Why Perimenopause Can Feel Like an Emotional and Energy Rollercoaster and What to Do About It
If you’re in your 40s and wondering why your motivation, mood, and stress tolerance seem to have changed, you’re not alone. Perimenopause, the years or even decade, leading up to menopause is a period of powerful hormonal transitions that don’t just affect your reproductive system. They influence your brain chemistry, energy, and emotional regulation.
Emerging research from longitudinal studies like SWAN and clinical hormone trials show that many of the emotional and cognitive symptoms of midlife like irritability, anxiety, brain fog, fatigue are rooted in neuroendocrine changes, not personal weakness or lack of willpower.
The Hormonal Landscape: Fluctuating, Not Just Falling
During perimenopause, estrogen and progesterone begin to fluctuate unpredictably. It’s these swings, rather than a steady decline, that can most disrupt brain balance. When estrogen spikes or drops suddenly, neurotransmitters like serotonin, dopamine, and GABA shift in response. This can create periods of anxiety, low mood, or emotional sensitivity that seem to appear out of nowhere.
Estrogen and the Brain
Estradiol (the main form of estrogen) supports the brain in multiple ways:
Boosts serotonin (mood and optimism)
Modulates dopamine (motivation and reward)
Enhances GABA (calm and relaxation)
Improves synaptic growth and mitochondrial energy
As estrogen fluctuates, these systems lose their usual stability. The result? Feeling “off,” unmotivated, or emotionally fragile even when life circumstances haven’t changed.
Progesterone’s Role
Progesterone converts into allopregnanolone, a neurosteroid that interacts with GABA receptors to calm the nervous system. When progesterone drops suddenly (as it often does in late reproductive years!) some women experience heightened anxiety, restlessness, or irritability.
Sleep Disruption and Fatigue
Estrogen decline also affects neurons in the hypothalamus, which regulate body temperature. This leads to night sweats and fragmented sleep. Sleep loss is one of the most potent drivers of low mood, poor concentration, and fatigue. Addressing sleep—whether through behavioral strategies, temperature regulation, or hormone therapy—can dramatically improve mental health.
Stress Reactivity and Inflammation
Estrogen normally dampens cortisol (the stress hormone) and keeps inflammation in check. When its buffering effect disappears, many women feel more reactive to everyday stress and experience new aches, brain fog, or fatigue. These physiological changes can masquerade as burnout or depression.
What the Research Shows
Women are two to three times more likely to experience new or recurrent depression during perimenopause than before it.
Estrogen withdrawal can trigger mood symptoms in women with prior perimenopausal depression, even if levels stay “within normal range.”
Not every woman is affected—genetics, early-life stress, and prior hormonal sensitivity all play roles.
The Good News: This Phase Is Manageable
Understanding that these symptoms have a biological foundation helps remove shame and self-blame. The most effective approaches combine medical, behavioral, and lifestyle strategies:
Treat sleep and hot flashes early. Better sleep often means better mood.
Consider hormone therapy if appropriate; transdermal estradiol can stabilize mood for some women.
Move your body in ways that feel good and build strength.
Address stress through nervous-system regulation. Breathwork, NSDR, and structured rest are medicine.
Use CBT or mindfulness-based approaches to improve coping and reduce anxiety.
Support the brain with nutrition—adequate protein, omega-3s, magnesium, and hydration.
Build your team. This is the time to find expert support. Don’t know where to start? Ask your friends who they see. Ask a provider you like for recommendations for physical therapy (and pelvic floor pt), a provider skilled at women’s hormone optimization, nutritionist, therapist, trainer, etc.
Closing Thoughts
Perimenopause is a biological transition, not a psychological failure. The changes you feel are your brain’s and body’s response to shifting hormones and with understanding and targeted support, balance and vitality can return.
Perimenopause isn’t the end of equilibrium—it’s the beginning of a new, wiser one.