By: Sarah Schufreider, LCSW, Menopause Mental Health Certified Therapist
Sarah Schufreider, LCSW, Menopause Mental Health Certified
Does any of this sound familiar? Your partner asks you to pass them the keys and you snap at them to “Get it yourself!” Or your kids tell you that they want you to take them to Target and you yell, “Can’t you see that I’m busy?!” You are quick to lose your temper over things, and as soon as you have calmed down, you feel immense guilt. You can’t understand why you can’t just pull yourself together.
Feeling crabbier isn’t all in your head. Hormone changes in perimenopause can affect your mood.
Increased irritability is one of the most commonly reported mood changes in perimenopause. In this blog, we will explore a little more about irritability, how hormones can play a role in increasing irritability, and what women can do to help themselves during this time of continuous hormonal fluctuation.
The Hormone-Mood Connection: Simply Explained
So what role do our hormones actually play in impacting our mood? Dr. Alison Shea, an ob-gyn and menopause expert at McMaster University explained it well in an article about menopause, the brain, and mood symptoms. She is quoted saying, “Your brain is basically being assaulted by all these changes in your hormones…Your brain is not functioning the way it was before, so it really is a roller coaster.” She goes on to explain the role that estrogen, a sex hormone in your body, plays in mood and happiness. She states that estrogen plays a role with serotonin, a neurotransmitter in our brains, that helps to keep us happy. Additionally, estrogen receptors are found in various parts of our brain, including areas that control mood, emotional regulation, impulsivity, and irritability. With fluctuating levels of estrogen, it becomes much harder for your brain to reliably maintain a calm, regulated mood at all times. (Source: How Menopause Symptoms Affect Your Brain and Mental Health )
Additionally, changes in another hormone, progesterone, can have an impact on a woman’s capacity to self-regulate and self-soothe. Since progesterone can work as a “calming” hormone, it can wreak havoc when its levels are constantly in flux.
Unfortunately, irritability and intense mood swings are extremely common symptoms of perimenopause and hormonal imbalance. Some days a woman’s hormones will be relatively stable and other days, they will be changing rapidly. Understanding how these changes impact the brain can help women develop increased levels of grace for themselves and their changing moods. (Source: Preventing Irritability in Perimenopause – Women’s Health Network).
In addition to the impact that hormonal changes have on the brain and mood, they also impact sleep. In fact, “recent Canadian data highlights an increased risk among women for insomnia, more daytime sleepiness, and elevated rates of sleep-related conditions such as obstructive sleep apnea (OSA), REM sleep behavior disorder, and restless leg syndrome.” These sleep disturbances can greatly impact a woman’s mood. If she isn’t sleeping well, her capacity to regulate her emotions and manage life’s daily stressors will be compromised. (Source: Vol. 2, Issue 1, Summer 2025 | Canadian Women’s Health Today)
Irritability As Information
As annoying as irritability is, it is also a powerful tool if we know how to use it. Instead of viewing irritability as something to squash, you can view it as a signal that you have some unmet needs and that you are feeling overloaded.
Take a moment to get really curious about where the irritability stems from. Likely, you will notice that the irritability isn’t just related to hormones. In my experience, the hormone fluctuations accentuate some long-standing resentments and burnout that already existed. If you are able to use irritability as an identification tool for overwhelm, you will be able to start identifying ways to combat the burnout.
What Helps Reduce Irritability in Perimenopause?
In my practice, many women state that they feel out of control with their mood. Unfortunately, feeling out of control just furthers the cycle of annoyance. Therefore, I work with women to identify some concrete steps to help them regain some sense of control in their lives. Important steps that help women regain a sense of agency include:
Sleep Protection: As we mentioned above, quality sleep is a major protective factor for someone’s mental health. Without good sleep, a person’s capacity to handle the ups and downs of their day is negatively impacted. Therefore, I encourage women to put tools in place to prioritize their sleep. These tools can include having a set bedtime routine, going to bed and waking at the same time, setting the temperature in your room to a comfortable level, minimizing distractions in your room, and not allowing screens in bed with you.
Boundaries: I haven’t met a woman in my therapy practice who is only responsible for themselves. Instead, I see women who are caring for their children, their aging parents, their careers, their communities, and everything in between. Although this goes against society’s intense pressure and constant messaging that women need to be “selfless,” women need to make sure their needs are being met. One great way to do this is by setting boundaries with others and with yourself. This is usually easier said than done. Learning how and when to set appropriate boundaries is one of the most common skills I work on with women in perimenopause.
Recovery Time: Going along with the idea of boundary setting is the truth that you deserve rest. You can often hear me saying to clients that “Rest is an Activity.” In order to be our best selves, we need to allow our bodies and mind a chance to rest and recover. A lot is being asked of us with the changes going on with perimenopause. Even just allowing yourself to acknowledge that you are deserving of rest is a good start towards decreasing the overwhelm you are feeling.
