The moody elephant in the room - how to manage it during perimenopause

Today, I’ll be talking about the 2nd pillar of our framework: Mood. As I'm sure you also noticed, things have changed. Some of all of the following may apply to you and to varying degrees:

• Irritability and Anger: Sudden, intense feelings of frustration or low frustration tolerance, often out of proportion to the trigger. 

• Mood Swings: Rapid shifts between feeling fine, anxious, tearful, or angry without clear external causes.

• Anxiety and Panic: Heightened baseline worry, feelings of overwhelm, or sudden physical symptoms of panic (racing heart, tightness in the chest).

• Depressive Mood & Low Energy: Persistent sadness, loss of interest in usual activities, reduced motivation, or feeling emotionally flat.

• Brain Fog and Cognitive Fatigue: Difficulty concentrating, forgetfulness, or trouble finding words, which can heighten anxiety and self-doubt.

• Sleep-Related Mood Disruptions: Night sweats and insomnia disrupt restorative sleep, significantly compounding daytime emotional instability.

Sounds familiar? 

The good news is: Well, you’re not going mad. This is the result of elevated cortisol and lower progesterone (the calming hormone), often combined with lower estrogen levels (responsible for the happy hormone - dopamine). This can make you feel like being constantly on edge. 

Now the bad news: There's no quick, single fix. But with the range of lifestyle changes, you can make this more bearable.

Medical Approaches

• Hormone Replacement Therapy (HRT): Estrogen therapy (often combined with progesterone if you have a uterus) can stabilise hormone levels and is often effective for perimenopausal mood instability, especially when linked to hot flashes or sleep disruptions.

• Non-Hormonal Prescription Options:

  • Low-dose SSRIs or SNRIs (antidepressants) can effectively manage anxiety, low mood, and vasomotor symptoms (hot flashes).

• Important to note: A detailed discussion with a physician or gynaecologist is essential to weigh the risks and benefits based on your individual health history.

  
  

Behavioural & Therapeutic Interventions

• Cognitive Behavioural Therapy (CBT): Very effective for perimenopausal anxiety and mood changes, providing tools to reframe negative thought patterns and manage stress. There are many apps offering free or low-cost sessions directly from your phone

• Stress Management & Mindfulness: Mindfulness meditation, breathwork, and yoga help regulate the sympathetic nervous system and lower baseline cortisol. Yes, easier said than done while you’re absolutely fuming, but remember it’s there and available to you.

  
  

Lifestyle Adjustments

• Sleep Hygiene: Maintain a cool, dark sleep environment, adhere to consistent sleep-wake times, and limit screen time before bed. Refer to my last week’s post on sleep for more details

• Regular Physical Activity: Exercise and resistance training boost endorphins, improve sleep quality, and support overall mental health. I will be focusing on exercise in a couple of weeks. Look out for the email. 

• Nutritional Support:

  • Eat a balanced diet rich in protein, complex carbohydrates, and healthy fats (such as omega-3 fatty acids) to stabilise blood sugar levels.

  • Limit alcohol and caffeine, both of which can make anxiety, mood swings, and night sweats worse. There will be a whole post on nutrition next week.