The hormonal fluctuations that occur during perimenopause and menopause can lead to sudden bursts of anger, heightened irritability, and intense mood swings. These reactions may be triggered by everyday stressors, and the physical symptoms associated with menopause — such as hot flashes, night sweats, and fatigue — can amplify these mood changes.
Understanding the causes and recognizing the symptoms can help you make lifestyle changes, seek the appropriate treatments, and improve your quality of life.
What Is Menopausal Rage?
Perimenopause, which is the transition into menopause, usually begins in your mid-forties, although it can start as early as your mid-thirties or as late your mid-fifties. Women enter menopause at an average age of 51 to 52 years old, but the transition period can begin anywhere from a few months to a decade or more earlier. Menopause itself is a single point in time, defined as 12 consecutive months after your last menstrual period. At this point, your ovaries have largely stopped releasing eggs and have ended their reproductive function.
Intense emotional changes and mood swings are not necessarily expected, though they can be fairly common among women in perimenopause. “Menopause rage is not a formal clinical term or medical diagnosis, but it is a term I hear many women use to refer to the intense irritability, mood swings, or anger that they experience during the menopause transition,” says Rebecca Thurston, PhD, distinguished professor of psychiatry and Pittsburgh Foundation chair in women’s health and dementia at the University of Pittsburgh.
According to the American College of Obstetricians and Gynecologists, about 40 percent of women experience symptoms similar to those of premenstrual syndrome. The results of a recent study, which looked at anger, irritability, and a lack of control in women at midlife, found that these feelings can be influenced by menstrual cycle phases and “reproductive age.” Women tended to have more symptoms just before their menstrual cycle began, and those symptoms were more pronounced during perimenopause.
Symptoms can fluctuate in intensity and vary widely among individuals, as the cause is both hormonal and circumstantial, often triggered by mundane everyday events. “You may be irritable and wake up anxious, and that can lead to you being angry with your partner,” says Naomi Busch, MD, a family medicine physician and Menopause Society certified practitioner, and founder of Seattle Menopause Medicine in Washington. “Things that you once tolerated and even enjoyed now irritate you — all of a sudden it’s like nails on a chalkboard.”
Why Does It Happen?
Hormone levels before your final menstrual period are oscillating — first estrogen and progesterone are high and then low, says Susan Reed MD, MPH, professor emeritus of obstetrics and gynecology and adjunct professor of epidemiology at the University of Washington. This in turn disrupts the brain’s production of essential neurotransmitters such as serotonin and dopamine, which regulate mood and emotional stability. The decrease in serotonin activity can lead to increased irritability and anger.
Another important hormone is cortisol, often called the “stress hormone” because it helps your body manage short-term stress. Menopause can intensify stress responses, which raises cortisol levels. When cortisol levels remain high for a prolonged period of time, irritability and emotional sensitivity may increase, and sleep may be disrupted.
“However, menopausal rage is not something well understood by the medical community, so we cannot say based upon research what is driving it,” says Dr. Thurston. “Many of us are not sleeping well, and when we do not sleep it compromises our ability to regulate emotions well.”
Thurston adds that she also treats patients for depression and anxiety, which increases during the menopause transition for many women. “I also try to understand what is going on at home,” she says. “I often find that women have been putting up with situations that they have been frustrated with for some time, and around the time of menopause, they just lose their patience to deal with these things and it is expressed as rage.”
How Do I Find Relief?
Fortunately, there are many things women can do to control these symptoms and find relief. Menopause rage can be effectively managed with medications and lifestyle interventions. Treatment will depend on your own individual symptoms and preferences.
Medications and Hormone Therapy
Because a lot of these symptoms are triggered by hormone fluctuations, it’s not surprising that many women find relief with hormone therapy. “Both in perimenopause and menopause, women can benefit from hormone therapy,” says Kathleen Jordan, MD, chief medical officer at Midi Health. “Menopausal hormone therapy typically consists of small doses of estrogen and progesterone that keep you from bottoming out on either hormone. These therapies can also be helpful in perimenopause.”
Dr. Jordan adds that many perimenopausal women do benefit from traditional menopausal hormone therapy like the patches and pills given in full menopause. “Sometimes we support women in this phase with the higher doses in the form of birth control pills, which also have estrogen and progesterone, but also have the dosing and schedule to control ovulation and stop those associated hormone swings,” she says.
Nonhormonal medicines are another option. These include selective serotonin reuptake inhibitors (SSRIs) or other types of antidepressant medications, which can be effective for stabilizing mood and reducing irritability. Anti-anxiety medications may also be helpful for managing anxiety and mood swings. “These are a good option for women who prefer not to use hormones or who cannot use them,” says Dr. Busch.
Lifestyle Interventions
Lifestyle changes that may help improve menopause symptoms include the following:
Adequate Sleep Sleep problems are common in perimenopause, and Jordan notes that about two-thirds of the women seen at her facility have significant issues with sleep. “This is such an important aspect of your health, especially in midlife,” she says. “It matters to overall quality of life and is also associated with better health outcomes.” A mix of lifestyle adjustments, such as establishing a consistent sleep schedule, creating a relaxing bedtime routine, and avoiding alcohol, caffeine, and heavy meals close to bedtime can improve sleep quality.
Regular Exercise Physical activity is a natural mood booster, as it releases endorphins that help reduce stress and irritability. It can also improve sleep quality and insomnia, and allow you to fall into a deeper sleep.
