“I don’t feel like myself anymore.”

One minute you’re fine. The next, you're tearful, snapping at your partner, forgetting what you walked into the room for, or lying awake at 3 a.m. with your mind racing.

If this sounds familiar and you’re a woman approaching midlife—it might not just be life stress. These emotional and cognitive changes could be tied to perimenopause or menopause. And the driver behind it? Often, it's oestrogen deficiency. Understanding the hormonal shifts happening in your body and their effects on your brain can help you feel more in control. Menopause doesn’t have to mean “putting up with it.” There are effective, evidence-based ways to manage symptoms and feel like yourself again.

Have you noticed unexplained mood changes recently? Perhaps sudden irritability, anxiety, or moments of sadness that seem to appear out of nowhere? If you’re a woman approaching midlife, these emotional shifts could be connected to perimenopause or menopause, often due to oestrogen deficiency. Understanding how hormonal changes affect your mood - and what you can do about them - can make this significant transition in a woman’s life easier to navigate.

Introduction to Menopause

Menopause is the natural point in a woman’s life when menstrual periods stop, typically between ages 45 and 55. But it’s the years leading up to this—perimenopause—that can feel most turbulent.

Your ovaries gradually stop producing eggs, and hormone levels, particularly oestrogen and progesterone, begin to fluctuate and decline. This hormonal rollercoaster can trigger a range of symptoms—hot flushes, night sweats, vaginal dryness, and, perhaps most distressingly, mood and memory changes.

Some women feel anxious or low for the first time in their lives. Others notice they can’t handle stress like they used to. These changes are not “just in your head”—they are biological and valid.

The Science of Menopause and Mood

Oestrogen plays a crucial role in regulating brain chemicals like serotonin and dopamine, the neurotransmitters that help stabilise mood and support cognitive function.

As oestrogen levels fluctuate, you may find yourself more vulnerable to depression, anxiety, and irritability—even if you’ve never struggled with your mental health before. Studies show that women are 2–4 times more likely to experience depressive symptoms during perimenopause.

Sleep disruption only makes matters worse. Night sweats and insomnia affect emotional resilience, creating a vicious cycle. Stress tolerance may also decline—things that once felt manageable now feel overwhelming. And the foggy thinking? That’s real too. Many women experience lapses in memory, slower word recall, and difficulty concentrating—commonly called “brain fog.”

Common Mood Swings During Menopause

Irritability: Snapping over small things

• Depression: Low mood, tearfulness, or lack of interest in life

• Anxiety: Worry, panic, or feeling “on edge”

• Emotional swings: Feeling fine one moment and overwhelmed the next

• Cognitive struggles: Forgetfulness, lack of focus, trouble with tasks

• Reduced libido: A common but often unspoken emotional side effect

These symptoms aren’t signs of personal failure. They are part of a neurological response to hormonal changes, and they’re treatable.

Hormone Replacement Therapy: Can it help?

Yes—and not just for hot flushes and night sweats.

HRT replaces the oestrogen and progesterone your body stops making. While it’s best known for easing physical symptoms, it can have powerful mood-boosting effects, particularly when started during perimenopause or early postmenopause.

Benefits for mood and wellbeing:

• Reduces depression: Multiple trials show that oestrogen therapy can significantly ease depressive symptoms.

• Calms anxiety: Especially helpful when anxiety stems from hormonal changes rather than life events.

• Improves sleep: Better sleep = better emotional regulation.

• Sharpens focus: Early use of HRT may support cognition and reduce “brain fog.”

• Improves libido: Hormonal balance can reignite sexual desire.

Systemic HRT (via patch, gel, spray or oral tablet) provides consistent hormone levels to support mood and brain function. Micronised progesterone, a body-identical form, is often better tolerated and carries a lower breast cancer risk than older synthetic options.

Types of HRT for Mood Management

Different HRT formulations offer varying benefits for mood symptoms:

• Oestrogen-only HRT: Ideal for women who’ve had a hysterectomy.

• Combined HRT (oestrogen + progesterone): Needed to protect the uterus in women who haven’t had a hysterectomy.

• Body-identical hormones: These closely match your body’s natural hormones and may have fewer side effects.

• Transdermal delivery (patches, sprays, gels): Avoids first-pass liver metabolism and may reduce clot risk.

• Topical vaginal oestrogens: Effective for dryness and discomfort, with minimal systemic absorption.

Risks of HRT

HRT is safe and effective for most women, but like any treatment, it comes with potential risks and side effects. Discussing your medical history—especially if you have high blood pressure, liver disease, or a history of uterine cancer—is essential before starting.

Key points to know:

• Serious risks are rare: Large studies, including the Women’s Health Initiative, show that serious adverse events from HRT are uncommon. The absolute increase in risk is small—fewer than 1 additional case per 1,000 women per year.

• Transdermal is safest: Patches, gels, and sprays avoid first-pass liver metabolism and are linked with a lower risk of blood clots than oral tablets (The Lancet).

• Formulation matters: Oestrogen-only HRT has a more favourable profile than combined HRT, especially regarding breast cancer risk. Oral forms carry higher risks of clots, nausea, and increased triglycerides.

