Understanding Hormone Changes and Mood During Perimenopause
By Elizabeth Silva, MSN, FNP-BC, MSCP
Many women are surprised to learn that the menopause transition—often called perimenopause—is not a smooth or linear drop in hormones. Instead, it’s a dynamic period marked by fluctuating estrogen and declining progesterone, both of which can affect mood, stress tolerance, and overall emotional well-being.
Not every woman experiences mood changes, but understanding what’s happening biologically can make this stage feel far less confusing—and far more manageable.
Estradiol: The Hormone That Starts to Roller-Coaster
Estradiol (the most active form of estrogen) plays a major role in brain chemistry, emotional regulation, and the menstrual cycle. During perimenopause, estradiol doesn’t simply “go down.” Instead, it becomes unpredictable:
Some months, estradiol surges higher than what’s typical in earlier adulthood
Other months, it drops very low
Menstrual cycles become irregular, reflecting this instability
Research consistently shows that estradiol variability—the swinging between high and low levels—is particularly associated with mood symptoms such as irritability, anxiety, tearfulness, and depressive feelings. Women who have had hormone-sensitive mood changes (such as PMS/PMDD or postpartum depression) may be especially responsive to these swings.
After menopause, estradiol eventually stabilizes at a low level, and many women report that emotional symptoms become less intense.
Progesterone: The Hormone That Gradually Fades
Progesterone is produced only after ovulation. As ovulation becomes less frequent in perimenopause, progesterone levels begin to decline steadily.
Because progesterone and its metabolites help regulate the brain’s GABA system—which promotes calm, sleep, and emotional steadiness—lower levels may contribute to:
Increased anxiety
Trouble sleeping
Feeling “on edge”
Irritability
These effects aren’t universal, but for some women, they are very noticeable.
How Hormone Changes Influence Mood
Estradiol and progesterone interact with key neurotransmitter systems:
Serotonin (supports stable mood)
GABA (calms the nervous system)
Dopamine (motivation, reward, energy)
The stress-response system (HPA axis)
When estradiol fluctuates sharply or progesterone declines, these systems can become temporarily dysregulated. This creates a “window of vulnerability” to new or worsening mood symptoms.
Women may be more likely to experience significant mood shifts during perimenopause if they have:
A prior history of depression or anxiety
A history of hormone-related mood sensitivity
High ongoing life stress
Frequent or severe hot flashes or night sweats
The Bottom Line
Perimenopause is a time of real biological change—not just in the ovaries, but in the brain. Shifting hormone levels can meaningfully influence mood and stress tolerance.
The key takeaways:
Estradiol becomes highly variable, which can affect mood.
Progesterone declines as ovulation becomes irregular.
These changes influence neurotransmitters and stress pathways.
Not all women experience mood symptoms.
For many, symptoms ease once hormones stabilize after menopause.
If you’re experiencing new or worsening mood symptoms during perimenopause, know that you’re not alone, and it’s not “just in your head.” There are evidence-based treatments—including lifestyle strategies, therapy, and hormone therapy—that can help.
References
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