Balanced Diet A healthy and balanced diet, rich in leafy greens, fruits, vegetables, whole grains, healthy fats, and lean proteins, doesn’t just provide essential nutrients — it may also help stabilize mood. “Nutritional contributions are key drivers [of mood changes] only if extreme, such as excessive consumption of sugar, prolonged fasting, or conversely, binge eating,” says Thurston.
Managing Stress Practicing relaxation techniques, such as meditation, mindfulness, and deep breathing exercises, or getting a massage can help calm your mind and reduce stress and anxiety.
Limit Alcohol and Caffeine Reducing alcohol and caffeine intake can help stabilize mood and reduce irritability.
Counseling or Therapy
Cognitive-behavioral therapy or other forms of counseling, psychotherapy, talk therapy, and behavioral therapy can be very helpful for treating depression and anxiety. These interventions can help women develop healthy strategies for coping and better understand the emotional changes they are currently experiencing.
“It is important for women to understand that they are not going crazy and that this is a chemical change in their body,” says Dr. Reed. “Now they can talk to their family and explain what’s going on, and it’s important that everyone in the family understand this.”
She adds that it is also important for women to examine whether there are other things going on in their lives that could be causing the anger. “Menopause may just be exacerbating it,” says Reed. “We know that at menopause, people who have anxiety and depression are more likely to experience mood changes.”
Supplements
“Many women do take various supplements for menopause-related symptoms, but even though many of them have been well studied, we haven’t seen any real benefit,” says Reed. That said, there are a few supplements that may help with select symptoms. Always speak to a doctor before starting or stopping any medications or supplements, even if they’re labeled “natural.”
Melatonin Taken as a supplement, this hormone that helps regulate our circadian rhythms, or sleep-wake cycle, may help in establishing good sleep patterns.
St. John’s Wort This is an herb and also a weak SSRI, says Busch, and it may be a good alternative for women who don’t want to take prescription medication.
Vitamin D There is no evidence that vitamins affect menopause symptoms specifically, but low levels of vitamin D are associated with increased symptoms of depression and anxiety. “Many women are low in vitamin D,” says Reed, “especially those living in northern climates where they may not get much sun during the winter. It is good to check levels and see if you may benefit from supplementing.”
When to See a Doctor
If your symptoms are mild, you may be able to manage them at home without needing any medication from your provider. But if symptoms are unbearable or are impacting your quality of life, it might be time to seek medical care.
“I think every woman deserves to have an informed conversation with a trained clinician about menopause, given the enormity of the impact these hormone changes have on women,” says Jordan. “Don’t be afraid to ask questions and do your reading too. Much has evolved in the area of menopause even in the last 10 years, so finding a provider who is up to date is essential.”
The Takeaway
Hormonal changes during perimenopause and menopause can cause mood swings, irritability, sleep disruptions, and even feelings of anger.
The expression of full-on rage may be more complex than can be explained by just hormone changes, as it may also be triggered by burnout, societal pressures, and everyday stressors,
The perimenopause period is the most challenging when it comes to mood swings, but it does stabilize as you enter menopause.
Treatments are available to help you manage your symptoms effectively, ranging from hormone therapy and other medications to lifestyle changes and psychosocial support.
John Paul McHugh, MD, is an obstetrician-gynecologist and lifestyle medicine specialist in southern California. He has always placed wellness at the center of his work, in both delivering babies and improving practice standards. Dr. McHugh believes that bringing lifestyle medicine to the center of health and wellness empowers patients to make the change they seek and enjoy the benefits of true wellness.
He is a graduate of Harvard Medical School and the Massachusetts Institute of Technology and a fellow of the American College of Lifestyle Medicine. He served as a department chair at Scripps Mercy Hospital in San Diego and is now the chair-elect for the American College of Obstetricians and Gynecologists for California.
He has published several articles in the American Journal of Lifestyle Medicine and served as a peer reviewer for many articles. He contributed to the first textbook of lifestyle medicine in women's health: Improving Women's Health Across the Lifespan.
Roxanne Nelson is a registered nurse and a medical/health writer who has written for a range of publications and for both healthcare professionals and the general public. Publications include Medscape, The Lancet, The Lancet Infectious Diseases, The Lancet Microbe, American Journal of Medical Genetics, American Journal of Nursing,; Hematology Adviser, MDEdge, WebMD, National Geographic, The Washington Post, Reuter's Health, Scientific American, AARP publications, and a number of medical trade journals. She has also written continuing education programs for physicians, nurses, and other healthcare professionals.
She specializes in writing about oncology, infectious disease, maternal and newborn health, pediatric health, healthcare disparities, genetics, end of life and access/cost of healthcare.. As an RN, she worked in newborn and pediatric intensive care, especially in settings with high rates of HIV infection and hepatitis B, and also in case management of NICU "graduates" who were now being cared for the home setting.
An avid traveler, Roxanne has traveled the globe and stepped foot on all seven continents. Some of her travel had a medical/healthcare focus, while the rest was pure adventure. She lives in the Seattle metro area with her partner and two cats, although that number tends to change!
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Silver NE. Mood Changes During Perimenopause Are Real. Here’s What to Know. Every Stage Health. February 2025.
Woods NF et al. Effects of Menstrual Cycle Phases and Reproductive Aging Stages on Arousal Symptoms: Observations From the Seattle Midlife Women’s Health Study. Menopause. May 27, 2025.
Andrew L. Coping With Menopause Rage and Anger. Menopause Care.
