Mood Shifts and Anxiety During Perimenopause: What's Going On?

Maybe you’ve always been calm under pressure.

And lately, things feel different.

Your heart races over something that wouldn’t have bothered you before. You feel irritable for no obvious reason. Your patience disappears faster. Or you find yourself lying awake replaying a conversation that, six months ago, you would have forgotten by morning.

Then comes the question: Is this perimenopause or is this just me?

Emotional changes can occur during the menopause transition. But the relationship between perimenopause, hormones, anxiety and mood is more complicated than many social media posts make it sound.

Hormones may be part of the picture. They are rarely the whole picture.

Mood can change during perimenopause

The Menopause Society notes that mood symptoms during perimenopause may be related in part to changing estrogen levels. Estrogen receptors are present in areas of the brain involved in mood regulation, although the precise mechanisms linking hormonal fluctuations and mood are not fully understood.

At the same time, perimenopause often arrives during an already complicated stage of life.

Work may be demanding. Children may still need you. Parents may need you more.

The Menopause Society specifically points to stressful life circumstances, sleep disruption, hot flashes, and other menopause symptoms as factors that may also influence mood during this transition.

What about anxiety?

Anxiety deserves a little more nuance.

Women certainly report anxiety during perimenopause, but researchers have not established that the menopause transition universally increases the risk of anxiety disorders for every woman.

A major 2024 review published in The Lancet found no compelling evidence that anxiety risk is universally elevated across the menopause transition. The authors cautioned against automatically attributing psychological distress to menopause because doing so can delay recognition of other mental health conditions.

That doesn’t mean the experience isn’t real. It means different women may have very different experiences.

Research from the long-running Study of Women’s Health Across the Nation found an interesting pattern: women who entered midlife with relatively low anxiety appeared more susceptible to developing higher anxiety symptoms during and after the menopausal transition, while women who already had high anxiety tended to remain highly anxious regardless of menopause stage.

Sometimes anxiety and hot flashes overlap

The Menopause Society notes that hot flashes may exacerbate anxiety because they can be unpredictable and uncomfortable. At the same time, anxious thoughts may trigger or intensify hot flashes in some women.

That creates a frustrating feedback loop:

Was I anxious because I had a hot flash? Or did the anxiety make the hot flash worse?

Sometimes there may not be a clean answer. And that’s precisely why looking at a single symptom in isolation can be misleading.

Sleep may be sitting underneath all of it

If you’ve read our piece on nighttime waking, you already know how common disrupted sleep can become during the menopause transition.

The Menopause Society recognizes sleep changes as one of the factors that can affect mood during perimenopause.

This doesn’t mean lack of sleep explains every emotional change. It means symptoms can interact.

Related: Why You Keep Waking Up at 3 AM During Perimenopause

Depression is different from having a bad week

Mood shifts, irritability, and occasional anxiety are not automatically depression.

But depression during the menopause transition deserves to be taken seriously.

A 2024 systematic review and meta-analysis of prospective studies found that women in perimenopause had a higher risk of depressive symptoms and depression diagnoses compared with premenopausal women.

The Menopause Society also notes that women with a previous history of depressed mood appear to be particularly vulnerable during this period.

That distinction matters. Not every emotional change requires a diagnosis. But persistent emotional distress shouldn’t automatically be dismissed as “just menopause,” either.

So why did your hormone test come back “normal”?

This is one of the more confusing parts of perimenopause. You may notice changes in your sleep, mood, energy, or menstrual cycle, so you get a hormone test hoping it will help explain what you’re experiencing. Then the results come back within the reference range, leaving you wondering how that can be possible when you clearly feel different.

The answer is that the test may be telling you something real, but it is only showing what your hormone levels looked like at that particular point in time.

During perimenopause, hormone levels can fluctuate considerably, and those changes do not necessarily follow a predictable pattern. This is one reason The Menopause Society notes that there is no single laboratory test or biomarker that can definitively determine whether someone is in perimenopause or where they are in the transition.

That does not mean the test result is wrong, or that your symptoms are necessarily being caused by your hormones. It simply means that a single measurement may not capture everything that is happening over time.

Your experience of perimenopause unfolds over weeks and months, while a hormone test captures one moment. Both can be useful, but they are telling you different things.

Understanding that difference can make it easier to look at your symptoms in context rather than treating one test result as the final answer.

“Normal” doesn’t mean “nothing has changed”

A hormone result can be normal, and you can still be experiencing real changes. That’s not necessarily a contradiction. It’s a reminder that understanding perimenopause often requires looking beyond a single test result.

It can be useful to step back and ask what has actually changed over time.

• When did the anxiety begin?
• Does it come in waves?
• Does it happen alongside disrupted sleep?
• Do you notice it around certain menstrual changes?
• Are hot flashes happening at the same time?
• Are there periods when you feel completely like yourself again?
• Are major life stressors changing too?

None of these questions can tell you on their own what is causing a symptom, and they shouldn’t be used to diagnose yourself. But they can help you and your healthcare professional understand what you’re experiencing in a way that a single symptom or measurement cannot.

The point isn’t to find a pattern and assume you know the answer. It’s to have enough context to ask better questions.

The goal isn’t to blame hormones for everything

There’s a strange contradiction happening around women’s health right now.

For years, many women felt their symptoms weren’t taken seriously.

Now the pendulum can sometimes swing too far in the other direction: every symptom becomes hormonal.

The reality is usually more complicated. Hormones can play a role, but so can sleep, stress, mental health, hot flashes, medications, other health conditions, and what else is happening in your life. Sometimes several of these factors are changing at the same time.

That’s why it can be more useful to look at how things change together rather than trying to find one explanation for every symptom.

At femmli, that’s the question we keep coming back to: what can we learn when we look at patterns over time instead of isolated moments?

Not because a pattern gives you a definitive answer, but because having more context can help you understand what you’re experiencing and have a better conversation about what to do next.