Distressed young woman in yellow sweater wondering about the causes of mood swings in females

Causes Of Mood Swings In Females

Medically reviewed on December 10, 2023 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

It’s natural to experience mood swings and irritability from time to time. In most cases, a mood change does not point to an underlying medical cause and may instead reflect feelings of stress, hunger, or fatigue.

In other cases, certain physiological processes or disorders can cause mood shifts, particularly in women and people assigned female at birth (AFAB) who experience cyclical hormonal changes every month.

Let’s explore the various causes of mood swings in females.

1. Hormonal Imbalances Or Shifts

The hormones are the body’s chemical messengers that glands produce and disperse through the bloodstream. The hormones travel to various organs and tissues to coordinate different functions and physiological processes.[1]

Women and people AFAB have distinct hormones, largely tied to reproductive health, that can impact their physical and emotional state. The primary female sex hormones are:

  • Estrogen – Fat cells and adrenal glands, located on the ovaries, produce estrogen. The hormone is largely responsible for regulating how you feel at different stages of the menstrual cycle and ovulation. It also prepares the body for a possible pregnancy by thickening the uterine lining during the first half of the menstrual cycle, called the follicular phase. It also plays a role in urinary, cardiovascular, bone, skin, and brain health. An increase in estrogen can increase your energy levels and sex drive and improve your focus.[2]
  • Progesterone – Progesterone is released by a temporary gland, corpus luteum, during the second half of the menstrual cycle (luteal phase), following ovulation. Progesterone also plays a role in thickening the uterine lining. If pregnancy occurs, progesterone levels will continue to rise throughout each term, helping to keep the uterus thick and healthy to help provide nutrients to the growing fetus. Outside of pregnancy, high progesterone levels can make you feel tired, although it may also help improve your mood.[3] Learn more about this in our article: Does progesterone make you tired?

All that said, a hormonal imbalance can occur when glands produce too little or too much of a hormone, which can significantly impact your overall health. Hormone-related conditions that may cause mood swings in females and people AFAB include [1]:

  • Irregular periods – Several hormones play a role in regulating the menstrual cycle, including estrogen and progesterone. Additional reproductive hormones include follicle-stimulating hormone (FSH), which stimulates the production of eggs and ovulation, and luteinizing hormone (LH), which also plays a role in the release of an egg into a fallopian tube. A disruption in one or more of these hormones can cause irregular periods or no period at all (amenorrhea). People with amenorrhea may also experience depression, anxiety, and trouble sleeping. [4,5]
  • Polycystic ovary syndrome (PCOS) – PCOS is characterized by an overproduction of testosterone, which can disrupt all phases of the menstrual cycle. This hormonal imbalance can also cause mood swings and mental health issues such as depression and anxiety.[6]
  • Infertility – Hormonal imbalances are the leading cause of infertility in women and people AFAB. Physiologically, infertility can disrupt one’s reproductive health and menstrual regularity. Emotionally, infertility can cause feelings of anger, guilt, sadness, anxiety, and hopelessness as well as decreased self-esteem.[7]
  • Acne – Hormonal acne includes blackheads, whiteheads, and painful cysts. While it affects both men and women, more cases are found in people AFAB, particularly when pregnant or going through menopause. It develops when hormones trigger the overproduction of oily sebum, which can clog the pores. Acne can cause stress, anxiety, self-isolation, and decreased self-esteem.[8]
  • Thyroid diseaseHyperthyroidism, the overproduction of thyroid hormone, and hypothyroidism, the underproduction of thyroid hormone, can have physical and psychological effects. Hyperthyroidism can lead to weight loss as well as anxiety, irritability, and nervousness. Hypothyroidism, on the other hand, may cause fatigue, weight gain, anxiety, and depression.[9]
  • Obesity – Hormones like leptin, insulin, sex hormones, and growth hormones affect the appetite and the metabolism. Disruptions can lead to an increase in body fat, which may cause stress, sadness, and low self-esteem. Obesity also puts people at a higher risk of developing mental health disorders, like depression, anxiety, binge-eating disorder, and bipolar disorder.[9,10]
  • Pregnancy – Several hormones play a role in pregnancy, including estrogen and progesterone, which can cause mood swings, irritability, depression, and tiredness collectively. Human chorionic gonadotropin (hCG), which helps to maintain progesterone production, can cause fatigue and nausea. Prolactin, which prepares the body for breastfeeding, may cause emotional changes later in pregnancy. Oxytocin, the love hormone, is also present. This hormone can contribute to a positive mood, as it facilitates bonding and attachment.[12]
  • Menopause – As women and people AFAB age, they’ll experience menopause. During this time, estrogen levels decrease, which can cause menstrual changes, hot flashes, sleep issues, and mood changes tied to irritability, depression, or fatigue.[13]

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Coping Strategies

In many cases, your healthcare provider may recommend synthetic hormone replacement therapy if you have low hormone levels. Higher-than-normal hormone levels may necessitate medication, surgery, and/or radiation therapy.

