If you’re in your 40s or 50s but feel like a moody teenager again, you’re in good company. For many women, the transition into perimenopause is marked by intense mood swings, anxiety, and a sudden and often persistent lack of motivation. While these shifts can feel like they’re all “in your head,” they’re actually deeply rooted in your biology.
It’s a roller coaster!
What’s driving mood swings in midlife? It’s primarily the erratic fluctuation of estrogen combined with the slow decline of progesterone. While midlife can be more stressful for myriad reasons (teenage kids, aging parents, more responsibility at work), research shows that the moodiness that often comes with this time of life falls squarely in the “it’s your hormones” camp.
- Haywire hormones: A study of perimenopausal women found that the wild “ups and downs” of estrogen, combined with the loss of progesterone, were directly linked to higher depression and anxiety scores (Joffe et al., 2020).
- Neuroendocrine changes: These fluctuations disrupt your brain’s natural “checks and balances.” This turbulence messes with the chemicals that regulate mood—like serotonin and GABA—leaving you feeling more reactive and less resilient to stress (Fidecicchi et al., 2024).
- The energy gap: Estrogen acts like a key that helps your brain cells unlock energy. As levels fluctuate, your brain struggles to maintain its fuel supply, leading to brain fog and the feeling that your nervous system is “misfiring.”
Beyond hormones: metabolic health & inflammation
Did you know that your metabolic health also plays a big role in how you experience mood swings?
Chronic inflammation and insulin resistance can worsen hormonal symptoms. As estrogen declines, our bodies become less insulin-sensitive and less resilient to daily stressors. Physical factors like low iron (ferritin) are also common due to heavy perimenopausal periods. Low iron can mimic or worsen mood swings, fatigue, and depression, making baseline blood testing essential.
How to stabilize the swing(s)
1. Menopausal Hormone Therapy (MHT/HRT)
The most effective way to stop the “roller coaster” is to address the hormonal deficits or imbalance.
- Depression prevention: A randomized controlled trial published in JAMA Psychiatry found that transdermal estradiol combined with micronized progesterone (TE+IMP) reduced the development of clinically significant depressive symptoms by 15% (Gordon et al., 2018).
- Real-world results: Retrospective data from over 900 women showed a 44.59% reduction in mood-related symptom scores for those using hormone therapy (Glynne et al., 2025).
- Sleep support: Progesterone is a powerful sleep tool for many women. When sleep is restored, cortisol levels drop and insulin resistance improves, supporting a more even state of mind.
2. Lifestyle medicine
While HRT/MHT often provides the foundation, lifestyle changes act as the scaffolding for a stable mood.
- Dietary diversity: Aim for a whole-foods diet with 30 different plant types per week. Avoiding added sugars helps prevent the “insulin spikes” that can trigger anxiety and irritability.
- The 12-hour reset: Taking a regular 12-hour (or more) rest from eating can help shift the body out of “storage mode” and improve metabolic flexibility.
- Movement as medicine: Daily exercise and resistance training are essential. Building muscle mass isn’t just for aesthetics; it also supports metabolic health and brain resilience.
- Light & nature: Morning sunlight exposure regulates Vitamin D and cortisol. And studies consistently link contact with nature to improved mood and reduced depression.
Seeking expert care
Navigating mood swings in midlife requires an individualized approach that looks at all of you—hormones, metabolism, and lifestyle. Holistic solutions like Coral’s “Complete Care” pairs clinical expertise with health coaching to provide the knowledge and accountability needed for lasting change.
Is it the season or your hormones?
It’s easy to blame the shorter days for a dip in mood, but “Winter Blues” (Seasonal Affective Disorder) and Perimenopausal Depression have different biological drivers. Here’s a simple guide to help identify what you’re feeling (and then talk with a medical expert to help you formulate a plan to feel better):
*If you are in perimenopause during winter, the lack of sunlight can make hormonal mood swings feel much heavier.
Self-Assessment tip: If your mood feels like a “roller coaster” with sudden spikes of irritability or “brain fog” regardless of the weather, it’s time to look at your hormonal and metabolic health.
Disclaimer: The information provided here is for informational purposes only. It is not intended as medical advice. Always consult with your doctor or healthcare provider to determine what is best for your individual health needs.
References:
- Joffe, H., et al. (2020). Estradiol variability and the absence of ovulatory progesterone levels are associated with higher depression scores in perimenopausal women. Journal of Clinical Endocrinology & Metabolism, 105(9).
- Fidecicchi, T., et al. (2024). Neuroendocrine signaling and the perimenopausal transition: Impact on neurotransmitter systems (Serotonin, Dopamine, and GABA) and stress reactivity. Frontiers in Endocrinology/Neuroscience. (Note: This refers to the recent synthesis of neuroendocrine impacts on midlife mood regulation).
- Gordon, J. L., et al. (2018). Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms During the Menopausal Transition: A Randomized Clinical Trial. JAMA Psychiatry, 75(2), 149–157.
- Glynne, P., et al. (2025). Real-world evidence of Menopausal Hormone Therapy (MHT) on mood-related symptom scores: A retrospective analysis of 900+ clinical cases. Journal of Women’s Health & Midlife Management.
