Hormonal mood swings – they’re not in your head

Hormonal mood swings – they’re not in your head

By Dr Judith Martin

From puberty to menopause, women have shifting levels of hormones but it’s only in fairly recent times that researchers have discovered links between these fluctuating hormones and our range of emotion.

Oestrogen secretion can have direct effects on neurochemicals such as serotonin and dopamine, both of which are implicated in the development of major depression and psychosis. 

For some women the week or so before each period can pass by smoothly. For others, they notice a little irritability or tearfulness.

For others still, the time before each period can be a hurricane of emotion that leaves them exhausted, confused, and often with a wake of emotional wreckage behind them. These women may be suffering from premenstrual dysphoric disorder.

Many women experience perinatal mental health issues. In Austalia, 15-20% of new mums experience post-partum depression.

The perinatal period refers to the period of time during pregnancy and for up to 12 months after the baby’s birth.

 As you can imagine, hormonal changes are significant at this time as a woman’s body maintains pregnancy, experiences childbirth, and readjusts to the post-partum period, regardless of breastfeeding or not.

 During the perinatal period, a range of mental health conditions may arise including major depression, anxiety, or psychosis.

 The difficulty in identifying perinatal conditions is in recognising when the normal irritability, low mood, or insomnia that accompanies pregnancy and the post-natal period is deemed to be pathological.

 We would say that a woman’s symptoms need assessment when they impair her function or cause her or her family significant distress.

Successful treatment of these conditions is important not only for the mother’s health, but also to optimise infant mental health and development.

If you’re lucky enough not to experience premenstrual or perinatal symptoms, don’t think you’re out of the woods yet, because here comes menopause!

The perimenopausal period is that time in life when a woman’s periods are tapering off to a point when there will be no further periods at all.

There can be rapid changes in oestrogen and progesterone levels. Perimenopausal depression and anxiety can occur in women with no previous history of mood disorder and is a confusing condition for women and their families to endure.

Thankfully, women who experience mental health symptoms due to hormonal changes no longer need to suffer. There are a range of evidence-based treatments available.

Treatment is commonly a combination of hormonal manipulation therapy (the oral contraceptive pill or hormone replacement therapy) with psychiatric medications, or psychological therapies. 

The truth is women do not have to suffer in silence or expect these changes to be a normal, expected part of their lives. 

It is important to visit your general practitioner if you are experiencing any significant mood change around the typical time of hormonal changes, even if you are already using the oral contraceptive pill. Your mental health matters.

Dr Judith Martin

Dr Martin is a consultant psychiatrist with a sub-speciality interest in geriatric psychiatry. Dr Martin works in the private sector, providing mental health care to both younger and older adults. She also provides psychiatric care to residents at a number of Brisbane nursing homes.

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Comments (5):

Hi Chrissy,

Thanks for your response to the article and I'm glad that you found it relevant to your circumstances. Firstly, I'm really pleased that you had a positive treatment response to both episodes of depression. The medications that you were prescribed seem appropriate to me and would certainly be medications that I would, and do, prescribe in your circumstances.

Hormonal changes can have a direct impact on the levels of neurotransmitters that are the target of therapy with these medications. Hence, even though there is a hormonal precipitant to the mood changes, these medications are effective and important treatments. However, it is usually worthwhile, particularly in menopause to find a great GP who can often use a combination of therapies to improve your mental state and overall well-being. I'm so pleased to hear that you found exactly that GP!

All the best for the future, and thank you for taking the time to comment on the article.


drjem - January 29, 2018

Hi Dr Martin, I'm in the UK and I found this article very interesting.

In my 30's I suffered with severe post natal depression after the birth of my 3rd child. I was prescribed Prozac at the time but stopped taking it once I felt my life was back on an even keel.

My menopause symptoms started when I was in my late 40's and once I was in my post menopausal stage in my early 50's I began to feel very depressed once again last year.

After finding a sympathetic female GP, I was prescribed a long term course of Citalopram 20mg which I found really helped me. Since taking these I feel so much better physically and mentally and I can certainly vouch for them if anyone needs something to tackle mild anxiety and needs to raise their serotonin levels permanently after "the change".

I am convinced that my 2 bouts of depression - 20 years apart - are triggered by hormonal changes in my body so I'd be interested to know your opinion on these anti-depressants.

ChrissyHamlin - January 29, 2018

Thank you Dr Martin. This was a great article and very helpful to so many women out there.

claremary - November 18, 2017

Hi Jo, I'm glad that you found the article useful. I'm not sure which stage of life you are in, but I would suggest having a chat with your GP about the changes that you have described. There may be a simple explanation for it and there may be a simpler way to treat it. Feeling physically ill around those times can be quite debilitating and you shouldn't just "put up with it". I hope that helps! Judith

DrJudith - November 17, 2017

Jude this was interesting. I have noticed a significant change in my cycle whereby both ovulating and night before period are now making my physically ill. Used to be just a mode swing (emotional PMS) but it's changed and I didn't think to see a DR. Is this be something I should just accept or would their be something that a Dr could actually do to help this?

jomckee05 - November 17, 2017