Menopausal mood swings: Why they happen and how to manage them

What you’ll learn:   

• Hormone fluctuations, particularly the rapid elevations and decreases in estrogen levels, are a primary cause of mood swings during menopause.       
• Lifestyle improvement can help manage menopause-related mood changes.       
• Medical treatments like hormone replacement therapy (HRT) and antidepressants can provide additional relief.

Mood swings are a common part of menopause, but they can be sporadic and confusing. Understanding why they happen is the first step toward managing them effectively and preventing them from disrupting your life.

Why do they happen? Fluctuating hormone levels, particularly estrogen, can lead to emotional shifts. While estrogen is commonly associated with the menstrual cycle, it also plays a key role in regulating mood-boosting chemicals like serotonin in the brain. As estrogen levels change, it can throw off this delicate balance, leading to irritability, sadness, or even anxiety. When combined with other menopause symptoms like hot flashes and night sweats that can interfere with sleep, you might be left feeling tired and emotionally drained.

The good news is there are ways to get relief. Lifestyle changes—like staying active, eating well, managing stress, and getting better sleep—can make a big difference. You can also consider treatments like hormone replacement therapy (HRT), antidepressants, or therapy. Remember, you don’t have to face this alone—talking to a healthcare provider and finding support can make this transition much easier.

At Noom, we believe managing menopause symptoms is about more than just coping—it’s about empowering you with tools and strategies to take charge of your well-being. By combining science-backed insights with personalized support, we can help you smooth out those emotional bumps and confidently navigate this transition. Ahead, we’ll explore why mood swings happen during menopause and share effective strategies to help you find balance and regain stability.

Menopause mood swings: Understanding the causes

Mood swings associated with menopause might start affecting you several years before your period stops. This transitional time frame is called perimenopause. Perimenopause typically begins in a person’s late 30s as the body gradually produces less estrogen, leading to hormonal fluctuations and the onset of symptoms like irregular periods, hot flashes, and mood changes.   This fluctuation might affect emotional stability in several ways:

• It might cause a dip in mood-stabilizing hormones: Studies have shown that when estrogen drops, serotonin production may decrease, leading to irritability, sadness, and emotional instability. 
• It might increase stress hormones: Lower estrogen levels can trigger increased cortisol production, commonly known as the stress hormone. Elevated cortisol may increase feelings of anxiety, which could create a feedback loop of heightened stress and further hormonal imbalance. 
• It may increase tiredness and irritability: When estrogen levels decrease, progesterone levels can also decrease. Progesterone also plays a role in mood regulation. Lower levels of this hormone can contribute to lethargy, anxiety, and irritability, compounding the emotional challenges of menopause.
• It can disturb sleep: Hot flashes and night sweats can disrupt your sleep, leaving you tired and irritable the next day. And let’s face it—everything feels more challenging when you’re not sleeping well. 

On top of that, life doesn’t pause for menopause. Work stress, family responsibilities, and social obligations continue, and these pressures can amplify your mood fluctuations. Now that you understand what’s causing your mood swings let’s look at how you can manage them. With the right strategies, you can smooth out those emotional bumps and find more balance in your day-to-day life. 

Menopause mood swings: Lifestyle changes that can help

Research suggests that addressing both physical and emotional health during this time can improve overall well-being and help stabilize mood. 

Regular exercise, stress management, and improving your diet have shown promise in reducing these symptoms by supporting hormone regulation and enhancing brain health. Let’s explore some practical ways to smooth out those emotional rollercoasters and help you feel more like yourself again:

