How to Fix Your Mood During Perimenopause
Have you ever snapped at your kids over something tiny, then locked yourself in the bathroom and cried, then wondered what on earth is wrong with you? If you're a woman in your forties, there's a decent chance the answer is: nothing is wrong with you. You're in perimenopause.
I sit with women every week who describe some version of this. The tears that show up out of nowhere. The rage over a dishwasher loaded wrong. The 3 a.m. dread spiral. And almost every one of them says the same thing to me: "I don't feel like myself anymore."
That sentence matters. Because you're right. You don't feel like yourself. Your hormones are on a roller coaster, and your mood bought a ticket whether you wanted it to or not.
So what's actually happening?
Perimenopause is the stretch of years leading up to menopause, usually starting sometime in your early forties. Here's the part nobody explains well: your estrogen doesn't just gently decline. It spikes and crashes, sometimes week to week. Your brain uses estrogen to help regulate mood, sleep, and stress. So when it's bouncing around, you're bouncing around.
And this isn't a small thing that happens to a few unlucky women. Researchers at University College London found that women in perimenopause are 40 percent more likely to experience depression than women who haven't started the transition yet. Some studies put the risk of a major depressive episode at two to four times higher during these years. Mood swings alone affect up to two-thirds of women going through it.
I share those numbers not to scare you, but because so many of my clients feel embarrassed by what they're experiencing. They think everyone else is handling midlife gracefully while they're falling apart. Not true. This is common, it's physiological, and it's treatable.
Okay, but how do I fix it?
Honest answer: there's no single fix. But there's a combination of things that genuinely work, and most women don't need all of them.
Talk to your doctor first. I mean it. Since hormones are driving a lot of this, your primary care doctor or gynecologist should be part of the conversation. For some women, hormone therapy changes everything. I'm a therapist, not a physician, so I won't tell you what's right medically. But I will tell you that the women I see who address both the hormonal side and the emotional side tend to do the best.
Guard your sleep like it's your job. Perimenopause wrecks sleep for a lot of women, and bad sleep makes every single mood symptom worse. You can't out-cope exhaustion. If night sweats or 3 a.m. wakeups are stealing your sleep, that goes on the doctor list too.
Name the pattern. This one sounds small but it's huge. When you can catch yourself and think "oh, this is the hormone thing, not proof that I'm a terrible person," everything softens a little. The shame spiral is often worse than the mood itself.
Lower the bar somewhere. Your stress tolerance is genuinely reduced right now. That's not weakness, it's biology. Something on your plate probably needs to come off, at least for this season. Most of my clients resist this one hard. Most of them also feel better once they do it.
Get real support for the mood piece. Therapy approaches like CBT and ACT work well for anxiety and depression, including when hormones are stirring the pot. And honestly, sometimes perimenopause just cracks open stuff that's been sitting there for years anyway. The marriage stuff. The resentment stuff. The "I've been taking care of everyone but me for two decades" stuff. Having a place to sort through all of it makes a difference.
You don't have to just push through
So many women treat perimenopause like a test of endurance. Grit your teeth, don't complain, wait it out. You could do that. It might last four years, it might last ten. Or you could get support and feel more like yourself a whole lot sooner.
I work with women in Morgan, Mountain Green, Weber County, and Ogden in person, and by telehealth anywhere in Utah. If what you're feeling looks less like mood swings and more like a fog that won't lift, my depression page might be worth a read. And you can always browse my services page to see everything I help with.
One more practical thing, because I know cost stops a lot of women from reaching out: I take Medicare Select Health, Regence BlueCross BlueShield, PEHP, and Optum/UHC. If you're not sure about your plan, ask when you contact me and we'll figure it out together.
If any of this sounded like your life, reach out and schedule a free consultation. You're not crazy, you're not broken, and you don't have to white-knuckle your way through the next several years alone.
Sources: UCL, "Women are 40% more likely to experience depression during the perimenopause," 2024; WebMD, "Menopause Emotions, Depression, Moodiness, and More"; Psychology Today, "10 Reasons for Perimenopausal Mood Swings"