Feeling “Off” in Midlife? It Could Be Your Hormones

Feeling “off” in midlife? You’re certainly not alone.  It’s been reported that 40% of women struggle with symptoms associated with mood during perimenopause.¹ Feelings of sadness, irritability, and anger are so common during this transitional time that it may feel like you’re struggling through a “midlife crisis” in your 40s and 50s.²

And most experts agree that perimenopause may feel overwhelming when you don’t have the right support to help you traverse this volatile time. 

In this article, Bonafide Chief Medical Officer, Dr. Alyssa Dweck, talks about the hormonal changes that can contribute to feeling off during menopause and how to distinguish them from other health issues during this transition.

Mood and Hormone Changes in Midlife Are Common

So, what exactly causes mood swings and shifts in mental health during midlife?

According to Dr. Dweck, there’s more than one hormone shifting in the body to cause these changes. 

“Contrary to popular belief, perimenopause symptoms are not simply due to decreased estrogen,” she explains. “Both extreme estradiol volatility and decreased progesterone production contribute to women feeling “off” during perimenopause.”

Dr. Dweck adds that this hormonal rollercoaster may contribute to the changes in mood, sleep, and cognition many women experience during menopause. In many cases, she says, the symptoms are temporary. 

“Many of these disruptive symptoms peak during perimenopause and improve substantially after menopause when hormone levels stabilize,” she adds.

Research shows that this menopause transition may be a challenging time, even for women with no prior psychiatric illness or mood instability.³ Those with a history of mental health issues, however, may need additional guidance, as preexisting conditions like anxiety or depression can become more severe during perimenopause for some.⁴

Unpredictable Mood and Hormone Changes in Menopause

After almost a lifetime of luteal phase mood swings during your typical menstrual cycle, many of us are no strangers to our moods shifting as frequently as our changing hormones.⁵

One of the more difficult aspects of mood and hormone changes in perimenopause, though, is that they’re often difficult to predict. While women may anticipate mood changes in the week leading up to their periods, perimenopausal mood symptoms may follow no predictable pattern due to erratic or absent ovulation.⁶

You may be wondering, “how can I tell if my symptoms are due to perimenopause or to conditions like anxiety, depression, or another medical issue, for example, like a poorly functioning thyroid?”

According to Dr. Dweck, women may find these answers by talking through their symptoms with a trusted healthcare provider. 

“Despite the many symptoms attributed to hormonal volatility during perimenopause, it’s our responsibility as healthcare providers to rule out other medical conditions that may present with similar symptoms,” she explains. “In most instances, a thorough history, physical exam, lab work, and potential imaging studies can determine the root cause(s) of such symptoms.  Symptom management may be quite different in these cases, depending on underlying cause.”

Early Menopause Signs

According to Dr. Dweck, changing hormones may indeed be the root cause if feeling “off” occurs alongside other common perimenopause symptoms. If your mood changes accompany the following symptoms, perimenopause may be at play:⁷

• Irregular periods (shorter, longer, lighter, or heavier)
• Hot flashes
• Trouble sleeping
• Vaginal dryness

Talk to a Healthcare Provider if You’re Feeling “Off”

Dr. Dweck suggests that every woman struggling with potential perimenopause symptoms—including a shift in mental wellness—reach out to a trusted healthcare provider.

Start by making an appointment with a primary care provider or gynecologist. It may also be helpful to ask for a referral to a certified menopause specialist. 

Only a qualified physician can assess your symptoms and rule out things like thyroid disorders, autoimmune issues, and other medical conditions that could also cause health changes and symptoms in midlife.^{8, 9} A healthcare provider can also help you assess specific treatment options like cognitive behavioral therapy (CBT), prescription medications like antidepressants or hormone replacement therapy (HRT), lifestyle changes or over-the-counter solutions, if menopause symptoms are disrupting your daily life.¹⁰

Resources

1. https://www.acog.org/womens-health/experts-and-stories/the-latest/mood-changes-during-perimenopause-are-real-heres-what-to-know
2. https://health.clevelandclinic.org/why-midlife-crises-are-different-for-women
3.  https://www.letstalkmenopause.org/menopause-mental-health
4. https://menopause.org/press-releases/women-with-serious-mental-health-conditions-likely-ill-equipped-for-menopause-transition
5. https://www.verywellhealth.com/luteal-phase-11728002
6. https://med.stanford.edu/news/insights/2024/05/mental-health-menopause-perimenopause-solutions.html
7. https://my.clevelandclinic.org/health/diseases/21608-perimenopause
8. https://health.clevelandclinic.org/you-think-its-menopause-but-could-it-be-a-thyroid-disorder
9. https://www.verywellhealth.com/thyroid-imbalance-mood-swings-anger-what-to-expect-5525842
10. https://www.mayoclinic.org/diseases-conditions/perimenopause/diagnosis-treatment/drc-20354671