Why do some women suddenly become irritable, or apathetic/emotionally flat, less tolerant, easily overwhelmed, and experience mood swings in perimenopause and menopause?
That is because perimenopause and menopause are not reproductive transitions.
They are a neuroendocrine transition.
Our hormones, estrogen and progesterone in particular, can have an effect on:
- Brain
- Stress response
- Neurotransmitters
- Sleep
- Inflammation
- Metabolism
- Hair skin
- Emotions/mood
- Cardiovascular
- Bone
Moody Blues:
For this article, I want to focus on the mood and emotions that hormone changes can influence.
Every woman is different and will respond to hormonal changes in her own unique way. Some women may barely notice a change, while others may feel more irritable, anxious, emotional, blue, or even strangely apathetic.
Now, we cannot simply group perimenopause and menopause together when it comes to mood changes. Although they are connected, they represent very different hormonal environments that can affect the brain, nervous system, emotions, and stress response in distinct ways. Perimenopause is often a time of fluctuation and unpredictability, while menopause tends to be more of a steady state of hormonal deficiency and adaptation.
So let’s start with perimenopause and mood first because, hormonally speaking, this is often where the emotional chaos really begins. We’ll tackle menopause and mood in a future article.
Climate Change is Real.
In particular, the emotional climate change that happens in perimenopause.
One day your fine and the next your're blue and sad and then shift into a tempest of rage. No one around you is sure when the emotional weather will change, not even you.
And, as you know, I love a good story to help bring these concepts to life.
So, let’s meet Anna, my perimenopausal avatar.
‘Hi, I’m Anna. How are you?
Me, you ask?
Well, I have no idea what the heck is going on with me.
You asked, so I am going to verbally-vomit all over you, about me.
I’m 38 years old and all of a sudden, I don’t even know myself anymore. My life feels like a mess.
I am so emotional. One minute I am fine, and then all of a sudden I feel like I am in a rage, and then I am crying like a big baby.
My husband is always testing the ‘emotional-climate.’ He will walk into a room and say, ‘Hey.’ And depending on my look (pure evil-eye), he will slowly back out of the room.
I’m either sad, mad, or just don’t care.
Nothing bad is really happening right now. Life is actually pretty good. Brad and I have been married for 15 years and have a 10 and a 12 year old. Everyone is healthy and doing well. That is, except for me.
All of a sudden, I feel like I can’t organize my life, I can’t get tasks done, and I’m not motivated to do anything.
I’ve never missed an appointment or been late to anything in my life. Now I have missed appointments, gotten my kids to school late, and cannot focus at all.
Now is this bc I have not been sleeping well? There will be a week that I sleep terribly, waking up multiple times in the night or even for hours. Then I will sleep great for a few days and go back to waking in the middle of the night again.
It makes no sense to me. It's not about my blood sugar, the foods I have eaten, or whether I have exercised. These emotions and sleepless nights just seem to happen without rhyme or reason.
I have lots of hobbies and projects I want to do. But instead of pulling out my painting (I love watercolors), I’m just feeling like I’m in a time-warp where the time flies and I get nothing done.
Last weekend, I worked so hard trying to focus and plan my daughter’s birthday party. It was a great turnout, and we had all her friends and their amazing parents, and so much great food, and the weather was perfect. But me? I should have been having fun. Instead, I felt constantly irritated and distracted by all the noise, putting on a fake-fun face, but I was not having fun. Is this my hormones, or is something seriously wrong with me?’
What is happening to Anna, and why is she experiencing this?
And more importantly, what can she do about it?
Science First!
Perimenopause is often a time of hormonal fluctuation, not simply hormone deficiency.
This is the distinction that makes women question their own sanity in perimenopause.
Because not every day is the same.
- One day they might feel great and slept awesome, and the next day they feel off and moody.
- One day might feel light and slender, and then the next a puffy linebacker.
- One week their sex drive might be amazing, and the next they couldn't care less if Chris Hemsworth took his shirt off and helped wrestle the duvet cover onto the California King comforter.
That is where the lack of consistency feels so upsetting or out of control. As humans, we want to justify why ‘something’ is happening, or make everything linear. But when it comes to perimenopause, that opposite is the case.
During perimenopause, estrogen does not slowly and gracefully decline in a straight line. Instead, it can fluctuate wildly. Hormones may surge high one week, crash low the next, and then partially recover again.
Progesterone often begins declining earlier in the transition, especially during cycles in which ovulation becomes less consistent.
Hormones are not just about periods and hot flashes. Our brain, nervous system, mood, and emotions all take notice of these fluctuations.
This is one of the reasons women in perimenopause may suddenly feel emotionally ‘off’, even when nothing else in life has dramatically changed.
