Mood Swings, Anxiety, and Perimenopause: What’s Actually Going On

You’re snapping at people who don’t deserve it. You’re anxious about things that never used to bother you. And somewhere in the back of your mind, you’re wondering if you’re losing it.

You’re not. What you’re describing has a name, a real physiological cause, and real treatment options. Let’s talk about it.

Why Perimenopause Messes With Your Mood

As estrogen levels start to fluctuate and decline during perimenopause, they take some of your brain’s mood-regulating chemistry along for the ride. Estrogen affects serotonin and other neurotransmitters tied to mood and calm, so as it swings, so can you. Add in the sleep you’re losing to night sweats or restlessness, and you’ve got a mood problem with a real, physical cause behind it, not a character flaw and not just stress.

This Isn’t Just Stress, and It Isn’t Just You

New anxiety, irritability, or low mood during perimenopause is common, even in women who’ve never dealt with anything like it before. It’s not weakness, and it’s not you handling life worse than you used to. It’s a hormonal shift affecting a part of your brain that used to have more consistent support.

What Actually Helps

There’s no single fix, and that’s actually good news, because it means there’s more than one way in. Depending on what’s driving your symptoms, your plan might include:

• Therapy or counseling, which has real, specific evidence behind it for menopause-related mood changes and sleep problems
• Medication, including antidepressants, when symptoms are more than mild
• Hormone therapy, which can ease the physical symptoms, like poor sleep and hot flashes, that are feeding the mood changes in the first place
• Practical support around sleep and daily habits, which matters more here than it gets credit for

One note worth being honest about: hormone therapy can help mood indirectly by treating what’s disrupting your sleep and comfort, but it isn’t a standalone fix for anxiety or depression on its own. For a lot of women, the best results come from combining it with therapy or medication, not choosing one over the other.

Why We Treat This as One Conversation, Not Two

A lot of women end up bouncing between an OBGYN who handles the hormones and a separate mental health provider who’s never heard the word perimenopause mentioned in the same visit. At Balance Medical, that’s not how this works. Dr. Rhonda Schafer-McLean evaluates the hormonal side, and Liz Castillo, FNP-C, evaluates whether psychiatric medication could help and manages that treatment directly, and the two of them are working from the same picture of what’s actually going on with you.

Curious what that could look like for you? Our perimenopause and menopause care and our behavioral and emotional health services are built to work together, not in separate silos.

A Couple of Quick Questions

Is this just perimenopause, or something else?

It can be hard to tell on your own, which is exactly why this is worth bringing up at a visit rather than guessing. We’ll look at your full picture, hormones and mood both, before assuming it’s one or the other.

Do I need to see a therapist and my OBGYN separately?

Not for the hormone and medication side of things, that’s one connected visit at Balance Medical. If therapy would also help, we’ll point you toward it, but you won’t have to start from scratch explaining your hormones to someone new.

Talk to Someone Who Will Take This Seriously

If your mood has changed and you can’t quite explain why, you don’t have to just tough it out or wait to see if it passes. Schedule a visit with Balance Medical in Bismarck, ND, and let’s figure out what’s actually going on.

Dr. Rhonda Schafer-McLean

Founder & Medical Director at Balance Medical & Bal Med Skin

Dr. Rhonda Schafer-McLean is a board-certified OB/GYN with more than 15 years of experience caring for women throughout North Dakota. As the founder of Balance Medical and Bal Med Skin, she combines advanced medical expertise with a genuine, down-to-earth approach. Whether she’s performing surgery or helping someone feel more confident in their skin, Dr. Rhonda believes every woman deserves care that’s personal, approachable, and tailored to her life.