “I used to be able to deal with this - why can’t I now?” can therefore be an important part of the perimenopause picture.

Progesterone, GABA and that “on edge” feeling

Oestrogen is only part of the story.

Progesterone also changes during perimenopause, particularly as ovulation becomes less regular.

One of the ways progesterone can influence the brain is through a substance called allopregnanolone, which is produced when the body metabolises progesterone.

Allopregnanolone interacts with receptors for GABA - gamma-aminobutyric acid. GABA is the brain’s main inhibitory neurotransmitter and can be thought of, very simply, as part of the brain’s braking system. It helps regulate nervous-system activity and is closely involved in stress, anxiety and feelings of calm.⁶

Allopregnanolone enhances signalling at GABA-A receptors.

As progesterone becomes more variable during the menopause transition, allopregnanolone and GABA signalling may become more variable too. Research into reproductive mood disorders suggests that some women are particularly sensitive to these changes.⁶

This is more accurate than saying that progesterone simply “switches on calm” and then disappears during perimenopause. The relationship is complex, and researchers are still learning exactly why certain women are more affected than others.

But it does help explain why hormonal change may sometimes feel less like straightforward sadness and more like:

I’m on edge.

Everything is irritating me.

I can’t switch off.

I have no patience.

I feel much more anxious than I used to.

That emotional shift can be very real - even when nothing obvious in your life has changed.

Does perimenopause cause mood swings?

Yes, mood swings can be part of perimenopause. Mood swings, irritability, anxiety and low mood are all recognised menopause-associated symptoms.¹ ²

But hormones are unlikely to be the only thing influencing how you feel.

Perimenopause often arrives during an already demanding stage of life. Work responsibilities may be increasing, children may still need you, parents may need more support, relationships may be changing - and then disrupted sleep, fatigue or hot flushes can be added on top.

Poor sleep deserves particular attention.

The NHS notes that sleep problems during perimenopause can leave you feeling more irritable, stressed and anxious, while Women’s Health Concern highlights that disturbed sleep can make emotional and cognitive symptoms feel worse.¹ ²

So your perimenopause mood swings may be influenced by several things at once: changing hormones, changes in brain signalling, disrupted sleep and the stresses already happening around you.

Why low mood during perimenopause is easy to miss

Hot flushes are widely associated with menopause.

Low mood is not always recognised in the same way.

That can mean women spend months wondering why they feel increasingly anxious, flat, irritable or emotionally overwhelmed without considering hormonal change as part of the picture.

Women’s Health Concern describes anxiety and low mood as very common emotional symptoms of menopause and stresses that psychological symptoms can be just as debilitating as physical ones.² Research reviews also suggest that the menopause transition is a period of increased vulnerability to depression and anxiety for some women.³

That does not mean every episode of low mood in your 40s is caused by perimenopause.

And perimenopause mood changes are not the same thing as clinical depression.

If low mood is persistent, you have lost interest or pleasure in things you would normally enjoy, your symptoms are significantly affecting everyday life, or you are worried about your mental health, speak to your GP or another healthcare professional. NICE recommends that depressive symptoms arising alongside other menopause symptoms are taken seriously, with options including menopause-specific CBT and, where appropriate, HRT.⁷

Recognising that hormones could be contributing is not about dismissing how you feel.

It is about giving you another useful piece of information.

How to support your mood through perimenopause

There is no single solution for perimenopause mood swings, because every woman experiences hormonal change differently.

But there are several simple foundations that may help support both your physical and emotional wellbeing.

Start noticing your patterns

For a few weeks, keep a note of your mood alongside your period, sleep, energy and other symptoms. A simple Mood & Cycle Tracker app can be a helpful tool for doing this.

You may begin spotting patterns that are difficult to see day to day: perhaps irritability becomes more noticeable at particular points in your cycle, or your mood is much harder to manage after several nights of poor sleep. 

That information can also be useful if you decide to speak to your GP.

Protect your sleep where you can

When you are exhausted, almost everything becomes harder to cope with.

Try to keep your sleeping and waking times reasonably consistent and create a wind-down routine that works for you. If night sweats or other menopause symptoms are regularly disrupting your sleep, it is worth discussing them with a healthcare professional rather than simply accepting poor sleep as something you have to live with.

