Why do I feel so flat in perimenopause, and what can I do about it?
- Nicola Shubrook
- 2 hours ago
- 4 min read
Feeling emotionally flat in perimenopause is common, and it is not the same as clinical depression. Several interconnected body systems are involved, and understanding them is the first step to doing something about it.
Image: Unsplash
The word that comes up most often in my clinic is not "sad," but "flat." My clients tell me they have lost their mojo, that everyday tasks feel overwhelming, and that all they want to do is lie on the sofa and doom scroll. They describe it as a muted version of themselves, with no drive or enthusiasm even for the things they normally love, and although they can still function, there is now a distance between them and their own life that was not there before.
If this sounds familiar, there is a reason it started in perimenopause, and it is not simply that your hormones are dropping. It is what those hormones were doing for your brain in the first place.
Oestrogen was running more than you realised
Oestrogen is not just a reproductive hormone. It is an active player in brain chemistry, supporting the production and activity of serotonin, the neurotransmitter most associated with mood stability and emotional resilience, influencing dopamine, which drives motivation, pleasure, and reward, and modulating GABA, the brain's main calming signal.
When oestrogen begins to fluctuate and fall in perimenopause, all of these systems are affected: serotonin production drops, dopamine signalling becomes less reliable, and the nervous system loses some of its natural buffer. This is not a mood disorder, although it can certainly feel like one. It is a physiological shift in brain chemistry driven by hormonal change.
But oestrogen is only part of the picture
I see in clinic is that the flatness almost always has more than one driver, and while oestrogen sets the stage, several other things tend to compound it.
Blood sugar instability
Oestrogen helps maintain the body's sensitivity to insulin, so as it falls, blood sugar regulation becomes less stable, and energy and mood can swing across the day, from a flat or foggy morning to a mid-afternoon crash to cravings in the evening. Many women interpret this as tiredness or low mood, when the immediate trigger is actually a blood sugar dip. Eating enough protein and fibre at each meal, and not skipping breakfast, are two of the most straightforward ways to stabilise this, and the effect on daytime mood and energy is often noticeable within days.
Disrupted sleep
Sleep changes are one of the most common perimenopausal symptoms, and one of the most underestimated mood drivers. Poor sleep has a significant direct impact on mood, and although the relationship runs both ways, the evidence suggests poor sleep affects mood more than mood affects sleep. Night sweats, waking at 3am, and difficulty dropping off are not minor inconveniences: they are direct contributors to how flat you feel the next day, which is why sleep needs to be part of any conversation about your mood.
Gut health
The gut and brain are in constant communication via the gut-brain axis, and the gut also plays a direct role in oestrogen metabolism, since an imbalanced gut microbiome can increase the breakdown of oestrogen before it can be used, contributing to lower circulating levels. Gut health is rarely the first thing anyone looks at in perimenopause, but in my experience it should be considered, particularly when mood symptoms come alongside bloating, constipation, or irregular digestion.
Additional reading:
A dysregulated stress system
Perimenopause often coincides with a particularly demanding life chapter, with career pressures, ageing parents, teenagers, and relationship strain all landing at once. The stress system relies on some of the same neurotransmitter pathways that oestrogen supports, so when both are compromised together, the nervous system has very little reserve left, and what would previously have felt manageable now feels overwhelming. That contributes to the flatness too.
What can actually help
The starting point is understanding which of these factors is driving your symptoms most, because the answer is different for every person. In clinic, I look at blood sugar stability, sleep quality and the reasons behind it, gut function, stress load and nervous system regulation, and nutrient status, since B vitamins, magnesium, iron, zinc and folate all affect neurotransmitter production directly, alongside the hormonal picture itself, whether through blood testing, functional testing such as the DUTCH test, or working alongside a GP or menopause specialist on HRT where appropriate.
Most women I work with have been told their bloods are normal, but a standard GP panel does not assess most of these things in the detail that is clinically useful, so there is usually more to look at.
Why antidepressants aren't always the answer
I hear all too often that women are offered antidepressants as the first step when their mood tanks in perimenopause, and yet this rarely provides a lasting solution. They may help in the short term, but longer term I often see them mask what is really going on, and coming off them later can bring its own difficult withdrawal effects. They also do not always work, particularly when the underlying issue is hormonal or gut related rather than a primary mood disorder. This is exactly why I created the Midlife Mood Reset.
The flatness is not permanent
It can feel permanent because it has often been present for months or years before a woman seeks support, but it is worth seeing it instead as a sign that several systems have shifted and need support. That support exists, it is specific, it is evidence based, and it works better when it is tailored to what is actually going on for you.
If you are wondering whether a root cause approach might help, a Clarity Call is the place to start.
