Hormones in Motion: Why Menopause Isn't Just About Hormone Loss
- Wendy Drummond
- Jun 8
- 5 min read
Updated: Jun 23
Many women arrive in perimenopause feeling as though they've suddenly become someone they don't recognise.
They're more anxious than they've ever been. Sleep becomes elusive. Small challenges feel overwhelming. Concentration disappears. Emotions feel closer to the surface.
Often they're told it's "just hormones."
But what if the story is more complex than that?
What if menopause isn't simply about hormone levels declining, but about how our brains and bodies respond to hormonal change itself?
Menopause Doesn't Happen in Isolation
Menopause is often described as a single event that marks the end of reproductive life. In reality, it's one chapter in a much longer story.
From puberty to the menstrual cycle, pregnancy, postpartum recovery, perimenopause and beyond, women's bodies are constantly adapting to hormonal shifts.
Women don't suddenly become hormonally sensitive in their forties or fifties. For many, they've been navigating hormonal fluctuations for decades.
Research increasingly suggests that the menopausal transition is characterised not simply by declining hormone levels, but by substantial hormonal variability. During this transition, women experience significant fluctuations in oestrogen and progesterone that can affect mood, cognition, sleep, and overall well-being (Harlow et al., 2012; Jia et al., 2024).
The Hidden Impact of Hormonal Fluctuation
Oestrogen does much more than regulate reproduction.
It influences neurotransmitters such as serotonin and dopamine, supports sleep regulation, affects stress responses, and plays a role in emotional processing.
When hormone levels fluctuate, the brain must continually adjust.
For many women, these adjustments happen smoothly.
For others, hormonal changes can trigger:
Mood changes
Anxiety
Sleep disruption
Brain fog
Irritability
Reduced emotional resilience
Emerging evidence suggests that some women may be particularly sensitive to normal hormonal fluctuations. Their hormone levels aren't necessarily abnormal. Rather, their nervous systems appear to respond differently to hormonal change, a concept that has been proposed across conditions such as PMDD, postpartum depression, and perimenopausal depression (Schmidt et al., 2017).
Looking Back to Understand the Present
One of the most useful questions clinicians can ask is:
"How has this woman responded to hormonal transitions throughout her life?"
Past experiences often provide valuable clues.
Women with a history of depression appear to be at significantly greater risk of experiencing depressive symptoms during perimenopause, with some studies suggesting a five- to twelve-fold increase in risk (Venborg & Mauritas, 2023).
Similarly, a history of postpartum depression may indicate increased vulnerability during later hormonal transitions.
Patterns matter.
The body often leaves a trail of information if we know where to look.
PMS and PMDD: Early Warning Signs
For some women, hormonal sensitivity first becomes apparent during their reproductive years.
While many women experience some symptoms before menstruation, Premenstrual Dysphoric Disorder (PMDD) is different. PMDD involves severe emotional symptoms that occur during the luteal phase of the menstrual cycle and typically resolve once menstruation begins.
Interestingly, women with PMDD generally do not have abnormal hormone levels.
Instead, they appear to have a heightened sensitivity to normal hormonal fluctuations.
Research by Richards and colleagues (2006) found that women experiencing perimenopausal depression were substantially more likely to have a history of PMDD than women who did not experience depression during the menopausal transition.
In other words, hormonal sensitivity may reveal itself decades before menopause arrives.
ADHD and Hormonal Change
Another important piece of the puzzle is ADHD.
Oestrogen supports dopamine activity in the brain. When oestrogen levels fluctuate, dopamine regulation can become less stable.
For women living with ADHD, this may contribute to:
Increased emotional dysregulation
Executive functioning difficulties
Sleep problems
Burnout
Greater difficulty managing daily demands
Research has identified higher rates of hormone-related mood symptoms among women with ADHD, suggesting that hormonal transitions may amplify pre-existing neurodevelopmental vulnerabilities (Dorani et al., 2021).
Many women receive an ADHD diagnosis for the first time during perimenopause. Often, ADHD hasn't suddenly appeared. Rather, hormonal changes have reduced the effectiveness of long-standing coping strategies.
The Sleep-Anxiety-Mood Connection
One of the most overlooked aspects of perimenopause is sleep.
Hormonal fluctuations can contribute to hot flushes and night sweats, which disrupt sleep quality. Poor sleep, in turn, affects emotional regulation, concentration, stress tolerance, and mood.
Research suggests a cascading pathway whereby vasomotor symptoms disrupt sleep, increasing vulnerability to anxiety and depressive symptoms (Caruso et al., 2019; Zandg et al., 2024).
At the same time, anxiety often emerges before depression.
Women frequently describe:
Increased worry
Restlessness
Irritability
Racing thoughts
Feeling "on edge"
When we focus only on low mood, we risk missing the broader picture. Sleep, anxiety, and hormonal changes often interact in powerful ways.
Moving Beyond Symptom Reduction
Understanding hormonal sensitivity doesn't mean every emotional experience can be explained by hormones.
Nor does it mean women are powerless.
While biology matters, psychological flexibility plays a crucial role in how we navigate life's transitions.
Approaches such as Acceptance and Commitment Therapy (ACT) can be particularly helpful during periods of hormonal change. Rather than attempting to eliminate uncomfortable thoughts, emotions, or physical sensations, ACT helps people develop the ability to stay present, respond with self-compassion, and continue taking meaningful action aligned with their values (Hayes et al., 2012).
The goal is not to control hormonal fluctuations.
The goal is to build the capacity to live well alongside them.
A Different Conversation About Menopause
Perhaps it's time to move beyond the narrative that menopause is simply a story of hormonal decline.
For many women, menopause is better understood as part of a lifelong pattern of hormonal adaptation.
When we recognise hormonal sensitivity, identify patterns early, and adopt a personalised approach to care, we can better support women through one of life's most significant transitions.
Because menopause isn't simply about hormones disappearing.
It's about understanding how women have been adapting to hormonal change all along.
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