Why Perimenopause Can Feel Emotionally Overwhelming

Perimenopause |
6 min read

Published

July 28, 2026

Medically reviewed by

Alyssa Dweck MS, MD, FACOG, MSCP, Chief Medical Officer

Dramatic mood swings. Lingering sadness. Irritability that leaves you, and loved ones, constantly on edge. If any of this sounds familiar, you may be experiencing the emotional rollercoaster that can accompany perimenopause. While menopause is defined as 12 consecutive months since your last period, perimenopause—the time leading up to it—unfolds over eight to 10 years before menopause.¹ This transition is characterized by volatile and then declining estrogen levels that can cause emotional shifts that make you feel less like yourself.²

Signs You’re in Perimenopause Signs You’re in Perimenopause

Individual experiences of perimenopause will be unique. Some women may start to notice irregular periods in their late-30s, while others may maintain regular cycles well into their 50s. Maternal genetics are a factor regarding the age of onset, which means you might expect to begin perimenopause when you’re around the same age as your mother was.³ But unfortunately, no one can accurately predict exactly how long the transition will last or specifically how it will make you feel.

If you’re experiencing what you think are perimenopause symptoms, it can be helpful to start tracking these in addition to your period during this time, especially as there’s no definitive test to determine the onset of perimenopause.⁴ Your first clue might be nothing more than occasional disruptions to your menstrual cycle.⁵ Missed periods or unusually heavy bleeding or clotting can be signs of more serious conditions, so it’s important to consult with a healthcare provider as your body changes.⁶ Continue to use birth control until you’ve gone a full year without a period and are officially postmenopausal, as pregnancy can still occur if you are menstruating, even if irregularly.⁷

Understanding Emotional Symptoms of Perimenopause

As estrogen production declines, it’s possible to experience symptoms like mood swings alongside physical changes. In some cases, changes in mood can seem more severe during perimenopause, especially when coupled with menstruation.^8,

Emotional symptoms that may feel worse during perimenopause can include:¹⁰

Irritability
Depression
Low energy
Anxiety
Mood swings
Feeling sad

Many of us may have experienced some or even several of the above-mentioned symptoms, but if you notice yourself becoming uncharacteristically irritable, anxious, or weepy, it may be time to take a closer look at your hormones. Once you know what’s going on, there are things you can do to help you feel more like yourself again. you feel more like yourself again.

Maximize Self Care During Perimenopause

A lot of physical and emotional changes occur during perimenopause, and incorporating some self-care routines can help you feel more like yourself again. Healthy habits can go a long way toward leveling out mood swings in perimenopause and restoring a stronger sense of control.

Cover the Basics ^11,12

Exercise: Aim for 150 minutes of moderate-intensity exercise every week and consider adding at least two days of resistance training, alongside activities like walking, swimming, or dancing.
Diet: A mood-boosting diet should include clean fruits and vegetables, lean protein, whole grains, and healthy fats to support your endocrine system.
Sleep: To improve your sleep hygiene, do your best to stick to a regular bedtime, limit screens in the evening, and ensure your bedroom is dark, cool, and quiet.
Connections: Spending quality time with friends and family can help improve your outlook while strengthening your social safety net.
Meditation: Practices like mindfulness, journaling, and meditation are simple ways to help boost wellbeing and lower stress during perimenopause.

Symptom Management Options to Consider for Perimenopause Mood Changes

If you’re interested in exploring other interventions or have specific concerns about emotional changes you’re experiencing, don’t hesitate to reach out to a healthcare provider.¹³ They can provide a range of options designed to supportwomen’s hormonal health during this transitional time.

Options to consider can include:¹⁴^,15,16

Hormone Replacement (HRT or hormone therapy or HT): Hormone therapies typically use estrogen or estrogen and progestins to help stabilize hormone levels during menopause. Your healthcare provider can help you decide if these options are right for you.
Talk Therapy: Transitions are stressful. A good therapist can help you navigate the physical and emotional changes of perimenopause and steer you toward resources when appropriate.
Antidepressants: The most common medications to stabilize mood include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). They can help some women manage depression symptoms during perimenopause, and research indicates they may also help alleviate hot flashes.

What to Do If You’re Struggling

Mood dysregulation and other perimenopausal symptoms may respond well to lifestyle changes, hormone replacement therapies, over the counter options, and other interventions. In many cases, these issues resolve on their own after menopause; but studies show that up to 70% of women experience significant mood swings during the menopause transition, and anywhere from 20% to 60% report depression during this time.^{16, 17}

If you’re dealing with symptoms of depression, have a history of mental illness, or are wondering whether your experience is normal, you don’t have to suffer in silence. Talk with your healthcare provider or reach out to other professionals for help.

Find additional resources for depression at:

9-1-1 or your nearest emergency room if it’s a mental health emergency
Substance Abuse and Mental Health Services (SAMHSA) National Helpline: Visit online or call 1-800-662-4357
National Alliance on Mental Illness (NAMI): Visit online, call 1-800-950-6264, or text NAMI to 741741
988 Suicide & Crisis Lifeline: Visit online or call or text 988
Psychologytoday.com is a great resource for finding mental health care providers specific to your needs

If you are experiencing depression during perimenopause, know that it can be diagnosed and successfully managed with the right support.^{18, 19}

A Positive Outlook

Perimenopause can feel like an unwelcome disruption, but there are upsides too; as many women have come to embrace a newfound sense of autonomy during this life stage. For anyone seeking relief from perimenopausal symptoms, management options range from holistic to pharmaceutical. And yet there are still times when it can all feel a little overwhelming. On those days, remember to give yourself a little extra TLC. And keep an optimistic eye on the future—postmenopausal women will be the first to tell you there’s a lot to look forward to on the other side.²⁰

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