What's actually happening.
The hallmark of perimenopausal mood change is its cyclical nature: worse in the late luteal phase, easing with the period. It is the same biology behind PMS, intensified by the wider hormonal swings of perimenopause. Women with a history of PMS or postnatal depression are particularly susceptible.
It often presents alongside fatigue, sleep disruption, and loss of resilience. Things that would not normally upset you feel disproportionate. Tearfulness with no identifiable trigger. A persistent low-level greyness that did not used to be there.
Common signs
- · Persistent low mood, particularly in the second half of the cycle
- · Loss of resilience to ordinary stress
- · Tearfulness without identifiable trigger
- · Loss of motivation, pleasure, or interest
- · Persistent negative self-talk
How I approach this.
The first step is recognising the pattern. A symptom diary across two cycles often reveals the cyclical nature, which both explains the experience and points to the treatment.
Where the pattern is clearly hormonal, oestrogen replacement is often more effective than an SSRI alone. For some women, a combination of both works best. The conversation is longer than a standard ten-minute appointment allows.
Where the picture is less clear, I will take a full mental health history and may suggest CBT, lifestyle interventions, or onward referral to talking therapy. The right answer is the one that fits your situation, not the one that fits the textbook.
Ready to feel steady again?
A 45-minute menopause consultation includes full assessment, a written plan, and an HRT prescription if appropriate.