Is This Depression? Or Perimenopause Rage?

Ragey? Let’s talk biology.

If you’ve found yourself snapping more than usual lately, at work, at your partner, at your kids, at the cat, you’re not alone.

Recently, a high-achieving midlife patient opened a session with:

“I hate my effing boss and I didn’t get the job. I need an antidepressant.”

But as we talked, what stood out wasn’t feeling sad.

It was irritability.

A much shorter fuse than she was used to. And a growing fear that she was becoming someone she didn’t like. She felt like she was becoming someone she didn’t recognize.

So we changed the question.

Not “What’s wrong with you?”

But “What might be happening biologically?”

How Perimenopause Affects Mood

Hormones can influence far more than hot flashes.

In perimenopause:

• A drop in progesterone can increase anxiety and lower stress tolerance.
• Changing estradiol levels can affect dopamine and serotonin, flattening mood or amplifying irritability.

That doesn’t mean every mood change is hormonal. Life stress, poor sleep, and medical issues matter too.

But when reactions feel bigger than the situation, biology is worth considering.

Multiple causes mean multiple possible solutions.

That might include:

• Hormonal or non-hormonal medication
• Therapy to build coping skills
• Prioritizing sleep
• Or a combination of the above

You don’t have to guess.

One Thing You Can Do Right Now

Track it!

Your mood, your anxiety, your irritability, whatever you’re noticing that you don’t like.

Pick a simple time frame like 7 to 10 days.

Write notes in your phone or on your calendar. Notice when things spike. Look for patterns.

Then bring that information to your doctor or therapist.

Patterns provide clarity while information builds agency.

You’re Not the Only One

A few weeks ago, I completely lost it over a microwave beeping. It was not my finest moment by far.

Midlife can shrink the time between irritation and explosion.

But awareness changes things and when we can see what’s happening, we can work on it.

• We can repair.

• We can explain.

• We can adjust.

And sometimes, like in my example, it starts with a simple apology. Because hormones may explain some behavior but they don’t excuse everything.

A Book That Captures This Phase Beautifully

If you want to feel understood, I often recommend Sandwich by Catherine Newman. I’ve added it to my recommended reading list here.

It captures how quickly emotions can oscillate in midlife; sometimes in ways even we can’t predict. And sometimes feeling seen is the first step toward feeling steadier.

You don’t have to rage on.

It’s possible to regain the calm you once had, but not by beating yourself up.

Blame your biology.

Then build your plan.

If you’re in Florida, Texas, New York, Ohio, or Indiana and would like help sorting this out, you can learn more about working with me here.