Estrogen and Our Brain:
Our brains are full of estrogen receptors: (Estrogen receptors alpha and beta)
- Hypothalamus: temperature regulation, sleep/wake cycles, stress response
- Hippocampus: memory, learning, stress regulation
- Amygdala: emotional alarm system to help process fear, anxiety, and threat detection
- Prefrontal cortex: Focus, emotional regulation, impulse control, and decision making
- Raphe nuclei: serotonin processing, mood, and sleep regulation
Basically, estrogen directly influences various brain regions involved in mood regulation.
So it makes sense that when estrogen is surging up and down in perimenopause, our moods would be affected too, right? Right!
Estrogen and Serotonin:
Perimenopause is not always a Quiet Riot. Sometimes fluctuating estrogen levels can affect serotonin signaling, making emotions feel louder, sharper, and harder to regulate.
Serotonin:
Serotonin is synthesized from tryptophan.
Estrogen can help upregulate serotonin synthesis. It does this by increasing the activity/expression of tryptophan hydroxylase, the enzyme responsible for serotonin production.
To put it simply:
More estrogen = more serotonin synthesis
Less estrogen = less serotonin synthesis
So it’s reasonable to assume that drops in estrogen in perimenopause (bc of the drop in serotonin synthesis) could cause anxiety, sadness/blues-y, feeling super sensitive, and even irritable.
But here is the catch in perimenopause: the surges in estrogen could amplify serotonin, which sounds great, right?
No, because when the estrogen suddenly drops in perimenopause, your serotonin synthesis does too. And that the sudden fluctuation can make a woman feel instantly off or crash.
It's the ups and downs of estrogen, which can happen over and over in perimenopause, that can really mess with your mood (by way of serotonin).
Hence, the result in perimenopause is anxiety, irritability, crying easily, emotional sensitivity, and feeling like you suddenly have no stress threshold, and everything feels overwhelming.
Also, estrogen can increase how our brains (neurons) respond to serotonin.
More estrogen = increased serotonin sensitivity
Less estrogen = decrease in serotonin sensitivity
Meaning that even if you have all the serotonin in the world, if you have a drop in estrogen, your brain has a harder time responding to it.
Again, hence the ups and downs of anxiety, irritability, feeling overwhelmed in perimenopause, even when nothing substantial has occurred.
Estrogen and Dopamine:
Dopamine is a neurotransmitter that affects:
- Motivation
- Pleasure
- Reward
- Drive
- Focus
But let’s look at this conceptually. Why do so many intelligent, high-functioning women all of a sudden feel scattered, foggy, and burnt out in perimenopause?
It’s your prefrontal cortex and dopamine!
Prefrontal cortex? What is that? It sounds like a porno-movie.
Well, it's not.
Your prefrontal cortex is the CEO of your brain.
It helps organize and regulate
- Attention
- Planning, focus
- Impulse control
- Multitasking
- Working memory and executive functioning (more on this below)
- Prioritization.
Basically, your prefrontal cortex helps you hold life together mentally.
Your prefrontal cortex helps with ‘executive function’ and ‘working memory.’
Well, what is executive function and working memory anyway?
Executive Functioning:
This is your brain’s ability to organize and manage tasks
- Starting tasks and finishing tasks
- Prioritizing
- Shifting between tasks
- Keeping track of information
- Resisting distraction
Working Memory:
Working memory is not long-term memory.
It's like it sounds, working.
Like a working dog, for example, my Aussie/border collie/blue heeler, Bob, he needs a job. He is always looking around, anticipating what I am doing, and generally trying to herd me (usually outside for a walk or to play ball).
Working memory = the moment-to-moment process of holding and manipulating information in real time.
Examples of working memory:
- Walking into a room and knowing exactly why you are there and what you are doing
- Following multiple-step instructions
- Holding a conversation easily, with the words coming out with ease
- Holding several thoughts and tasks in your head at once
- Starting a project and actually finishing it
- Barking hysterically at the kid on the skateboard coming directly at you (wait, that’s Bob)
Prefrontal cortex no longer sounds like an X-rated movie anymore, huh? It sounds like an important part of your team. It sounds like, gimme more of that prefrontal cortex stuff!
The prefrontal cortex relies heavily on dopamine to function effectively and efficiently.
And dopamine signaling relies heavily on estrogen.
When estrogen fluctuates in perimenopause:
-
Dopamine signals become less stable, and PFC efficiency drops like a rock, and instant overwhelm occurs with paralysis or flailing, ineffective action.
- AKA: Can’t make a decision, can’t focus, constant squirreling, super snappy/snarky, don’t care, whatever, and I lost my phone, again.
Meso-OG and Dopamine (and estrogen):
I Just Want a Treat! I Deserve a Reward!
Meet the Mesolimbic Pathway!
