Hormonal changes in perimenopause can trigger one of its most common symptoms and one that can really affect a woman’s happiness: rage! Perimenopause rage not just caused by hormones; factors such as gut health, liver function, and stress resilience play an equally crucial role.
Integrative Medicine Specialist and guest blogger, Dr. Anna Forbes, explores how women can tackle these symptoms holistically, fostering a smoother transition and unlocking the potential for thriving in midlife and beyond.
What is perimenopause rage?
Mood swings, irritability, low mood, and even feelings of anger or rage, are common – especially during perimenopause when your hormones are in a state of flux.
What causes perimenopause rage?
Many women already have hormonal imbalances before the age of 40. The first hormone to be hit is progesterone (which is calming), while oestrogen declines more slowly. This creates a state of oestrogen dominance, fuelling symptoms like anxiety, anger and mood swings.
When the liver and digestive system aren’t functioning optimally old hormones and toxins aren’t efficiently eliminated. If the gut microbiome is out of balance, oestrogens that are supposed to eliminated get reabsorbed which worsens oestrogen dominance and inflammation.
Chinese medicine has long linked an overburdened liver to anger. When the body is struggling to detoxify and regulate hormones, emotional symptoms can become overwhelming.
So many women enter perimenopause already inflamed, stressed, and running on empty. It’s no surprise they feel angry! On top of which their gut is inflamed and their liver is sluggish, all of which feed hormonal imbalances and inflammation.
Most women in midlife are running on the stress hormone cortisol. Studies have shown that increased oestrogen in perimenopause leads to higher levels of cortisol. Since cortisol and progesterone have an inverse relationship, the more stressed a woman is the lower her progesterone levels become. This amplifies mood swings, irritability, and rage.
Poor sleep and disordered blood sugar control can also contribute. Although mood symptoms like anxiety can influence sleep problems, research suggests that poor sleep has a much bigger impact on mood than the other way around.
What’s more, as oestrogen levels change your blood sugar control can get worse, leading to blood sugar dips that trigger low mood and irritability.
Raging for a reason?
Perimenopause often comes at a time of increased life stresses and responsibilities. You may have a demanding job or children and older parents relying on you. Many women have put up with years of frustration. Then perimenopausal hormone changes come along reducing tolerance and allowing rage to surface.
All of the ancient traditions of medicine from around the world have recognised for a very long time that suppressed anger can lead to all kinds of physical health problems. More recently, a new field of medicine called psychoneuroimmunology has confirmed that thoughts and emotions really do affect our health. Perimenopausal anger can actually be a gift, like a safety valve, forcing us to let off the steam of suppressed emotion before it goes deeper, creating havoc in the form of physical illness.
However, it can be scary when your mood seems beyond your control. This is where Mind-Body-Medicine options such as Emotional Freedom Technique (EFT) and Acceptance and Commitment Therapy (ACT) can help. These therapies target the underlying emotions, allowing anger, frustration and other built-up emotions to be dissipated instead of suppressed.
Diet & lifestyle support for perimenopause rage
Studies show women in cultures with a more natural diet, relaxed lifestyle, and strong community don’t experience menopause the way we do in the West. What you eat and how you structure your day can have a significant impact on your hormones and mood.
Eat to balance blood sugar
Following a blood sugar balancing diet can help to balance your mood and stabilise energy levels. Include a wide range of vegetables and fruits, high-quality protein such as wild or grass-fed meat along with nuts and seeds, gluten free whole grains, plenty of healthy fats and oily fish.
This will provide you with all the fibre, healthy fats and vitamins you need. It will also deliver high levels of plant compounds called phytoestrogens which can help to balance hormone levels.
As much as possible aim to cut our white carbohydrates, processed and sugary foods.
Have some probiotic foods everyday
Foods such as sauerkraut, kimchi, water kefir, kombucha and other naturally fermented foods can help to support the balance of the gut microbiome. Aim to include one fermented food each day.
Perimenopause & the importance of supporting your liver
Foods which support the liver are also very helpful when it comes to anger, so eating organic liver, artichoke, beetroot and other liver-loving foods is a good idea.
Practice better sleep hygiene to help your mood
Poor sleep can quickly lead to low mood, increased stress and irritability. One way to increase your chances of a good night’s sleep is by improving your bedtime routine. Go to bed and get up at the same time each day, avoid caffeine after 12pm and don’t use your phone or other devices in the 2-3 hours before bed.
Exercise to relieve stress
Regular exercise can boost your levels of stress-relieving endorphins and provide an outlet for feelings of anger.
Drink less alcohol
Alcohol disrupts the balance of serotonin and dopamine in your brain, affecting your mood. It can also magnify feelings of resentment, anger and anxiety so it’s best avoided or kept for special occasions only.
Practising mindfulness can help you process your feelings
Regular mindfulness practices can make it easier to process feelings of rage constructively. Mindfulness also lowers levels of the stress hormone cortisol.
Testing and personalisation
In our clinic we usually start by getting a full hormone overview with a DUTCH test, as well as assessing nutrient status, the gut microbiome and looking at nutrigenomic profiles to see whether there are any genetic factors that might be affecting hormonal balance and mood. This allows us to create a personalised approach.
In addition to tailored supplements, diet and lifestyle, we often include herbs to support hormones and mood.
Herbal remedies containing phyto-sterols can be used to smooth out the fluctuations in hormone levels. We also often include at least one herb that will help the liver to metabolise hormones and support the gut with excretion. If there are feelings of stress and overwhelm, nervine herbs that support calm and sleep, and adaptogens that moderate the stress response can also be helpful.
Thanks to Dr. Anna Forbes BMedSci(Hons), MBBS, DHP, MDCH, DipSIM for this insightful and empowering blog.
Dr. Anna Forbes is an Integrative Medicine Specialist and Founder of the Forbes Clinic of Integrative Medicine www.theforbesclinic.co.uk
If you have questions regarding the topics that have been raised, or any other health matters, please do contact them using the details below:
nutrition@cytoplan.co.uk
01684 310099
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Last updated on 16th April 2025 by cytoffice
