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Mood changes

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Mood changes

Mood changes/swings are one of the hallmarks of menopause. Mood swings are particularly common during the premenstrual phase, and occurs as part of PMS (premenstrual syndrome, a group of symptoms typically experienced between ovulation and your period), which often worsens during perimenopause. And although mood swings are transient, not chronic, that doesn’t make the feelings of irritability or rollercoaster emotions any less frustrating. For most, mood swings subside post-menopause.

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    The science

    Mood swings and feelings of anxiety and sadness are common during perimenopause and into menopause.

    Your fuse may become ridiculously short, you may be irritable one minute, sad the next, and maybe you tend to easily break down in tears, from frustration, a cheesy commercial, or anything, really (we call this “emotional lability” in medical speak). However you experience this, it’s no fun. Like most other symptoms, these mood changes can be caused by fluctuating hormone levels, specifically estrogen, progesterone, and serotonin.

    Estrogen & serotonin

    The production of estrogen is correlated with the action of serotonin, a neurotransmitter that acts as our “happy hormone” by reducing anxiety and fostering feelings of wellbeing. This is why, as estrogen fluctuate during the menopausal transition, serotonin pathways can be affected, which can affect mood.

    Progesterone & GABA

    Progesterone is the “calming hormone” that may also influence Gamma-Aminobutyric acid, or GABA for short. GABA is a neurotransmitter that produces a calming effect when it binds to its receptors. Progesterone potentiates (increases) the effects of GABA, and therefore lower progesterone levels during perimenopause and menopause may result in less GABA-like activity, thus increasing the chances of mood swings, anxiety, and sleeplessness.

    This, by the way, helps explain why mood changes frequently pop up when we’re PMSing. After we ovulate but before we begin our period, we’re in what’s called the “luteal phase” when estrogen level is high initially but then drops before our period starts (and remember, low estrogen can affect serotonin). Once we begin our period, estrogen levels rise, which causes our mood to stabilize.

    The graph below illustrates one theory of PMS mood symptoms, where the interplay between estrogen, progesterone, and serotonin and specifically their fluctuations throughout the menstrual cycle, may be a likely contributing factor.

    According to estimates, the number of women who experience mood symptoms during perimenopause hovers around 10-20%, with the risk increasing for those of us with a history of postpartum depression and premenstrual dysphoric disorder, or PMDD (a severe form of PMS with more intense and significant emotional symptoms like sadness, irritability, moodiness, etc.).

    There are very few scientific studies that support the hypothesis that menopause contributes to chronic clinical depression, severe anxiety, or erratic behavior. Most of us will transition through menopause without experiencing a major mood disorder. But, just because the mood changes may not be classified as “major” doesn’t mean they should be discounted.

    There’s a lot going on during this phase of our life! Hormone fluctuations, external stressors, poor sleep, night sweats, a changing body, fertility challenges, and often caring for parents and kids…you name it.

    When all of the above comes together, it makes for the perfect storm of emotional distress that may lead to mood swings and a decreased sense of overall well-being.

    It’s important to remember that not all women will experience mood changes during the menopause transition, and not all mood changes during this life phase are due to menopause. Severe symptoms like depression or anxiety that prevent you from functioning, disrupt relationships, and are associated with suicidal thoughts need medical attention and there is nothing shameful about it. In those situations, although we support integrative and holistic approaches, urgent medical care and even pharmacologic therapy may be appropriate first steps.


    “We are conditioned not to share and to think we are alone in feeling a certain way. This is particularly true when mood-related symptoms are concerned. Let’s talk about this. Let’s make it discussable.

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    What you can do

    We’re all about equipping you with the know-how to understand your symptoms, and we especially emphasize the specific, tangible ways to manage them. Our goal is to empower YOU to take charge of your menopause journey, starting today.

    A quick note about product recommendations…Elektra Health is not paid to feature any products. We just like them and think you might too, though we can’t guarantee any results.

    Many lifestyle changes have been evaluated for their effect on PMS and PMDD symptoms, including exercise, nutritional modifications, mind-body practices, and acupuncture. However, with so many avenues to take, it can be hard to know where to start. That’s why it’s necessary to have a healthcare provider (or Elektra!) who can work with you to chart the best way forward.


    Nutrition & Diet

    The Standard American Diet — which tends to be high in carbs, fat, sugar, and salt — is directly correlated with increased PMS and PMDD symptoms. That’s why, when it comes to nutritional interventions for mood changes, we want to move towards low-glycemic-index diets that won’t dramatically spike our blood sugar (which in turn affects mood). Here are some helpful tips:

    • Limit or eliminate sugar-sweetened beverages and alcohol
    • Kick processed foods to the curb
    • Incorporate more green leafy vegetables, nuts, fatty fish (e.g., salmon and sardines), berries, and dairy (if tolerated)

    It’s also important to incorporate diuretic foods that decrease bloating and water retention, such as parsley, tomatoes, tomatoes, onions, garlic, asparagus, and watermelon…but not coffee. For more information on nutrition during menopause, check out Elektra’s guide.

    Holistic Practices

    Before having any conversations around hormonal interventions for mood changes, lifestyle factors such as stress and sleep must be addressed — which is easier said than done when everything and everyone seems to be competing for your attention.

    Here’s what Elektra’s founding physician, Dr. Anna Barbierei, MD recommends:

    To reduce stress:

    Get out in nature

    Routine, frequent exposure to the great outdoors has been shown to reduce anxiety and depression while improving an overall sense of well-being. Don’t underestimate Mother Nature!

    Cultivate a meditation practice

    Over time, you’ll condition yourself to be more present while letting thoughts come and go. We recommend guided meditations on apps such as Headspace, Insight Timer, and Calm.

