Medically reviewed by Dr. Tamara Neuhaus MD

Perimenopause & Depression- Tips for Managing Mood Swings

Little things are bothering me so much more than they ever did, and I’m so snappy with my husband and kids. I just don’t feel like myself. - Diane, 51

What is it?

For a lot of women, the changes they start noticing in their mood are the most upsetting symptoms of menopause. You may find yourself reacting in ways that feel unfamiliar, embarrassing, or out of proportion. Discomfort becomes anxiety. The blues become deep sadness or depression. Irritation becomes rage. The people on the receiving end of this moodiness are often the ones you care about most, including yourself.

Why does it happen?

There are a few factors that can play a role in your changing mood. Dwindling hormone levels, insufficient sleep, and stress are at the top of the list. So if night sweats or the urge to pee are keeping you awake, or increased pressure at work or home are adding to your stress level (all common at this age), you’ve got a perfect mood storm brewing.

What can you do about it?

Depending on the root cause(s) of your mood changes, there are different approaches you and your doctor can consider. You may have to try a few of them before figuring out the cause and its best treatment.

Hormone Therapy (HRT)

Some women find that their mood is improved with the use of hormone therapy. There are a few reasons this treatment works. Because it brings your estrogen back up to its pre-perimenopause levels, all of those cells in your body that rely on this wonder hormone to function at peak performance, go back to, well, performing at their peak. The muscles that support your bladder and urethra can once again hold your pee in all night. Your hypothalamus keeps your body temperature in check, so you’re not plagued by hot flashes and night sweats. Your libido returns, as does the moisture needed to make sex feel good, so sex is more satisfying. Your energy level improves, so you can get the exercise you need to improve your health and state of mind. And all of this can help you sleep better. You’d be amazed how much easier it is to cope with all of the responsibilities of midlife when you consistently catch the Zs you need.

Other Medical Interventions

If you’re wary of hormones or have a health history that’s incompatible with HRT (prior breast cancer or a prior blood clot), taking a prescribed antidepressant like an SSRI or SNRI can help boost your mood. Even if you just take them at a very low dose, they can help control hot flashes and night sweats, which could be enough to keep your sleep—and your cope-rope—from fraying.

Herbal Therapies

Lavender, St. John’s wort, lemon balm, passion flower, and ashwagandha can be helpful with mood, as can supplements like L-theanine, Omega-3, GABA, SAMe, and 5-HTP.  While you don’t need a prescription for these supplements, it’s best to consult with your doctor before you add one to your routine.

Lifestyle Adjustments

Two of the very best things you can do to improve your mood are to 1. get out in nature and 2. exercise. Finding the motivation to do either is going to be hard at first. But once you make the commitment and stick to it, you’ll start looking forward to the mood-lifting effect they have on you. Think of movement as medicine and Mother Nature as your therapist. Another great habit to develop is daily meditation. Even five minutes a day has been shown to reduce stress, depression and more.


And speaking of therapists, a good marriage and family counselor can help you and the people who love you work through this tumultuous time in your life. It is absolutely okay to ask for help from the people closest to you. You don’t have to solve this on your own.

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At The Cusp, we provide expert menopause care. We are a comprehensive, convenient virtual healthcare service dedicated to help you feel better.