Women enter menopause after going 12 months without getting their period. The years leading up to menopause are called perimenopause. During perimenopause, many women start to notice their periods becoming irregular. Your menstrual flow may be longer or shorter than it was before. It may also get heavier or lighter. These changes are caused primarily by shifting estrogen and progesterone levels as your body prepares itself for menopause, which will involve no periods. Estrogen and progesterone are hormones that help to regulate the female reproductive system.

Many women have additional symptoms during both perimenopause and menopause. These symptoms may include:

  • hot flashes
  • vaginal dryness
  • diminished sex drive
  • trouble sleeping
  • mood swings

Mood can be affected by many things, from an argument with a loved one to a traffic jam. It’s not always clear what causes mood swings and the irritability that often accompanies them. Mood swings also differ from depression, which is not typically linked to menopause.

Menopause usually occurs when a woman is in her 40s or 50s. According to the Mayo Clinic, the average age of menopause for American women is 51. The process leading up to menopause begins much earlier. When women are in their mid to late 30s, their estrogen and progesterone levels start to slowly decrease. This natural, gradual process leads to perimenopause, and then menopause. As your ovaries produce less of these hormones, your body and brain may experience multiple changes. Some of these changes are related to mood.

Estrogen helps to regulate several hormones, which may have mood-boosting properties. These include:

  • serotonin
  • norepinephrine
  • dopamine

Estrogen also helps to support certain types of brain functioning, such as cognition. When estrogen levels change, your mood may change with it. The decrease in estrogen can also cause some women to have occasional episodes of forgetfulness, or “fuzzy-brain,” which may lead to frustration, negatively affecting mood.

Menopause and perimenopause can create physical challenges that may negatively affect mood. These include trouble sleeping and issues with sex. Many women also experience anxiety about aging and stress about the future, which can cause upset and mood swings.

Not all women have mood swings during menopause. You can’t always predict who will experience them and who won’t. Some conditions may put women at greater risk. These include:

  • a history of depression
  • high levels of stress
  • poor physical health

You may be able to reduce or diminish mood swings by making proactive lifestyle changes. Here are some ideas for how to combat mood swings:

  • Get aerobic exercise. According to at least one study, performing 50 minutes of aerobic training four times a week helped to alleviate several menopausal symptoms, including night sweats, irritability, and mood swings. Exercise and physical activity release endorphins and other feel-good chemicals in the brain. Pick the time of day you are most likely to stick to a plan, and choose the exercises or activities you most enjoy. You may want to stagger your workouts. Try running one day and swimming the next, or go cycling every other day. You don’t need to train like an Olympian to get mood-boosting results. Taking a brisk walk before work or after dinner may be just as impactful on reducing mood swings as training for a marathon.
  • Eat healthy food. Eating healthy foods could be just as good for your mood as it is for your body. You may simply feel better after eating a protein-rich salad than you would after downing a quart of fudge ripple ice cream. A varied diet containing healthy foods, such as fruits, vegetables, lean protein, and fiber-filled whole grains, is more likely to provide you with omega-3 fatty acids, folate, and other nutrients that may help improve your mood.
  • Let go of stress. For some women, de-stressing may be as easy as losing themselves in a page-turning mystery novel. For others, gentle yoga, meditation, or quiet walks in nature may help improve mood and decrease stress and anxiety. Try experimenting with deep breathing exercises or yoga poses that help you cleanse your mind or that feel like a mini-vacation.
  • Get enough sleep. Not getting enough shut-eye can add to irritability and mood swings. Create a nighttime routine that supports drifting off to sleep comfortably. Shutting off electronic devices, making sure your room is cool in temperature, and eliminating ambient light may help. Avoiding caffeine and alcohol can also help you to maintain healthy sleep cycles. Sleep should last 7 to 8 hours to allow healing and repair of immune function.

Seeing a doctor or medical professional may help if your mood swings are:

  • extreme
  • causing added anxiety
  • making it difficult to participate fully in life

To prepare for your appointment, keep a diary of your mood swings, including any possible triggers. You’ll also want to jot down information about your day, including:

  • activities
  • stressful situations
  • meals
  • medications or supplements you are taking

Be sure to let your doctor know about any mood-altering substances you use occasionally or regularly.

Your doctor will want to do a physical exam to rule out any underlying cause for your mood swings. They will also take a blood test to determine your hormone levels and thyroid function.

The exam and diary will help you and your doctor determine if lifestyle changes will be enough, or if additional types of treatment should be considered.

Short-term hormone replacement therapy (HRT) may be a good option for some women to alleviate mood swings and other menopause-related symptoms. Some types of HRT increase risk of:

People with a history of the above are not good candidates for HRT. You should ask your doctor to help you weigh these increased risk factors against the potential benefit of HRT, considering the severity of your symptoms. HRT is available in several forms, including:

  • vaginal patches
  • creams
  • pills

Acupuncture treatment may also help some women with mood swings, by balancing hormonal levels and increasing production of dopamine and norepinephrine. Acupuncturists call this qi, the balancing of energy flow within the body.

Mood swings related to menopause and perimenopause tend to fade once the body’s hormonal system stabilizes. This can take months, or even years. Following a proactive plan that includes healthy lifestyle choices is often enough to diminish mood swings. If you need additional support, medical intervention may be your best option.