Mood Swings During Menopause: What Really Helps

What the guideline recommends

The German S3 guideline on peri- and postmenopause clearly categorizes the available options. Hormone therapy may be considered if psychological symptoms appear as a consequence of menopause or worsen concurrently with it. For depression requiring treatment, drug therapy follows general treatment guidelines, as there are currently no specific efficacy studies for perimenopause.

The guideline also points out that the connection between hormonal changes and mood is not always clearly proven but cannot be ruled out. Classical SSRI antidepressants are not recommended as a first choice against hot flashes alone, but they are part of general treatment for true depression.

Interestingly for herbal approaches: According to the guideline, perimenopausal women can be offered isoflavones for depressive symptoms and anxiety. However, for postmenopausal women, isoflavones should not be specifically used against depressive symptoms, as the data here is weaker. Caution is explicitly advised for black cohosh (Cimicifuga), as the evidence for mood and depression is too limited. Forms of exercise such as yoga and Qigong, as well as cognitive behavioral therapy, are also mentioned as supportive measures.

Saffron: the most compelling research

Among herbal active ingredients, saffron has received the most attention in recent years. In a randomized, placebo-controlled study with 86 perimenopausal women, one group took 28 milligrams of a standardized saffron extract (affron) daily for twelve weeks. A significantly greater improvement in psychological symptoms was observed compared to placebo, with about one-third fewer anxiety and low mood symptoms compared to baseline.

A more recent, also placebo-controlled study from 2026 investigated the same saffron extract in women between 50 and 70 years of age with low mood and poor sleep. Here, too, the same daily dose of 28 milligrams was used for twelve weeks, focusing on mood and sleep quality. The 30 milligrams used in the Midlife Formula is close to this investigated dose.

Why saffron might affect mood is not yet fully understood. It is discussed that its ingredients, such as crocin and safranal, are linked to the serotonin system and have antioxidant properties. This is a plausible approach, but not proof of a specific effect in the body.

Important for classification: In the perimenopause study, saffron had no effect on hot flashes and physical symptoms that clearly differed from placebo. These are also individual, comparatively small studies. However, the mood-lifting effect of saffron has also been observed in further studies in adults, which makes the overall data promising, even if it is not yet conclusive. Saffron can therefore be supportive, but it does not replace medical treatment.

Overview of phytochemicals and nutrients

In addition to saffron, other substances are discussed. An honest classification is more important than grand promises.

• Isoflavones from red clover or soy:plant-based substances with weak estrogen-like effects. According to guidelines, they can be offered to perimenopausal women for depressive symptoms and anxiety.
• L-Theanine:an amino acid from green tea. Studies in adults have shown a calming effect on stress and tension, usually at higher doses. There are currently no specific studies for menopause.
• Apigenin:a phytochemical associated with relaxation and sleep. The evidence for this is still early.
• Magnesium and B vitamins:they contribute to the normal function of the nervous system and psyche and are a sensible foundation, especially with a one-sided diet.

Especially in midlife, a good basic supply is not a given. A one-sided diet, stress, and a changed metabolism can lead to a shortage of important nutrients, and these are precisely what are relevant for the nervous system and mood. No single substance is a switch for a good mood. A combination of a solid nutrient base and targeted, well-researched active ingredients is more sensible.

What you can do in everyday life

Lifestyle has a major impact during this phase, often more than many expect.

• Exercise:regular exercise and meditative forms such as yoga or Qigong are explicitly mentioned in the guidelines for psychological complaints and quality of life.
• Sleep:sleep and mood are closely linked. If hot flashes disturb sleep, it is worth addressing this specific point.
• Stress and thoughts:cognitive behavioral therapy can help to better cope with symptoms and distressing thoughts.
• Everyday factors:alcohol and a lot of caffeine can increase restlessness and sleep problems. Daylight in the morning and a reasonably fixed daily rhythm help the body get back into sync.
• Connection:social contacts and openly addressing this phase of life provide noticeable relief. Just knowing that the symptoms have a biological background takes pressure off many women.

Rarely is a single measure most effective, but rather the combination: exercise, good sleep, fewer irritants, and a supportive environment interact.

When you should seek medical help

Mood swings are part of menopause, but not every low mood is purely hormonal. Talk to your doctor if your low mood lasts longer than two weeks, if you lose joy and interest in almost everything, if you feel hopeless, or if thoughts arise that life is no longer worth living. These are not signs of weakness, but an important reason to seek support. A thyroid disorder can also cause similar symptoms and can be clarified with a simple blood test. Effective help is available, from counseling options to herbal options to hormone therapy, and seeking support early is a sign of strength, not weakness.

Conclusion

Mood swings during menopause are real, common, and biologically based. They are primarily caused by the significant hormonal fluctuations of this phase, which affect neurotransmitters in the brain. This knowledge alone relieves many women of the burdensome feeling that something is wrong with them.

A multi-layered approach is helpful: a good nutritional foundation, well-researched active ingredients such as saffron and isoflavones, a coherent lifestyle with exercise and sleep, and, if necessary, medical support. None of these components alone is the complete solution, but together they can make a big difference. And if symptoms become severe, seeing a doctor is the most important step. You don't have to go through this phase alone or in silence.