Can Menopause Change Your Personality? Doctors Explain The Phenomenon
Quick show of hands: Who’s heard the term “reverse puberty”? Anyone? It’s the nickname experts sometimes use to describe the process of perimenopause (the four- to 10-year transitional period leading into menopause). And, boy, is it an accurate description. Not only is your body phasing out of its reproductive years (menopause is marked by 12 consecutive months with no menstrual cycle), but your hormone levels can fluctuate wildly too. Remember how angsty and rage-filled you felt as a teenager during puberty? Well, welcome to reverse puberty as a mid-life woman.
During these years, a sense of feeling “not like yourself” is common, and can manifest in many ways. You may find your temper shortened. Your sex drive tamped down. Your mental acuity dulled. You may feel anxious or depressed. These are all typical side effects of the physiological shifts during perimenopause—but they can also be a result of the life stage during which perimenopause takes place, says MargEva Morris Cole, MD, assistant professor of obstetrics and gynecology at Duke University School of Medicine.
“Midlife is a time with a whole lot of stressors, and people sometimes discount that while they're focusing so much on their hormones,” she says. “In people's 40s and 50s, they've got responsibilities that weigh on them—whether it’s work or family—and then on top of that, feeling like they're aging and more tired when they're doing all of those things.”
Blend all of these changes together, and it can seem as if your entire personality has changed overnight. But has it truly? And what can be done about the Big Feels we have during this time? Read on for expert advice on navigating all those menopausal mood shifts.
Meet the experts: MargEva Morris Cole, MD, is an assistant professor of obstetrics and gynecology at Duke University School of Medicine and is a NAMS Certified Menopause Practitioner. Wendy Perello, MSW, LCSW, is a therapist licensed in Massachusetts, New Jersey, and New York.
How Perimenopause Affects The Brain—And Your Mental Health
Yes, hormones (in particular, shifting levels of estrogen, progesterone, and testosterone) play a key role in your mood during perimenopause. And while every woman will experience these shifts differently, Dr. Cole says she’s noticed general themes in her work.
“When people are in early perimenopause or late reproductive years, the problem really isn't dropping hormone levels—it's crazy surges and crashes,” she says. “People can end up with really high estrogen levels when they're ovulating and then they drop later in the cycle. Often what people are complaining about then are really intense mood swings and anger.”
As a woman shifts into the later stages of perimenopause, estrogen levels drop overall, often accompanied by a different set of symptoms.
“It varies, but for a lot of people, this is when they start talking about brain fog and anxiety and low mood and feeling just kind of irritable all the time,” Dr. Cole says, adding that some patients have likened the experience to having a cloud over their head. “They may not say ‘I feel blue,’ or ‘I feel down,’ or ‘I feel less vibrant,’ but they just have this sense of being weighed down.”
Hormones are only part of the equation, though.
Other common perimenopause symptoms, such as vasomotor symptoms that include hot flashes and night sweats, can also have a ripple effect when it comes to your mental health. For instance, if night sweats are consistently waking you up at 3 a.m. and disrupting your sleep cycle, you’re probably going to feel irritable, rather than well-rested, the following day. Or if unexpected hot flashes arrive during an important work meeting or first date, you could be left feeling embarrassed or anxious.
“People that I see, a lot of times, aren't coming in because of menopause—they're coming in because they feel anxious or they feel depressed,” says therapist Wendy Perello, MSW, LCSW. “My job is to help get to the root of where that stuff is coming from. When I see women in this age group, I talk about perimenopause and menopause, because a lot of women don't even realize this could be impacting how they feel.”
And the impact can be significant: Menopause has been linked to anxiety and depression, according to a 2023 systematic review in Australasian Psychiatry, which found that menopause “increases vulnerability to depression and anxiety.” While the review authors theorized this could be due to fluctuating hormones, they also didn’t discount the possibility of vasomotor symptoms and other menopausal symptoms having an effect. (More research is needed on that front!) The review also found that women with a history of a major depressive disorder are more likely to have a recurrence during the menopausal transition.
Ultimately, as your body undergoes changes during perimenopause, so too will your mood, which may cause you to behave in ways you typically wouldn’t—whether it’s lashing out at your partner over loading the dishwasher wrong or crying at your desk when you get a less-than-glowing performance review.
Are these personality changes permanent?
While any significant life events, such as menopause, could leave their mark, both of the experts WH spoke with agreed that this transitional period does not fundamentally change who you are as a person. And the good news is that symptoms may lessen or even go away once you’re fully postmenopausal.
“The brain and mood symptoms often within, let's say a couple of years of the final menstrual period, tend to stabilize,” Dr. Cole says. “For things like brain fog or feeling like you're having a hard time multitasking, people's brains have enough plasticity that they remodel, and people manage to get back to their same work efficiency and thinking efficiency that they used to—even if it may be in a slightly different way—they've learned new ways of managing.”
As for whether depression symptoms specifically lessen after menopause, the Australasian Psychiatry systematic review found mixed results: Some quoted studies found an elevated risk for depression after menopause, while others found the opposite. (Another area that could potentially benefit from further study!)
How To Manage—Even Harness—This Period Of Change
If you’re struggling with mood shifts during this transition, there are many possible strategies for coping, says Dr. Cole. “In perimenopause and in menopause, we don't just look at one hammer to attack the problem,” she explains.
The first step your doctor will likely recommend is lifestyle changes.
“Now is the time to do modifiable things that will improve your long-term health and wellbeing,” Dr. Cole says. “How do you modify your stressors? How do you establish boundaries with family and friends? How do you make sure that you are taking time for yourself? That you are eating a diet that makes you feel well and getting your exercise in and whatever works best for you as far as managing mood?”
For many, that latter objective may also entail therapy, during which your therapist can also help you identify possible positive avenues for change.
“I think it’s important to identify the things that you think are making you feel this way,” Perello says. “If it's anxiety, do you meditate? Do you use box breathing? Do you use a journal? Acknowledge that it's also part of your life and it's something that you can't necessarily control, but you do have ways to manage it, like hormone therapy.”
Hormone therapy is another one of those therapeutic hammers Dr. Cole was referencing. Depending on your unique concerns, your doc may prescribe you any combination of estrogen, progesterone, and/or testosterone to help regulate your levels, which could, in turn, help stabilize your mood. In addition to—or in lieu of—hormones, your doc could also prescribe a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) to help manage symptoms. And not just the mood ones! Even when a patient isn’t on hormone therapy, SSRIs and SNRIs have been shown to help with hot flashes.
While it’s easy to focus on the downsides of this time of change, remember that there are many positives that come with menopause. If you’re someone who’s been concerned about preventing unwanted pregnancies (hello, daily birth control pills!) or had painful or heavy periods, those issues are now behind you.
And given that this time often coincides with other life changes, such as children leaving the nest (or—at the very least—becoming more independent), menopause could mark a new phase of self-discovery and self-care in your life.
“I think it can be a very liberating time where you're focusing more on yourself,” Perello says. “How do I take care of myself at this stage of my life? What do I do for my body? You’re probably more in tune with how you feel because you've been forced to pay attention to sleeping and eating and exercising and all that, which hopefully has helped.”
It’s also helpful to remind yourself that you are not alone in this. Millions of women have—and are—going through the same thing you are right now.
“If we can be positive about it, let's do that,” Perello says.
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