Some of the most concerning symptoms of perimenopause are the wildly swinging moods ranging from crippling anxiety, low mood, low motivation, anger, tearful episodes, irrational responses to stressors, memory issues, brain fog etc. We may experience a number of these symptoms. We may experience them periodically. Sometimes it’s hard to tell if you’re in the middle of a funk, or if it’s something more serious.  

What’s Going On?

It may be reassuring to know that there can be a relatively simple explanation as to why we experience mental symptoms at this time. It is of course mostly about the fluctuation and gradual decline of madam oestrogen!

Oestrogen isn’t only produced and used in the reproductive organs. We have receptors for oestrogen all over our body, including in the brain.

Oestrogen plays a role in influencing our levels of serotonin, the neurotransmitter that supports good mood and sleep. 

It also supports cognitive function, so as our body adapts to the decline in oestrogen, during the perimenopause, we can experience symptoms such as forgetfulness and difficulty processing and learning new things.  

Our levels of progesterone and testosterone are also declining at this time which can also impact on our mental health.

Progesterone helps to balance oestrogen and helps us remain calm, so declining levels can naturally lead to more heightened anxiety. It is also a key regulator of sleep, so could be contributing to insomnia too.

As well as the decline in oestrogen, other factors such as a lack of sleep due to night sweats, stress of juggling families, relationships and careers, and certain medical issues can also impact our mental health.

Health issues such as thyroid imbalances, digestive imbalances, autoimmune conditions, food allergies and sensitivities are all worth considering if you find symptoms don’t ease, or if you are concerned. The functional medicine approach that I use in my 1:1 clinics will also help you support your health in these areas and specifically where nutrition and lifestyle factors and nutrient deficiencies are playing a role. 

HRT can help many women transition through the perimenopause and beyond alongside dietary and lifestyle changes.  However, if you have an underlying health condition, I would suggest tackling this before, or at least alongside HRT as HRT won’t address all of the root causes.

What You Can Do Now

Let’s take a look at some simple strategies for coping with these symptoms

1. It can help to just recognise and acknowledge that the symptoms you are experiencing are likely to be due to the fluctuation of hormones.  Your body and mind are adapting to the changes and decline in oestrogen. They will catch up, but it may just take some time.

2. Keep a simple diary or journal of your symptoms and thoughts.  Getting them down in writing can help process your thoughts, as well as helping you identify any key patterns, especially if your symptoms are around your menstrual cycle, or you start to notice your triggers such as a poor night’s sleep, certain foods etc

3. Name the emotion.  Can you take a step back and name what you’re feeling? This can help you decide what to do next to help you feel better. This is really helpful if your using coping strategies that are detrimental to health such as alcohol, sugar or overeating generally

  • Is it fear or anxiety?  Then can you talk to someone else, or join a support group?
  • Is it low motivation? Could a quick walk outside help gee you up a bit?
  • Is it anger?  Would an exercise class help? Or a good old swearing session! Or some breathing exercises or meditation to help you calm down.
  • Is it frustration with a partner?  Can you explain to them what you’re feeling and why, and then come back to any issues a bit later?
  • Is it boredom? What can you do to shake up your routine? 
  • Is it overwhelm?  What can you let go of that doesn’t need to take priority right now? Can you retreat for a short while to your bedroom, or a soak in an Epsom salt bath?

4. Allow yourself to slow down.  Trying to do it all and have it all may just be too much right now.  You’re going through what is essentially puberty in reverse, so give yourself some slack, just as you may have needed to do with your teenage kids as they went through puberty. Sometimes you just need to grab yourself some time and space for a re-set. It’s not only you that will benefit. Those around you are likely to benefit too!

5.  Diet

Blood sugar imbalances are often one of the number one culprits of mood swings. This is because when we have a blood sugar dip, our body is flooded with the stress hormone cortisol to try and raise blood sugar levels.  Now, more than ever, we need to get our diet right. That doesn’t mean restrictive diets, it means eating in a way that supports our health.  

  • Eating regularly in a relaxed state
  • Eating good quality real food that has a balance of protein, healthy fats and complex carbohydrates. A lack of any of these can be a factor in mental health symptoms.
  • Eating lots of plant foods. 
  • Keeping well hydrated. 
  • Avoiding or limiting stimulants, alcohol, sugar and poor-quality processed and refined foods

This is of course a huge topic in itself, but just getting regular meals and good quality well-balanced food is foundational. Please keep an eye out for my upcoming online programme which tackles this.

There are also key nutrients such as B vitamins, magnesium and other minerals, essential fatty acids etc that are so important for mental health.

6. Support your gut health.  We are not only what we eat, but what we absorb and what our gut bacteria do for us. Did you know your gut bacteria produce B vitamins and fatty acids that support our mental health, and that there’s a direct link between gut and brain health? Also, if the walls of our intestines aren’t working optimally, we can absorb a higher load of toxins from the gut into our body which can lead to higher levels of inflammation which in turn can impact mood and mental health.  Please ask for help.

7. If you do feel that you can’t cope and that your symptoms have lasted more than a couple of weeks, then please make an appointment to discuss this with your GP. Clinical depression and more serious mental health issues should be medically ruled out. They will also be able to guide you as to whether HRT might be a solution for you.

If you are concerned and would like to book a no-obligation Discovery Call, then please email me on [email protected]


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