Hi, I’m your Mesolimbic Pathway. You can call me Meso-OG.
I am part of your brain’s reward system, and I help regulate:
- Pleasure, motivation, excitement, and anticipation.
One of the neurotransmitters I work closely with is dopamine.
When estrogen fluctuates during perimenopause, dopamine signaling within my pathway may fluctuate too.
Up and down estrogen levels = reduce dopamine signaling = affect Meso-OG.
And this is where women may start noticing:
- Things that used to feel exciting suddenly feel flat
- Motivation feels lower
- Pleasure feels muted
- Rewards do not “hit” the same way anymore
- Lower libido (where did my sex drive go?)
One day, going to Disneyland is so much fun, and the next, I'm not having any fun, and I don't know why.
GABA and Progesterone:
In perimenopause, women can feel:
- Wired
- Anxious
- Overstimulated
- Hypervigilant
- Waking at 3 am
- Ruminating
- Intrusive thoughts
- Unable to settle down: tired but always feeling ‘on’
Why? Well… meet progesterone. Or more accurately, the lack thereof.
Progesterone is not just a reproductive hormone. It has neuroactive and calming effects in the brain.
Progesterone converts to allopregnanolone, which strongly binds with GABA receptors (GABA-A receptors).
GABA = gamma-aminobutyric acid
GABA is the brain’s major inhibitory/calming neurotransmitter.
Its job is basically:
- slowing things down
- calming neuronal firing
- reducing overstimulation
- promoting relaxation
- helping sleep
- buffering stress
You can think of GABA as your brain’s brake pedal.
Progesterone often declines EARLIER than estrogen because:
- Ovulation becomes inconsistent
- Anovulatory cycles increase
- The corpus luteum function becomes less robust
Less ovulation → less progesterone → less allopregnanolone → less GABAergic calming activity.
This is where everything feels: LOUD
- Hard to drown out the noise
- Too much stimuli, everywhere
- Crowded places feel overwhelming
- Less emotional buffering, AKA: stop being so sensitive!
- Edgy, wound up, intense, overbearing, stick up the rear Val (I say this from my personal experience)
- Stress hits harder and lasts longer
- Easier to snap, cry, panic, or shut down
- Even small inconveniences suddenly feel enormous
- Worried about everything
NO Sleep:
Then bring on the sleep, or again, lack thereof. Falling asleep easily, then it’s 2:30 am, and you’re wide awake like it's 7 am. And by the time you fall back to sleep (1-2+hours later if at all), it’s time to wake up.
Why is that/this happening?
Welcome to the stage, our opener is a newbie but packs a punch! She’s chaotic. She’s inconsistent. She cancels plans at the last minute and ruins everyone's sleep.
Give it up for… LUTEAL INSUFFICIENCY!!! Introducing, Luteal Insufficiency!!
Hits include:
- 2:30 on a Tuesday night…
- Running up that hill, if only I could make a deal with GABA
- Under Progesterone Pressure
- Somebody that I used to know (before peri)
- No sleep, till Brooklyn
The classic hallmark in perimenopause is that the luteal phase function often becomes weak (AKA Luteal insufficiency). After ovulation (the egg leaves the ovary), there is a spot on the ovary called the corpus luteum. The corpus luteum will and should release progesterone. In luteal insufficiency, the corpus luteum may not secrete progesterone sufficiently.
This can cause insomnia and trouble staying asleep, leading to waking at 2:30am and being unable to fall back asleep. It can also cause heavier periods (which can lead to anemia), shorter cycles (two periods in a month), and spotting before and after periods.
Cortisol Buffer:
Cortisol is not your enemy. In fact, we need cortisol to live. But with fluctuating estrogen and low progesterone levels, cortisol can take off like a runaway train. Estrogen and progesterone help to rein in or buffer cortisol levels.
In perimenopause, the unabated cortisol can cause anxiety, irritability, hyper vigilance (that jump out of your skin when someone taps you on the back), trouble sleeping at night, and the dreaded cortisol-belly.
One day, it is rainy, gray, and blue. The next jump in the bunker, well, crawl space, or anything offering emotional protection, because the tornado sirens are blaring. Or grab your gear and evacuate immediately because Hurricane Perimenopause is charging through town.
Not to make light of it, but sometimes humor helps because perimenopause can profoundly affect mood, emotions, stress, sleep, patience, and the ability to emotionally “weather” life.
What Can Anna do?
Upgrade to the paid version, where we dive into potential solutions, including progesterone support, estrogen balance, rhythmic dosing, neurotransmitter support, cortisol regulation, sleep strategies, and supplements commonly used to help support anxiety, overstimulation, mood swings, irritability, focus, and the “wired but exhausted” perimenopausal brain.