Talking To Your Family About What’s Going On
Many women wonder how to explain to their loved ones about what's happening to them without creating excuses or without blaming themselves. Some ideas for how to share information with your loved ones include:
Remind yourself and your loved ones that what is going on is new to all of you, but that it is a common and natural process. Half of the world’s population will eventually go through menopause! So, you aren’t alone in this experience.
Teach them about hormones’ impact on mood and the brain. Get them some basic information on the changes that are happening with your body and brain. You can show them articles, blog posts, podcasts, books…anything that helps to demystify perimenopause. Let them understand that this is a biological process in the same ways that digestion, breathing, and puberty are.
Ask them to share how the irritability and mood changes have impacted them and brainstorm together about how you can collaboratively cope with the challenges and stressors that you are all experiencing.
Acknowledge the areas that feel most challenging for you and identify ways that your loved ones can help you in these areas. Maybe you need someone else to take over making dinner? Or maybe you need to keep the thermostat set to a colder temperature at night in order for you to sleep more soundly. Practice proactively asking for what you need. I always joke with my clients that I’m still waiting for my crystal ball to arrive! But, in the meantime, I can’t expect to read people’s minds or for them to read mine.
When Irritability Signals Something More
Irritability can often make us feel down or frustrated. But, when does irritability go from being an annoyance to something more concerning, like symptoms of depression and/or anxiety? Some questions to consider:
Daily Functioning: Is my irritability impacting my capacity in any of the following areas?
Sleep
Energy/Motivation
Appetite
Memory
Concentration
Relationships: How much is your irritabilty affecting the quality of your relationships with others in your life?
Occupation: Is your irritability interfering with your job functions or your ability to get along with your co-workers?
Pleasure: Are you still able to find pleasure in things that you usually find enjoyable?
Thoughts of Harm: Are you having thoughts of harming yourself or others? (If you are in crisis, please go to your local emergency room, call 911, or call 988 to reach a 24/7 mental health crisis line.)
If you are experiencing greater difficulty in any of these areas, it may be worth connecting with a mental health professional to get further assessment and support. You can find menopause-informed therapists through directories such as the Menopause Society or through Bria Better Health.
How Can Therapy Help You Address Irritability
In my therapy practice, I see women who say that they feel like they are in a perpetual bad mood. Oftentimes, they can’t even name anything in particular that is wrong or what is triggering the bad mood. They just know that they feel like they are ready to snap at anything and anyone. When this happens, the first thing I do is normalize the experience for them. It is so important that women know that they aren’t alone in this and that they aren’t going crazy. From there, I provide some education on hormones’ impacts on mood. Then we begin to explore possible hormonal, physical, emotional, and social changes that can be contributing to this increasing irritability. Depending on what we find during our assessment, we may make plans use therapeutic interventions such as Behavioral Activation and Cognitive Behavioral Therapy for Insomnia (CBT-I) to help tackle sleep disturbances that contribute to increased irritation. Additionally, I often refer clients to menopause-informed providers such as gynecologists, acupuncturists, and physical therapists to help address other possible causes of irritability.
The most important thing is that women know that they don’t need to go through this alone. There are doctors who can evaluate hormonal causes and discuss treatment options, and a menopause therapist can help address the emotional side of things. You can feel comforted knowing that supports like online menopause therapy providers in Chicago and greater Illinois exist. They can help you manage the hormone fluctuations that are inevitable in perimenopause.
Irritability isn’t a character flaw, and you don’t have to white-knuckle your way through it. Online menopause therapy is available across Chicago and Illinois.
Frequently Asked Questions
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Fluctuating hormones, poor sleep, and built-up stress all make it harder to stay patient. When several of these hit at once, small things can feel much bigger than usual.
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Yes, it’s one of the most commonly reported mood changes. It can show up months or years before periods stop.
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Protecting your sleep, setting boundaries, and building in recovery time often help. A doctor and a therapist can also help you decide what else may be useful.
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If it comes with persistent low mood, loss of interest in things you enjoy, panic, or thoughts of harming yourself or others, reach out for support. If you are in crisis, call 988.
***(If you are in crisis, please go to your local emergency room, call 911, or call 988 to reach a 24/7 mental health crisis line.) ***
Sarah Schufreider, LCSW, is a Licensed Clinical Social Worker (Illinois license # 149016639) based in Chicago, IL and the founder of Six Hearts Counseling PLLC. She has a Menopause Mental Health certification from Bria Better Health. She focuses on mid-life transitions including menopause, parenting special needs and medically complex children, SPACE (Supportive Parenting for Anxious Childhood Emotions), grief, and postpartum depression. Sarah’s goal is to help her clients feel like they can take control of their life again through identifying their values, learning concrete skills to manage and regulate their emotions, and work to challenge mental obstacles that are creating stuck points to change. Learn more about her work at About Sarah.
Last updated: October 20, 2026