2. Nutritional Deficiencies

Women of reproductive age are largely affected by nutritional deficiencies around the world.[14] In the United States, however, nutritional deficiencies are less common, since most people have access to food. That said, lower-income individuals may still struggle to consume the necessary vitamins and minerals, particularly if entire food groups are avoided.[15]

The most common nutritional deficiencies include but are not limited to [15]:

  • Vitamin D – Can cause fatigue, bone pain, muscle aches, weakness, and mood changes tied to depression, such as hopelessness, sadness, anxiety, loss of appetite, and loss of interest in activities. Vitamin D deficiency is extremely common, with an estimated one billion individuals deficient in the world.[16]
  • Iron – May feel cold, tired, short of breath, and, in effect, irritable, depressed, or anxious. Low iron levels are also tied to schizophrenia.
  • Vitamin B12 – Deficiencies in B12 can lead to fatigue, numbness in the extremities, and difficulty balancing or walking as well as depression, anxiety, psychosis, dementia, and delirium. Vitamin B12 deficiency is less common, affecting an estimated 2% to 15% of adults.[17]
  • Calcium – Low estrogen levels can make someone more susceptible to a calcium deficiency. Symptoms can include anxiety, anger, depression, and perceived stress.[18]

Coping Strategies

To combat nutritional deficiencies, ensure that you’re eating a well-rounded diet of fruits, vegetables, whole grains, protein-rich food, and dairy. If you choose not to consume a certain food group, or you can’t due to allergies, consider adding vitamin and mineral supplements to your day.

3. Stress

Events that we perceive as threatening, such as lifestyle changes, financial problems, and relationship issues can cause feelings of stress, which can impact overall health and wellness. During times of stress, the body produces cortisol, a steroid hormone that regulates [19]:

  • The body’s stress response
  • Metabolism and nutrient absorption
  • Inflammation
  • Blood pressure
  • Blood sugar
  • Sleep-wake cycle

Chronic stress can expose your brain to elevated cortisol levels for long periods, which can cause such psychological symptoms as [19]:

  • Irritability
  • Extreme mood changes
  • Depression

One study observed that about 50% of patients diagnosed with depression also have elevated cortisol levels.[20]

Cushing syndrome, or hypercortisolism, is a condition—although uncommon—in which the body produces too much cortisol. Of those diagnosed with Cushing syndrome, 70% are women or people AFAB. Those with hypercortisolism can experience libido changes, fatigue, irritability, anxiety, mania, psychosis, panic disorder, confusion, and cognitive impairment.[21]

Research also found that patients with Cushing syndrome had a lower-than-average quality of life. More specifically, they exhibited poorer physical health and difficulty adjusting to new environments and social situations. Of these patients, 29% reported severe psychiatric disability.[21]

Coping Strategies

If you’re experiencing high levels of stress throughout the day, you can speak to your healthcare provider about starting medication that may ease your anxiety or stress. You can also prioritize self-care and take time to yourself to unwind by:

  • Taking a warm bath
  • Going on a walk
  • Stretching, doing yoga, or meditating
  • Journaling
  • Listening to music
  • Moving your body
  • Speaking to loved ones
  • Eating healthily
  • Taking breaks from emotional triggers

4. Medications

Several medications have been tied to depression, a chronic mood disorder that can cause [22]:

  • Sadness, tearfulness, emptiness, and hopelessness
  • Anger, irritability, and frustration
  • vLoss of interest in activities or sex
  • Sleeping too much or too little
  • Fatigue, lack of energy, and lack of motivation
  • Anxiety, agitation, and restlessness
  • Feelings of worthlessness, guilt, or shame
  • Difficulty concentrating, remembering, or making decisions
  • Thoughts of self-harm or suicide
  • Physical pain

These medications include but are not limited to:

  • Isotretinoin, used to treat acne
  • Anticonvulsants, used to control epilepsy
  • Barbiturates, used to treat anxiety and epilepsy
  • Benzodiazepines, used to treat anxiety and insomnia
  • Beta-adrenergic blockers, used to treat heart problems
  • Calcium-channel blockers, used to treat cardiovascular issues
  • Interferon alfa, used to treat cancer and hepatitis
  • NuvaRing, used for birth control
  • Opioids, used to relieve pain