• Get moving: Physical activity isn’t just great for your health—it’s a natural mood booster. Research shows that 50 minutes of aerobic exercise four times a week can significantly reduce symptoms like night sweats, mood swings, and irritability. In fact, women who stuck to regular aerobic workouts reported fewer mood disturbances and greater emotional stability compared to those who didn’t. 
• Improve your diet: Research shows that what you eat can make a big difference during menopause. In one study, women who combined healthy eating with exercise saw a 24% drop in menopause-related symptoms, including mood swings. Fill your plate with colorful fruits and vegetables, high-fiber carbs, healthy fats, and lean proteins to fuel your body and mind. Noom’s menopause diet is here to help with personalized guidance that will help you make healthy, mindful choices that will support your body’s changes through menopause. 
• Reduce stress: Managing stress is key to keeping mood swings at bay. Try stress-busting techniques like deep breathing, meditation, or yoga to help you feel centered. A study found that mind-body exercises can improve sleep and reduce anxiety and low mood during menopause. These practices help lower cortisol levels (the stress hormone) and promote relaxation. Even just 10 minutes a day can have a calming effect on your mind. Noom’s Success Kit contains a collection of breathing exercises, guided meditations, and relaxation techniques that can help you lower your stress levels.
• Improve your sleep: Sleep is your emotional reset button, and it plays a key role in managing mood, energy, and even weight during menopause. Hormone fluctuations can disrupt sleep, leading to cravings and lower energy for physical activity. Studies show that 40 to 60% of women experience sleep disturbances linked to hormone shifts and stress. Here’s what to work towards:
  • Aim for 7 to 9 hours of quality rest each night by creating a calming bedtime routine like reading or listening to soothing music.
  • Avoid caffeine or alcohol before bed.
  • Stop eating and drinking a few hours before sleep.
  • Make your bedroom a no-phone zone to prevent blue light exposure that can disrupt sleep.
• Reach out and connect: Sometimes, a good chat with a friend or loved one can work wonders for your mood. Consider joining a support group to connect with others who understand what you’re going through. Noom Community is a great place to start. You’ll be able to chat with others who not only have the same health goals but who also may be going through the same aging-related changes. Just search “Menopause” in the Community section of your Noom app to join the Menopause group and get support. Remember, you’re not alone—about 4 in 10 women experience mood changes during this time.

Menopause mood swings: Medication that can help

Managing menopause-related mood swings can feel overwhelming, especially when lifestyle changes don’t cut it. Fortunately, medical treatments can help by addressing the hormonal imbalances behind mood fluctuations. Here’s a look at some options:

Hormone replacement therapy (HRT)

Also referred to as menopausal hormone therapy (MHT) or hormone therapy (HT), HRT is one of the most effective treatments for managing menopause-related mood swings. Declining estrogen levels during menopause can disrupt neurotransmitters like serotonin and dopamine, which regulate mood. HRT typically involves estrogen or a combination of estrogen and progesterone. Let’s take a look at the different types:

• Estrogen-only HRT: This type of hormone replacement therapy is typically recommended for people who have undergone a hysterectomy (surgical removal of the uterus).
• Combined HRT: For those who still have a uterus, a combination of estrogen and bioidentical progesterone (also referred to as micronized progesterone or MP) is prescribed. The inclusion of bioidentical progesterone reduces the risk of endometrial cancer, which can increase when estrogen is taken alone by someone with a uterus. Additionally, this form of progesterone is associated with fewer risks compared to synthetic progesterones (progestins) that were once commonly used in combined HRT.

By stabilizing hormone levels, HRT helps reduce mood swings and may also ease other symptoms like hot flashes and night sweats. It is available in different forms, including:

• Oral tablets
• Skin patches
• Gels and creams
• Estradiol sprays

Systemic treatments, such as pills and patches, provide the most benefit for mood swings, while localized forms like vaginal creams primarily target other symptoms like vaginal dryness. 

Does HRT have any risks?

HRT has been associated with concerns about breast cancer, largely due to a 2002 Women’s Health Initiative (WHI) study that linked HRT to increased risk. However, recent reevaluations suggest the risk was overstated, with media coverage at the time amplifying fear without proper context. The study primarily involved women over 60, past the ideal age for starting HRT. Initiating therapy closer to menopause often provides greater benefits with fewer risks. Personalized treatment, begun within 10 years of menopause and before age 60, has been shown to be a safe and effective option for managing symptoms when tailored to an individual’s needs.

While highly effective, HRT isn’t suitable for everyone and requires discussion with a healthcare provider, who will consider factors like age, overall health, and individual needs to determine if this treatment is the right fit. 

