By Dr. Heidi Queen, MD | Certified by The Menopause Society

If you’ve ever found yourself thinking, “Why am I suddenly so emotional, anxious, or down—what’s going on with me?”, you’re not alone. Mood swings, irritability, anxiety, and even depression are surprisingly common during the menopause transition. And while many women are told to simply “ride it out” or accept these changes as part of getting older, the truth is: these symptoms have real, biological roots—and they are treatable.

As a functional medicine physician certified by The Menopause Society, I see every day how misunderstood the emotional effects of perimenopause can be. This stage of life isn’t just about hot flashes and changing cycles—it’s also a pivotal time for brain health and emotional resilience. The good news? With the right understanding and support, you can feel like yourself again.

What’s Happening to Your Mood?

Perimenopause (the transition leading up to menopause) is more than a hormonal phase—it’s a neurological one. Estrogen plays a key role in brain function. As levels begin to fluctuate and eventually decline, your brain must adapt. This adaptation process can trigger mood-related symptoms like:

• Depression or low mood
• Anxiety or panic
• Irritability
• Brain fog
• Sleep disturbances

In fact, studies show women are two to four times more likely to experience depression during perimenopause than before. And it’s not just about estrogen—changes in progesterone, DHEA, cortisol, and even gut health can all influence how you feel emotionally during this time.

Why Functional Medicine Looks Deeper

While conventional medicine often defaults to antidepressants (and in some cases, those may be helpful), a functional medicine approach aims to uncover why mood changes are happening. Rather than isolating symptoms, we consider the full picture of your health: hormones, inflammation, nutrition, stress, lifestyle, and genetics.

Here’s what a personalized, integrative plan may include:

• Hormone Support: Bioidentical hormone replacement therapy (HRT) can ease mood symptoms and support cognitive function, especially when estrogen levels drop.
• Nutritional Guidance: An anti-inflammatory, brain-supportive diet rich in healthy fats, proteins, and colorful vegetables can help stabilize mood.
• Stress & Nervous System Care: Practices like mindfulness, acupuncture, or adaptogenic herbs can calm your stress response and improve sleep.
• Adrenal & Gut Health: Supporting the adrenals and healing the gut can restore hormonal balance and improve neurotransmitter function, especially serotonin and GABA.

HRT vs. Antidepressants: What’s Right for You?

When women describe mood changes during perimenopause, they’re often offered a prescription for antidepressants—even when the root cause is hormonal. While antidepressants can help with mood in some cases, especially if there’s a history of clinical depression, they don’t address the hormonal imbalances at play.

If your mood changes are new and started around midlife, it’s worth exploring whether hormone replacement therapy (HRT) is a better fit. Estrogen, in particular, has a profound effect on serotonin—the “feel-good” neurotransmitter. When estrogen declines, serotonin often drops too, leading to feelings of sadness, irritability, or anxiety.

Bioidentical HRT, when used appropriately and under medical guidance, can restore hormonal balance, improve emotional stability, and support long-term brain health. At Energize Health & Hormones, I work closely with each woman to evaluate whether HRT is appropriate, safe, and aligned with her goals.

Your Brain on Estrogen

It’s not just your mood—estrogen impacts cognition, memory, focus, and overall brain function. That’s why so many women in perimenopause describe “brain fog,” forgetfulness, or a sense that their mental sharpness has dimmed. What’s happening is real: estrogen helps regulate blood flow to the brain, supports neurotransmitter activity, and even protects against inflammation.

When hormone levels drop, the brain has to work harder to do the same things it used to do with ease. That’s why women may feel more mentally and emotionally taxed—even with the same daily tasks.

Addressing these changes holistically can bring clarity back. Whether that means hormone therapy, targeted supplements, or lifestyle shifts like improving sleep and reducing mental load, there are real strategies that work.

My Approach: Individualized, Evidence-Based, and Collaborative

Every woman’s experience of perimenopause and menopause is unique—so the care should be too. In our work together, I start by listening closely. Your history, symptoms, goals, and intuition all matter. From there, we may use advanced lab testing to explore hormone levels, nutrient deficiencies, inflammation markers, and more.

Together, we build a plan that might include:

• Bioidentical HRT, if appropriate
• Functional nutrition support
• Herbal or nutrient-based mood stabilizers
• Lifestyle strategies to regulate the nervous system
• Collaboration with a licensed therapist or counselor
• A complimentary session with our functional nutritionist to align diet with hormone health

You Don’t Have to Tough It Out

You’ve spent decades taking care of others—your family, your work, your community. Now it’s time to take care of you. Mood changes in midlife are not “just part of being a woman.” They’re a sign your body and brain are asking for support. And you deserve to feel steady, clear, and emotionally well.

If you’re feeling unlike yourself lately—or if anxiety, irritability, or low mood are interfering with your quality of life—know that help is available. You don’t have to tough it out, and you’re not alone.

Ready to Feel Like Yourself Again?

If you’re navigating emotional changes and wondering whether hormones could be playing a role, let’s talk. At Energize Health & Hormones, we’ll take a thoughtful, whole-person look at what’s going on and create a personalized plan that supports your mood, your mind, and your well-being. Schedule a consultation today—and take the first step toward feeling like you again.