Hormones. Changes in hormone levels can lead to feelings similar to those experienced in PMS.  Specific symptoms include irritability, anxiety, tension (Bromberger et al., 2013) as well as cognitive symptoms like difficulty concentrating (Greendale et al., 2020). Its not just you. An analysis of a longitudinal SWAN analysis found that women in perimenopause were more likely to be anxious or irritable than those who were premenopausal  (Bromberger et al., 2013).  These changes are driven by fluctuations in hormones ahead of menopause. Many of the hormones which are fluctuating as we move through perimenopause (Estrogen, Progesterone, and FSH)  have an impact on production of and reception of serotonin (Bethea et al., 2002). Serotonin helps your body with cognitive function, happiness, temperature, sleep, sex drive, and hunger. (Berger et al., 2009) 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).  Many 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 (Bromberger et al., 2011)

 

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. Soares & Zitek (2008), advanced this framework, describing women in perimenopausal state as being more sensitive to the neurobiological effects of hormonal changes. This hypothesis has been supported by subsequent research (Maki et al., 2019). 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 (Baglioni 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. It's more than just the PMS, perimenopause is a long period of transition with lots of other changes happening. Some might be welcome, some neutral, and others might be frustrating. Many women report an increase in anxiety and an increase in depression during this transition. You have got this.  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.