Mood Swings and Anxiety in Perimenopause: Symptoms Doctors Still Miss

Added: 2026-05-07

[00:00:00]Perimenopause begins in the brain, and one of the biggest changes we first see is mental health changes. I am so proud of this chapter in the new perimenopause on mental health. I'm going to read you a small excerpt, so bear with me. The emotional and psychological symptoms of perimenopause have long been chalked up to personality flaws or excessive stress or waved off based on the medical bias that women are just unhappy, unnecessarily complicated, dealing with unresolved trauma, or even unintelligent.

[00:00:33]I know this because I was trained in a medical system that taught this brand of bias and characteristic dismissiveness.

[00:00:41]We learned that women tended to somatize their emotions and that they were more likely to complain and that midlife unhappiness was almost a psychological inevitability.

[00:00:51]It took years to untangle this bias in myself, and much of medicine is still working on doing the same. Thankfully, we finally have science, often the only lever strong enough to shift long-standing trends in clinical practice on our side. Research now confirms what many women have long known intuitively. The mood-related symptoms that emerge during perimenopause are often biological, not purely psychological. Indeed, we now have clear evidence that the hormonal fluctuations of perimenopause can profoundly affect mental health.

[00:01:25]And when you step back and look at the full picture, this shouldn't be surprising. We've already recognized the hormonal roots of postpartum depression, driven by the dramatic withdrawal of estrogen and progesterone after birth.

[00:01:39]Similarly, we accept that premenstrual dysphoric disorder is triggered by sensitivity to the hormonal changes in the luteal phase of the menstrual cycle.

[00:01:48]What's happening in perimenopause is more of the same, hormone-driven mood dysregulation. Only now it's happening in the context of erratic and sustained endocrine disruption. It may be too soon to call this a watershed moment. Maybe not. But it's a significant shift in how we understand mental health in midlife, and it's long overdue.

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