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Hormones. Changes in hormone levels can lead to feelings similar to those experienced in PMS.  Specific symptoms include irritability, depression, anxiety, low energy, and difficulty concentrating. (Mallory, AB, 2022)  These changes are driven by fluctuations in hormones ahead of menopause. Many of the hormones which fluctuate significantly during perimenopause (Estrogen, Progesterone, and FS)  have an impact on production of and reception of serotonin. Serotonin helps your body with cognitive function, happiness, temperature, sleep, sex drive, and hunger. (Cleveland Clinic, 2025) As we progress through perimenopause, hormone shifts may no longer be linked with menstrual cycles.

 

Higher FSH variability and estradiol fluctuations have been linked to negative mood shifts independent of other symptoms (Freeman et al, 2006).  Roughly 40% of women report experiencing changes in mood while going through perimenopause and women are more than twice as likely to report feelings of depression during perimenopause (Freeman et al, 2006)

 

Through perimenopause, progesterone levels can also become erratic before eventually declining. Fluctuations in progesterone have different impacts on different women. Some women report an increase in anxiety similar to Premenstrual Dysphoric Disorder (PMDD) as progesterone levels fluctuate (Backstrom et al, 2013).

 

Window of Vulnerability Hypothesis. Schmidt et al (1998), coined this term/concept of women in perimenopausal state being more sensitive to the neurobiological effects of hormonal changes. This hypothesis has been supported by subsequent research. There is a link between prior history of depression or bipolar disorder and relapse during perimenopause. (Musial, et al, 2021) 

 

Sleep & Mood Relationship. There is a strong relationship between sleep quality and overall sense of wellbeing. When sleep quality is poor, research has shown risks of developing symptoms of depression double (Bagloni et al, 2011) If you're struggling with sleep quality, you're not alone. Check out our page on the relationship between perimenopause and sleep.

 

You're not alone. After decades of being able to predict and manage when PMS is coming, not knowing when these swings are coming and how long they'll last can be A LOT. Working through this phase of life may take some new techniques, framing, habits, and support systems. Tools and techniques exist to help us flourish through this phase.