Antidepressants

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can help regulate mood by balancing serotonin and norepinephrine. These medications can also reduce vasomotor symptoms (VMS), e.g., hot flashes and night sweats. Since hot flashes and night sweats can disrupt sleep and contribute to irritability, addressing these symptoms with SSRIs or SNRIs can create a positive feedback loop, enhancing mood and emotional resilience. Common options include:

• Escitalopram (Lexapro)
• Paroxetine ER (Paxil CR)
• Venlafaxine XR (Effexor XR)

Gabapentin

Originally developed to treat seizures, gabapentin can alleviate certain menopause symptoms like hot flashes, which can affect mood. By mitigating hot flashes, gabapentin may indirectly improve mood stability, as these symptoms can disrupt sleep and contribute to irritability. However, its direct impact on mood disorders like anxiety or depression during menopause requires further research. It’s important to consult with a healthcare provider to determine if gabapentin is appropriate for managing menopause-related symptoms.

Menopausal mood swings: Other treatments

Additional treatments like cognitive behavioral therapy (CBT) and herbal supplements may offer some relief.

Cognitive behavioral therapy (CBT)

CBT is a structured, evidence-based therapy that helps people identify and change negative thought patterns and behaviors. It is especially useful for managing stress, anxiety, and depression, which are common during menopause. Studies have shown that CBT can be highly effective in reducing mood disturbances, improving emotional regulation, and enhancing coping mechanisms. This therapy empowers people to manage the psychological impacts of menopause and improve their overall quality of life.

Herbal supplements

While many women turn to herbal supplements for relief, the scientific evidence on their effectiveness for menopause-related mood swings is limited. Here’s what we know:

• Black cohosh: Often used for hot flashes and night sweats, but research on its impact on mood swings is inconclusive.
• St. John’s wort: This herb is commonly used for depression but lacks sufficient evidence to confirm its effectiveness for menopause-related mood disturbances.
• Evening primrose oil: Some studies suggest it may help with hot flashes, but there is little evidence showing significant benefits for mood.
• Valerian root: Known for its calming properties, it may help with sleep, but there aren’t enough studies to confirm its effectiveness in mood swings during menopause.

While these supplements are widely used, there is no solid evidence proving that they are effective in managing menopause-related mood swings. Always consult a healthcare provider before incorporating these or any new supplements into your routine.

Menopause mood swings: How long will they last?

Menopause-related mood swings are most intense during perimenopause when hormone levels fluctuate significantly. During this time, women may experience heightened irritability, anxiety, and even depression. Once a person has reached menopause (marked by 12 months without a period), hormone levels stabilize, and mood swings typically improve. 

That said, it’s not the same for everyone. Some women still experience emotional changes even after menopause, often due to things like stress, health issues, or lifestyle factors. If those feelings linger, it’s important to check in with yourself and seek support when needed.

Menopause mood swings: When to seek professional help

If mood swings are affecting your life and your relationships, it’s important to reach out to your doctor. Here are some guidelines:

1. You’re having thoughts of self-harm or hopelessness. These feelings are serious and should never be ignored. Call 988 if you or someone you know is experiencing a mental health crisis.
2. Your mood changes last longer or feel more intense than usual. If sadness, anxiety, or anger is sticking around for weeks or making it hard to function, it’s time to talk to a doctor.
3. Daily life feels unmanageable. Whether it’s trouble at work, tension in your relationships, or losing interest in the things you love, don’t hesitate to seek help.
4. Your physical symptoms are overwhelming. Exhaustion, sleepless nights, or persistent hot flashes can all make mood swings worse. Treating these can help lighten the emotional load.

Reach out to a healthcare provider, therapist, or counselor if you find that your emotional well-being is not improving despite lifestyle changes or if you feel like you need extra support managing symptoms. Sometimes, a combination of therapy, medications, and lifestyle changes is necessary to manage the emotional challenges of menopause effectively.

National resources for support:

The Menopause Society (The North American Menopause Society): Provides resources for women experiencing menopause, including information on mood swings and available treatment options.

Taking Control of menopausal mood swings

Riding the emotional waves of menopause doesn’t have to be a solo journey. By understanding the changes happening in your body and adopting practical strategies, you can work toward steadier moods. Regular exercise, balanced nutrition, stress management techniques, and quality sleep are powerful tools that can make a real difference.

Noom offers tailored support to help you create a plan that fits your life, tackling mood swings and other menopause symptoms. Our program includes daily lessons on emotional eating, self-care, and stress management, all designed with menopausal women in mind. Learn how Noom can walk alongside you through this transition and help you find balance in both body and mind.