    Cultivate a gratitude and/or journaling practice

    Studies have linked both practices to decreased anxiety, and they can also help improve general feelings of well-being and facilitate mindfulness. Here are some great tips on how to start a gratitude practice.

    Prioritize downtime with family & friends

    While we may be conditioned with a “go-go-go” mentality, it’s important to step back and prioritize rest and downtime with loved ones (pencil it into your calendar!). After all, human beings are social creatures, and we derive comfort from connection.

    Don’t forget about “me” time

    Call it what you want — self care, alone time, R&R — but you deserve it. There’s nothing “selfish” about taking time for yourself, especially when it supports your mental health and overall wellness. Think of it as putting your mask on first in an airplane, so you can be better equipped to help others.

    Prioritize sleep

    To improve sleep, we usually need to pull a few different levers – there is usually no single solution. It’s all about sleep hygiene (completely weird term, we know). Lifestyle factors like exercise and diet, routines and schedules, and calming activities are all part of it, and sometimes, select supplements can play an important role too. But doing what needs to be done to improve sleep is critical. For a deeper dive into how to improve sleep, check out Elektra’s guide to sleep issues.

    There is no managing mood swings if you’re sleep-deprived!


    Scientists have found that regular movement decreases overall levels of tension, elevates and stabilizes our mood, improves sleep, boosts self-esteem, and eases PMS symptoms. Not too shabby, right? To reduce anxiety, we recommend a mix of aerobic cardio (preferably high-intensity interval training) several times per week due to its positive effect on mood and depression, strength training, and yoga or qigong, an ancient practice of coordinated body movement, meditation and breathing.

    Supplements & Over-the-Counter Solutions

    Supplements and over-the-counter solutions may be effective in supporting your mood symptoms…if you choose wisely. We recommend consulting with your healthcare provider first to ensure you’re using something with optimal efficacy and safety (i.e. backed by clinical research) or consulting with Elektra’s providers. Here’s a quick primer from our team on how to go about selecting high-quality supplements.

    Many supplements and herbs have been evaluated for treatment of PMS and PMDD, while others are designed to foster a sense of calm by helping to reduce levels of everyday stress and promote high-quality sleep.

    Swedish Flower Pollen

    Swedish flower pollen, which is marketed as the product Serenol, is an extract made from the pollen and pistils of a certain family of grasses. When taken every day, it helps provide hormone-free relief from emotional symptoms such as mood swings, irritability, and uneasiness. (Note: Serenol contains royal jelly, which is weakly estrogenic, so it’s not recommended for women with hormone-positive breast cancer.)

    Vitex (aka Chasteberry)

    The hormone-balance properties of Vitex have been found to help relieve symptoms of perimenopause, including PMS-related mood changes


    Studies have shown ginger to be effective in reducing the severity of both mood and physical PMS symptoms.

    There are other supplements that may help with mood regulation, like magnesium, GABA, St. John’s. Wort, and kava kava, but we encourage discussion with a trained provider (like Elektra!) to ensure their appropriateness and lack of interaction with other supplements or medications.



    We tend to focus on sleep, nutrition, and stress management — all of which can have an incredibly powerful impact on symptoms — before turning to hormonal treatments for menopause-related mood changes. If you do opt for hormonal treatment (for example, low-dose birth control for severe PMS and PMDD in early perimenopause), it should be coupled with mind-body interventions. In other words, nothing should exist in a silo, especially for something as complex as our mood.

    Data are mixed about whether HRT helps with mood issues like anxiety, which can contribute to mood changes, with smaller studies showing conflicting results or no effect. However, it is reasonable to consider hormonal treatment, especially if one has other symptoms that we know can be helped by HRT (like hot flashes) to help with mood fluctuations. Refer to our complete guide for a full run-down on hormone replacement therapy (HRT).


    SSRIs and SNRIs remain the first line of pharmacologic defense for mood changes, as well as anxiety and depression in perimenopausal women who are unable or not interested in hormonal therapies, and can also be considered for mood changes.

    SSRIs are selective serotonin reuptake inhibitors and SNRIs are serotonin and norepinephrine reuptake inhibitors — total tongue-twisters! These neurotransmitters are antidepressants that work by regulating serotonin (the “happy hormone” that controls mood) and norepinephrine (plays a key role in the body’s “fight-or-flight” response to stress). Numerous trials have demonstrated their safety and efficacy for severe mood-related PMS and PMDD symptoms, although it should be noted that common side effects include weight gain and low libido.

    Common SSRIs include fluoxetine/Prozan and sertralin/Zoloft. Other examples are:

    • Escitalopram/Lexapro: associated with less weight gain and sexual side effects (i.e. low libido) than others
    • Venlafaxine/Effexor: associated with higher risk of withdrawal symptoms, so proper weaning is important and should be done under the guidance of your provider

    If you’re experiencing an emergency and need immediate help, call 911 or go to the nearest emergency room.

    Suicide Prevention Lifeline
    + 1-800-273-8255

    Crisis Text Line
    Text HOME to 741741

    We’re always keeping an eye out on emerging research and the latest clinical studies. Subscribe to our weekly Elektra Digest for the latest, science-based info direct to your inbox. Something work well for you that’s not listed here? We want to hear it! Shoot us a note at [email protected]. (We’re human, promise.)

    Disclaimer: This information is for general educational purposes, and should not be used as a substitute for medical advice, diagnosis or treatment of any health condition or problem.

    As with anything you put into your body, taking dietary supplements can also involve health risks. You should consult a medical professional before taking supplements and inform your doctor about any supplements, as well as any medications you already take, since there may be interactions.


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