Medically reviewed on February 4, 2022 by Jasmine Thompson. 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.
Women will go through many changes throughout their lifetime. One of the most prominent is menopause, which marks the end of child-bearing years.
Leading up to menopause is a phase known as perimenopause. This phase begins with many physiological changes, and these changes may not just be physical. Read on to learn more about perimenopause and its potential effects on mood (and consider checking up on key hormones with the at-home Perimenopause Test).
Perimenopause is different from menopause, as it is considered a transition phase into menopause. As the process of perimenopause can be unique to every person, identifying the exact timing of when a woman begins perimenopause can be difficult. On average, most women experience perimenopause in their 40s, but it’s not uncommon for some to feel the effects of perimenopause as early as their mid-30s .
For most, perimenopause lasts an average of three to four years. However, some people may experience perimenopausal symptoms for up to a whole decade. For others, the transition can be much quicker, lasting just a few months . Menopause officially begins when there hasn’t been a menstrual period in 12 consecutive months .
Perimenopause naturally comes with various physiological changes resulting from changing hormone levels, namely estrogen. Estrogen levels go up and down normally, but they're generally consistent and predictable with a regular menstrual cycle. Those fluctuations can be much sharper, more uneven, and unpredictable during perimenopause, resulting in some dramatic symptoms .
Estrogen plays a significant role throughout the body, even beyond sexual and reproductive health. It makes sense that those sudden spikes or drops in estrogen would contribute to physical changes. It’s important to note that exact perimenopause symptoms and their severity may differ from person to person. Here are some common symptoms:
One of the most common symptoms associated with menopause, hot flashes, can begin before menopause. During perimenopause, an estimated 35 to 50 percent of women experience hot flashes. These are characterized by sudden waves of body heat that can last 5 to 10 minutes at a time. This heat can start at the face, neck, scalp, or chest and radiate outward .
The heat can vary from person to person. You may only feel it as a slight warmth. Others may experience a hot flash that is more intense, and they may sweat through their clothes.
Vaginal atrophy can also come as a result of low estrogen levels. With less estrogen, the walls of the vagina become thinner, dryer, and less elastic. This can result in general irritation and itchiness, and sex can feel painful without lubrication .
Related to vaginal atrophy, the lining of the urethra also becomes thinner. The urethra is a tube that connects to the bladder and transports urine out of the body. Along with a thinning lining in the urethra, the pelvic muscles tend to relax and weaken as you get older. The loss of bladder control is a common and often embarrassing problem called urinary incontinence .
While menopause is marked by a complete end to periods, the menstrual cycle is still active during perimenopause. However, the cycle may become irregular or otherwise not what you’re used to. Cycles may become longer or shorter than usual, and you may even skip periods. If there is a 60-day gap between periods, you are likely in the later stages of perimenopause. This means that there is still a possibility of getting pregnant, though the chances are low .
Along with irregularity, periods may be lighter or heavier than normal.1 Without the right hormones to regulate the uterine lining during a cycle, that lining may grow thicker than normal. A thicker uterine lining means more blood and tissue is shed during a period .
Fluctuations in estrogen and other hormones can potentially contribute to mood changes. Estrogen is linked to serotonin synthesis. Serotonin is a hormone involved with feelings of happiness and general regulation of mood .
However, more research is necessary to determine how perimenopause and hormonal changes affect mood and mental health. Hormonal imbalances can cause clinical depression or anxiety for some individuals. However, continuous depression, anxiety, and irritability are not normal to menopause and perimenopause. Some women may be more sensitive to hormonal changes. Still, for most, any mood changes and/or chronic mood issues are more often related to life stressors, other health factors, and/or a history of depression, anxiety, or other mental health disorders .
However, for some, the effects of perimenopause can contribute to overall changes in mood. Night sweats, for example, can mean that sleep is affected, and you may not be getting enough sleep at night. This can lead to grumpiness or irritability. Even minor sleep deprivation can lead to more stress, anger, sadness, and mental exhaustion. Extended insomnia can eventually contribute to depression and anxiety .
Vaginal atrophy and dryness mean that the frequency of sexual activity may decline because it may be extra painful, uncomfortable, or otherwise unpleasant. Less sex can result in more stress or anxiety in life, and you may feel insecure about sexual relationships with your partner. If your lack of interest in sex continues or returns and causes personal distress, you may have a condition called sexual interest/arousal disorder .
Perimenopause comes with a wide range of symptoms. Mood changes may be one of those symptoms, but they may be more a side effect of other symptoms of perimenopause. More research is necessary to determine the effect of hormones on mood during perimenopause.
1. Perimenopause - symptoms and causes. Mayo Clinic. URL. Accessed February 4, 2022.
2. Perimenopause: Rocky road to menopause. Harvard Health. URL. Accessed February 4, 2022.
3. Urinary incontinence - symptoms and causes. Mayo Clinic. URL. Accessed February 4, 2022.
4. Menopause. Endocrine Society. URL. Accessed February 4, 2022.
5. Can Menopause Cause Anxiety, Depression or Panic Attacks? Cleveland Clinic. URL. Accessed February 4, 2022.
6. Sleep and Mood. Harvard Medical School. URL. Accessed February 4, 2022.
7. Low sex drive in women. Mayo Clinic. URL. Accessed February 4, 2022.