Anxiety and mood swings in perimenopause

You are standing in the supermarket and suddenly feel your heart pounding, your hands clammy, a vague panic that seems to come from nowhere. At home you burst into tears over something trivial. "This is not me at all," you think. And yet it happens to you, time after time. For many women in perimenopause, this is a familiar and unsettling pattern.

What strikes me is how often women blame themselves for this. As if it were weakness, or imagination. It is neither. Your hormones are fluctuating, and those fluctuations directly affect your brain chemistry. That you feel different than you are used to is therefore not a matter of character but a physically explicable phenomenon, and that knowledge alone can already take away part of the unease.

What hormones do to your mood

Oestrogen and progesterone are not only reproductive hormones. They also influence brain chemicals that regulate your mood, such as serotonin. In perimenopause, your oestradiol in particular swings up and down sharply, and it is those swings, rather than the low level itself, that seem to be linked to irritability, low mood and anxiety.

The NHG guideline for GPs recognises that mood complaints can be part of menopause. At the same time, Thuisarts stresses that not every low or anxious period at this stage of life is automatically caused by hormones. That distinction matters, because it determines which help fits best.

Is it menopause, or something else?

Here I want to be honest: it is tempting to pin everything on hormones, but that is not always justified. Complaints that resemble menopausal anxiety can have other causes.

That last row deserves emphasis. Persistent anxiety or low mood that affects your daily life is not an automatic part of menopause. Seeking help for it is not a sign of making a fuss, but sensible.

Which values can help?

A blood test cannot measure your feelings, but it can help rule out physical causes. With persistent mood complaints at this stage, it can be sensible to look at your thyroid and, with fatigue, at your ferritin and vitamin B12. If you want a broader hormonal picture, a women's hormone panel may fit. Always have the result interpreted by your doctor: numbers without context say little.

The quiet role of sleep

Sleep is an underrated link in this story. Night sweats and hot flushes interrupt your rest, and chronically poor sleep makes you more sensitive to anxiety and low mood. A vicious circle forms: hormones disrupt your sleep, poor sleep amplifies your mood complaints, and those in turn make it harder to settle. Breaking that circle often starts not with your mood, but with your nights. A cool bedroom, a steady rhythm and limiting alcohol and caffeine in the evening can already make a difference.

How do you talk about it?

Many women carry these complaints for a long time before seeking help, partly from shame, partly because they think it "comes with the territory". My experience is that naming it already brings relief. With your GP you do not need a perfect story: just tell them what you notice, when it started and how it affects your life. A symptom diary over a few weeks, with your mood, sleep and cycle side by side, helps your doctor see a pattern and choose the right direction together with you.

What you can do yourself

• Name it. Knowing your hormones play a part takes away the shame. You are not "going mad".
• Protect your sleep. Poor sleep amplifies anxiety and low mood. A steady rhythm and a cool bedroom help, especially with night sweats.
• Move regularly. Exercise is one of the best-supported ways to support your mood.
• Limit triggers that amplify it. Too much caffeine, alcohol and few moments of recovery can feed anxiety. Small adjustments add up.
• Do not wait too long for help. If complaints persist or get you down, see your GP. Talking helps, and treatment is possible.

You are not losing it

Anxiety and mood swings in perimenopause are real, explicable and open to discussion. They do not mean something is wrong with you as a person, but that your body is going through a hormonal shift. With the right information, some self-care and, where needed, professional help, you can get through this. Read on via our guide to perimenopause.