Perimenopause symptoms
Mood and emotions
Emotional changes during perimenopause
It isn't that you are sad, exactly. It isn't that you are anxious, in the way that word is normally used. It's something harder to name. You react to things in ways that surprise you. You feel less resilient than you used to — things that would once have passed over you now catch.
A 2024 study published in Menopause examined what women actually mean when they use the phrase "not feeling like myself" during perimenopause. They found it consistently mapped to a cluster of real, measurable symptoms — anxiety and vigilance, volatile mood including sudden irritability and anger, fatigue, brain fog, and sexual changes. Not vague dissatisfaction. A recognised pattern of experience, now documented in the research.
Oestrogen does not only regulate the reproductive system. It is active throughout the brain, including in regions that govern emotional regulation, stress response, and mood. Research from the SWAN study found that women in perimenopause have approximately double the risk of elevated depressive symptoms compared with premenopausal women. A clinical review confirmed that perimenopause is associated not only with the return of mood disorders in women who have experienced them before, but with first-onset mood disorders — meaning women who have never experienced depression or significant anxiety can develop them during this transition for the first time.
Mood symptoms in perimenopause are frequently attributed to stress, depression, or anxiety without any exploration of whether hormonal change might be the driver. Women are sometimes offered antidepressants at this point. Antidepressants can be appropriate and effective for some women — this is not a straightforward situation. But for women whose mood symptoms are primarily perimenopause-related, treating the hormonal context may be more relevant. It is worth raising explicitly with your doctor: that you are aware the menopausal transition is associated with mood changes, and that you would like to discuss whether there is a hormonal dimension to explore.
A persistent sadness or emotional heaviness not tied to events. Tearfulness without knowing why. A reduced capacity to feel pleasure in things that usually bring it.
Worry that feels disproportionate or difficult to turn off. A sense of threat or unease that doesn't quite connect to anything specific. Anxiety can appear during perimenopause in women who have not experienced it before.
A lower threshold for frustration. Reacting more sharply than you intend to, more quickly than feels like you. Research suggests irritability in perimenopause can be a distinct, hormonally-driven experience.
Sudden surges of fear, physical agitation, a racing heart, a sense of something being badly wrong. Panic-like episodes are documented as part of the psychological picture of perimenopause.
Finding ordinary demands feel unmanageable. Days that would previously have been navigated without difficulty now feel like too much. Research links this to the same cluster as "not feeling like myself."
The 2024 Menopause study found that women who described themselves as "not feeling like myself" consistently reported a cluster of emotional, cognitive, and physical symptoms that existing menopause scales had not been capturing well.
A loss of drive and enthusiasm, difficulty starting things, a flatness where engagement used to be. Research describes this as part of the depressive symptom profile associated with perimenopause.
A persistent physical and emotional keyed-up quality — being on edge, unable to settle, braced. This belongs to the anxiety spectrum that commonly accompanies perimenopause.
Mood changes are among the most frequently reported experiences of perimenopause, but also among the most misattributed — to stress, life circumstances, or personality. Longitudinal research is unambiguous: the risk of depressive symptoms rises significantly during perimenopause. Anxiety symptoms — including persistent worry, tension, and panic-like episodes — also increase during this period, especially in women also experiencing sleep disruption and vasomotor symptoms.
Sleep is the most significant amplifier of mood symptoms in perimenopause. The relationship runs in both directions: poor sleep worsens mood, and elevated anxiety makes sleep harder. Vasomotor symptoms also increase the risk of mood difficulties, both through the sleep disruption they cause and through their own direct effect on the nervous system. Prior history matters — but perimenopause can also produce first-onset mood disorders in women with no previous history.
Mood symptoms in perimenopause are frequently attributed to stress without exploring whether hormonal change might be a significant contributing factor. If you have been given a diagnosis of depression or anxiety and have not felt that it fully explains what you're experiencing, you are within your rights to say so. It is reasonable to ask specifically whether your doctor considers the menopausal transition relevant to what you are describing.
Mood and emotions is one of the eight domains in the Thea Klara survey. The survey covers low mood, anxiety, irritability, panic, feeling overwhelmed, feeling unlike yourself, loss of motivation, and tension — each rated by how often it happens and how much it affects your life.
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Coslov N et al. "Not feeling like myself" in perimenopause. Menopause. 2024.
Musial N et al. Perimenopause and First-Onset Mood Disorders. Focus (Am Psychiatr Publ). 2021.
Bromberger JT et al. SWAN studies on depressive symptoms across the menopausal transition.
Narrative review on mood and anxiety disorders in perimenopausal women. Maturitas. 2024.
Thea Klara provides self-advocacy tools, not medical advice. This content has been written to help you understand and describe your experience. It is not a substitute for a conversation with a qualified healthcare professional.