Keep moving

You do not need a punishing exercise routine.

Walking, swimming, strength training, cycling, yoga, dancing - whatever you are most likely to continue - all count.

The NHS recommends regular exercise alongside rest and relaxing activities to help with menopause-related mood changes, while physical activity can also support sleep and wider long-term health.⁸

Eat regularly and nourish yourself well

When life feels busy, it can be tempting to run on caffeine, grab whatever is easiest and then realise at 4pm that you have barely eaten.

Aim instead for regular, balanced meals containing protein, fibre-rich carbohydrates, fruit and vegetables and sources of healthy fats.

The goal does not need to be a “perfect diet”. Think of nutrition as giving your brain and body the raw materials they need while they are already adapting to change.

Give your nervous system opportunities to slow down

If your tolerance for stress feels lower than it used to, adding more pressure to “cope better” probably is not the answer.

Instead, look for small ways to reduce the load: getting outside, taking a walk without your phone, slowing your breathing, spending time with people who help you feel grounded or trying practices such as yoga, mindfulness or meditation.

CBT can also be helpful for menopause-associated depressive symptoms, sleep difficulties and some other menopause symptoms.⁷

Consider targeted nutritional support

Supplements do not replace sleep, diet, exercise or medical support where it is needed, but some women choose them as an additional part of their daily routine.

If mood has become one of your main concerns and you are looking for a perimenopause mood supplement, look for ingredients that have a clear reason for being included rather than simply the longest possible ingredient list.

For example, saffron has become an increasingly researched ingredient for mood and emotional wellbeing. A randomised, double-blind, placebo-controlled study using 30mg of the standardised Safr’Inside™ saffron extract for eight weeks investigated its effects in healthy adults experiencing subclinical low mood, anxiety and/or stress, with improvements reported in some mood-related measures.⁹

Efamol Omega Femme contains 30mg of Safr’Inside™ saffron extract alongside Efamol Rigel® Evening Primrose Oil and vitamins B6, D3 and E. Vitamin B6 contributes to normal psychological function and the regulation of hormonal activity, making the formula a targeted option for women looking for everyday nutritional mood support through perimenopause.

A supplement should sit alongside - rather than replace - the wider foundations that support your wellbeing.

Feeling different can be a clue

Perimenopause does not look the same for every woman.

For some, the first thing they notice is a changing period.

For others, it is sleep.

And for many, it may simply begin with a feeling that they are not quite themselves.

If you are suddenly more irritable, emotional, anxious or easily overwhelmed, it does not automatically mean perimenopause is responsible. But if those changes are appearing alongside shifts in your cycle, sleep, energy or other symptoms, it may be worth considering hormones as another part of the picture.

Understanding how perimenopause affects mood can be the first step towards understanding what your body is telling you - and finding the support you need to feel more like yourself again.

References

1. NHS. Symptoms of menopause and perimenopause. Updated 2026.
2. Women’s Health Concern / British Menopause Society. Emotional wellness in menopause. 2023.
3. Alblooshi S, Taylor M, Gill N. Does menopause elevate the risk for developing depression and anxiety? Results from a systematic review. Australas Psychiatry. 2023;31(2):165–173.
4. Gordon JL, Rubinow DR, Eisenlohr-Moul TA, Leserman J, Girdler SS. Estradiol variability, stressful life events, and the emergence of depressive symptomatology during the menopausal transition. Menopause. 2016;23(3):257–266.
5. Marsh WK, Bromberger JT, Crawford SL, et al. Lifelong estradiol exposure and risk of depressive symptoms during the transition to menopause and postmenopause. Menopause. 2017;24(12):1351–1359.
6. McEvoy K, Osborne LM. Allopregnanolone and reproductive psychiatry: an overview. Int Rev Psychiatry. 2019;31(3):237–244.
7. National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). Updated 2026.
8. NHS. Things you can do to help menopause and perimenopause symptoms. Updated 2026.
9. Jackson PA, Forster J, Khan J, et al. Effects of Saffron Extract Supplementation on Mood, Well-Being, and Response to a Psychosocial Stressor in Healthy Adults: A Randomized, Double-Blind, Parallel Group, Clinical Trial. Front Nutr. 2021;7:606124.