What to Do When Menopause Affects Your Mood

Is it the hormones, the hot flashes or just midlife stress?

Joelle Klein

Updated October 16, 2025

A woman at a table resting her head on her hand with closed eyes and a withdrawn expression

Yulia-Images/Getty Images

Do you find yourself snapping at your spouse or co-worker more than usual? Are you frequently losing your patience with your children or just losing your cool in general? Do you feel, at times, sad, irritable or angry? If you answered yes and you’re in your 40s or early 50s, chances are you’re in perimenopause.

Perimenopause is the transition stage to menopause. And menopause is when a woman has gone without a period for a full 12 months. The perimenopause transition, which can last from four to eight years, is when a woman’s hormone levels fluctuate before settling at lower levels post-menopause. Hormone fluctuations can make you more vulnerable to irritability, anxiety and impatience. The hot flashes and night sweats brought on by hormonal changes, which affect 80 percent of women, add their own challenges to sleep and mood.

But menopause is not the only thing women face in midlife. They may be caring for aging parents, moving their teens to college or welcoming them back home, or taking on more responsibilities at work.

Given this confluence of life events, it’s not surprising that 40 percent of women in the menopause transition report mood issues similar to premenstrual syndrome, or PMS. They experience irritability, weepiness, low energy and mood swings. Yet, many women don’t connect these feelings with menopause.

Unlike PMS, perimenopause-related mood symptoms are not tied to a monthly period. They can come and go for years without any pattern or trigger.

“I think some women have come to expect that they might have mood issues related to their menstrual cycles, but they don’t necessarily anticipate it during the menopause transition. It may be more unexpected then,” says Dr. Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health and medical director for The Menopause Society, a nonprofit research organization for health professionals.

Who gets moody and why?

During perimenopause, women may experience a spectrum of mood issues ranging from minor to severe. For some women, hormonal changes make them more vulnerable to a major depressive episode, a severe form of depression, although most complaints are about mild to moderate changes in mood. Women who have had hormone-related mood changes, like PMS or postpartum depression, which occur during times when hormones fluctuate wildly, are at increased risk of mood issues during perimenopause, according to Faubion.

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Changes in estrogen can affect neurotransmitters, such as serotonin and GABA, both important for regulating mood and anxiety, leaving some women more vulnerable to depression and anxiety. “Women with prior histories of depression or anxiety disorders are particularly vulnerable during perimenopause to having worsening symptoms,” says Dr. Lisa Weinstock, a reproductive psychiatrist who specializes in women’s health.

On the other hand, some women experience mood swings simply because of bothersome menopause symptoms. “Insomnia, decreased libido, hot flashes. Who wouldn’t be more moody?” Weinstock says.

How to feel like yourself again

The first step to returning to a more even, less reactive mood is to talk to your primary care doctor or OB/GYN to find out if, in fact, you’ve started perimenopause and to discuss your symptoms.

Faubion says that women are going to have to experiment with treatment options, which include antidepressants, hormone therapy and cognitive behavioral therapy, depending on their symptoms. For minor mood shifts, lifestyle changes, such as limiting alcohol, exercising and eating a healthy diet, can help.

Antidepressants

“For a true depressive episode, the first-line therapy is the same as first-line therapy for depression at any other time of life, which includes antidepressants and cognitive behavioral therapy,” Faubion says.

Women who’ve experienced depression before should return to the treatment that worked for them before, she says.

Additionally, some antidepressants have the added bonus of minimizing hot flashes. It’s important, Weinstock counsels, to have a comprehensive mental health evaluation before you jump to using psychiatric medications.

Hormone Therapy

For those with mood swings and bursts of anger or irritability who are not clinically depressed, symptoms may still “impact people’s functioning in significant ways and their quality of life,” Weinstock says.

Hormone therapy, also called menopausal hormone therapy, or MHT, for those who don’t have health contraindications, can help in various ways. For starters, MHT is the gold standard treatment for managing hot flashes, which can impact mood and sleep. Additionally, there is evidence that MHT can help with mood issues around the menopause transition.

“Hormone therapy is not FDA-approved for sleep management. It’s not FDA-approved for mood management. Can it help with all of these things? Yes,” Faubion says.

A randomized controlled trial published in JAMA Psychiatry in 2018 of 172 perimenopausal and early postmenopausal women ages 45 to 60 found that a year of transdermal estrogen, which is estrogen administered through a skin patch, plus progesterone was more effective than a placebo in preventing clinically significant depressive symptoms.

Cognitive Behavioral Therapy (CBT)

CBT is a type of psychotherapy that helps combat feelings of depression and anxiety by identifying and addressing negative thoughts and behavior patterns. Research shows that CBT is effective in treating low mood and anxiety, as well as hot flashes and sleep issues, related to menopause.

The British Menopause Society, an educational group for healthcare professionals, recommends CBT as a treatment option for women experiencing anxiety, depressed mood and hot flashes during the menopause transition and after menopause. CBT also offers a bonus: improved menopause-related sexual issues.

The bottom line is that there are treatments to help women going through menopause who are experiencing major or minor mood-related symptoms that are impacting their lives. If you are having these symptoms, it’s important to speak with your doctor or therapist about any troubling mood changes to learn about your options.