• Timing is key: Starting HRT before age 60 or within 10 years of menopause onset offers the greatest benefit with the lowest cardiovascular risk.

• Side effects: Some women experience breast tenderness, headaches, or spotting, especially early on. These usually settle as your body adjusts.

Reducing Risks and Side Effects

To reduce the risks and side effects of hormone replacement therapy (HRT), it’s essential to use the lowest effective dose for the shortest duration necessary. Women can discuss alternative treatments, such as non-hormonal prescription medicines or lifestyle changes, with their healthcare professional to find the best approach for their needs.

Regular monitoring and follow-up appointments can help identify potential side effects and adjust treatment as needed. Women with a history of breast cancer or other health conditions may need to take extra precautions or avoid certain types of HRT. Bio-identical hormones and compounded hormones may have different risks and benefits compared to traditional HRT, so it’s important to weigh these factors carefully.

Maintaining a healthy diet, exercising regularly, and avoiding smoking can also help reduce the risk of side effects. By working closely with a healthcare professional, women can develop a personalised treatment plan that minimises risks and maximises the benefits of HRT.

Alternative Treatment Options

If HRT isn’t suitable, there are non-hormonal options that can help manage symptoms:

• SSRIs/SNRIs: Low-dose antidepressants that reduce hot flushes and lift mood

• CBT (Cognitive Behavioural Therapy): Can improve sleep, anxiety, and mood symptoms

• Testosterone gel: Can help with low libido and sexual wellbeing

• SERMs: Non-hormonal drugs for hot flashes and vaginal symptoms

• Lubricants and moisturisers: For vaginal dryness

• Lifestyle support: Diet, exercise, and stress management are powerful allies

Lifestyle Changes to Support You Through Menopause

No matter your treatment choice, how you live matters.

• Move more: 150 minutes of exercise weekly (even brisk walking) can ease symptoms, improve mood, and support heart and bone health.

• Eat well: A diet rich in whole grains, fruits, and vegetables—and lower in fat—can reduce hot flushes, support hormone balance, and aid weight management.

• Prioritise sleep: Good sleep hygiene is essential. Try winding down tech-free before bed, keeping your room cool and dark, and getting up at the same time daily.

• Manage stress: Meditation, deep breathing, yoga—even 10 minutes daily—can reduce cortisol and improve mood stability.

• Stay connected: Social support protects mental health. Join a support group, talk to friends, or seek therapy—it’s not a sign of weakness..

The Royal College of Obstetricians & Gynaecologists, amongst other organisations, provide resources and guidance on alternative treatment options for menopausal symptoms. By exploring these alternatives, including hormone therapy as an effective treatment, you can find a strategy that works best for you and helps maintain your emotional well-being during this transition.

Menopause and Relationships

Menopause can place strain on relationships. Mood swings, low libido, fatigue, and emotional disconnect can create distance. Open, honest communication with loved ones is key.

Counselling or support groups can be helpful, and many women find that when symptoms are managed—whether through HRT, lifestyle, or therapy—their relationships improve naturally.

When to Seek Professional Help

If your mood changes are affecting your ability to function, seek professional support. Look out for:

• Persistent low mood, hopelessness or tearfulness

• Anxiety that interferes with daily life

• Sleep problems despite trying self-help strategies

• Thoughts of self-harm or feeling like you can’t cope

These aren’t just “menopausal mood swings”—they’re valid reasons to get help. And support is available.

Embrace this new chapter

Menopause isn’t just an end. For many women, it’s the beginning of a new, powerful stage of life.

Once symptoms are under control, many report feeling more confident, assertive, and self-aware. This can be a time of reinvention, a chance to refocus on what matters most.

With the right treatment and support—whether medical, psychological, or lifestyle-based—you can reclaim your energy, clarity, and joy. You don’t have to suffer in silence.

Menopause deserves attention, compassion, and care.

References

1. Palmer KR, Tong S, Kaitu'u-Lino TJ. Management of menopause symptoms pre-and post-treatment of cancer. Lancet. 2024

2. Brown L, Hunter MS, Chen R, Crandall CJ, Gordon JL, Mishra GD, Rother V, Joffe H, Hickey M. Promoting good mental health over the menopause transition. Lancet. 2024

3. Harlow SD, Mishra GD, Brinton RD, Demakakos P, El Khoudary SR, Gold EB, Joffe H. Menopause: pathophysiology, symptoms, sequelae, and management. Nat Rev Dis Primers. 2023

4. Melby MK, Lock M, Kaufert P, Sievert LL, Crawford S, Avis N, Colvin A, Gold EB, Greendale GA, Karlamangla AS, Lindberg CE, Tepper PG. Cultural aspects of menopause: comparative studies in Japan and the United States. Climacteric. 2019

5. Greendale GA, Sternfeld B, Huang M, Han W, Karvonen-Gutierrez C, Ruppert K, Cauley JA, Finkelstein JS, Jiang SF, Karlamangla AS. Changes in body composition and weight during the menopause transition. JCI Insight. 2019 Mar 7;4(5)