Getting off birth control, or other medications, can often cause mood swings. In other cases, antidepressants and medications like Ritalin®, corticosteroids, and certain antibiotics can cause mania—a mental illness in which people can experience periods of extreme changes in mood, energy, and activity level. Symptoms of a manic episode include [23]:

  • Extreme happiness or excitement
  • Inflated self-esteem
  • Talkativeness
  • Racing thoughts
  • Impulsive behavior
  • Delusions and hallucinations

Coping Strategies

If you or a loved one is experiencing mood changes after starting a medication, speak with your healthcare provider. They may change the medication, implement a talk therapy plan, and/or discuss self-management strategies.[23]

Manage Your Mood Swings With Everlywell

If you or a loved one is suffering from irregular mood swings, consult with a healthcare provider at Everlywell. Our telehealth appointments are virtual and private—putting your needs at the forefront of every session.

Through our online women’s health services, a clinician will talk with you via telehealth to discuss your symptoms and come up with a course of action to help balance your moods. Sign up today.

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  1. Hormonal Imbalance. Cleveland Clinic. Published April 4, 2022. URL. Accessed November 15, 2023.
  2. Estrogen. Cleveland Clinic. Published February 8, 2022. URL. Accessed November 15, 2023.
  3. Progesterone. Cleveland Clinic. Published December 29, 2022. URL. Accessed November 15, 2023.
  4. Amenorrhea. Cleveland Clinic. Published March 23, 2023. URL. Accessed November 15, 2023.
  5. Follicle-stimulating hormone. Cleveland Clinic. Published January 23, 2023. URL. Accessed November 15, 2023.
  6. PCOS. Cleveland Clinic. Published February 15, 2023. URL. Accessed November 15, 2023.
  7. Sharma A, et al. Psychological Problems Related to Infertility. Published October 15, 2022. URL. Accessed November 15, 2023.
  8. Hormonal acne. Cleveland Clinic. Published September 10, 2021. URL. Accessed November 15, 2023.
  9. Thyroid disease. Cleveland Clinic. Published April 19, 2020. URL. Accessed November 15, 2023.
  10. Obesity and hormones. Better Health. URL. Accessed November 15, 2023.
  11. Sarwer D, et al. The Psychosocial Burden of Obesity. Endocrinol Metab Clin North Am. Published September 2016. URL. Accessed November 15, 2023.
  12. Hormones During Pregnancy. Johns Hopkins Medicine. URL. Accessed November 15, 2023.
  13. What Is Menopause? NIH. https://www.nia.nih.gov/health/what-menopause. Published September 30, 2021. URL. Accessed November 15, 2023.
  14. Jiang S, et al. Global, Regional, and National Estimates of Nutritional Deficiency Burden among Reproductive Women from 2010 to 2019. Nutrients. Published February 16, 2022. URL. Accessed November 15, 2023.
  15. The truth about nutrient deficiencies. Harvard Health Publishing. URL. Accessed November 15, 2023.
  16. Cleveland Clinic. Vitamin D deficiency: Causes, symptoms & treatment. Cleveland Clinic. URL. Accessed November 16, 2023.
  17. Cleveland Clinic. Vitamin B12 deficiency: Symptoms, causes & treatment. Cleveland Clinic. URL. Accessed November 16, 2023.
  18. Du C, et al. Relationships between Dairy and Calcium Intake and Mental Health Measures of Higher Education Students in the United States: Outcomes from Moderation Analyses. Nutrients. Published February 12, 2022. URL. Accessed November 15, 2023.
  19. Cortisol. Cleveland Clinic. Published December 10, 2021. URL. Accessed November 15, 2023.
  20. Dziurkowska E, et al. Cortisol as a Biomarker of Mental Disorder Severity. J Clin Med. Published November 8, 2021. URL. Accessed November 15, 2023.
  21. Cushing syndrome. Cleveland ClinicPublished December 27, 2022. URL. Accessed November 15, 2023.
  22. Depression. Mayo Clinic. Published October 14, 2022. URL. Accessed November 15, 2023.
  23. Mania. Cleveland Clinic. Published September 14, 2021. URL. Accessed November 15, 2023.

Jillian Foglesong Stabile, MD, FAAFP is a board-certified Family Physician. Since completing her residency training in 2010, she’s been practicing full-scope family medicine in a rural setting. Dr. Foglesong Stabile’s practice includes caring for patients of all ages for preventative care as well as chronic disease management. She also provides prenatal care and delivers babies. Dr. Foglesong Stabile completed a teaching fellowship in 2020 and teaches the family medicine clerkship for one of her local medical schools. Dr. Foglesong Stabile’s favorite thing about family medicine is the variety of patients she sees in her clinical practice.

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