Mood changes during the menopausal transition, from dread to rage (and everything in between)
What if the mood changes of perimenopause and menopause are not signs that you are malfunctioning, but invitations into a deeper truth? The dominant narrative tends to be one of pathology: this is a stage of life where “everything goes wrong,” just like how in younger years, periods were dismissed as unpleasant, inconvenient, and limiting. Breasts were framed as awkward. Fertility was reduced to either a burden or an asset. These stories were not authored by women in their wisdom, but by the patriarchy, capitalism, big pharma, and the medical-industrial complex.
But what if instead of pushing away these experiences as merely biochemical, or as problems to be solved by “balancing your hormones,” we widened the lens? What if we explored the critical tension between the biochemical, the psychosocial, and the cultural? What if these intense feelings—dread, rage, exhaustion, grief—are messengers, guiding us into the next evolution of our lives, and perhaps even our society?
THE FEELING OF DREAD: IS IT YOU, OR THE WORLD?
So many women we meet in the clinic describe waking with an overwhelming sense of dread or doom in their 40s and 50s. Biomedicine explains this through fluctuating estrogen and progesterone: estrogen modulates serotonin and dopamine, progesterone metabolises into a GABA-calming neurosteroid, and when these rise and fall suddenly, the amygdala—the brain’s fear centre—becomes hyper-reactive. Cortisol spikes on waking can leave us feeling anxious before the day even begins.
But hormones are not the whole story. We live in a hyper-complex, overstimulated, crisis-laden world. The natural world itself is in distress—burning, flooding, unravelling. What if women’s dread is not a hormonal failing, but an embodied recognition that something really is wrong? Not just in the self, but in the greater world we belong to.
Chinese medicine teaches that in perimenopause, the Chong Mai, the Sea of Blood, becomes turbulent. Qi rises rebelliously, creating surges of anxiety and fear. This is not pathology but initiation. The destabilisation of the Chong opens a portal to deeper awareness. The dread is not meant to be silenced but heard. It asks us: What will you do with this knowing? Will you numb it—or will you let it call you into action?
THE FIRE OF RAGE: FUEL FOR CHANGE
Rage is another common companion in the menopausal transition. In the mainstream story, this rage is dangerous, shameful, hormonal, something to suppress. But what if rage is not madness but medicine?
Biomedically, declining progesterone means less GABA buffering, so irritability rises. But psychosocially, rage often reveals where we have bent ourselves to fit a world that does not honour cyclic rhythms, embodiment, or the feminine. Through that lens, rage is justified. It is the fire that teaches us to say, “no more”.
Rage is sacred fuel. Perhaps it is not something to be medicated away, but something to be harnessed. In Daoist philosophy, when the Liver Qi is constrained for too long, heat rises, and anger appears. But anger can be creative—it can move stagnation, cut through illusion, and set things in motion. Feminism gave us a seat at the man’s table, but it rarely valued feminine power, grace, and wisdom on their own terms. Rage might be the midlife gift that forces us to change that.
EXHAUSTION: YOUR BODY CALLING YOU HOME
Then there is exhaustion. The bone-deep fatigue that so many women report. Yes, hormones play a role: disrupted sleep from night sweats, circadian cortisol shifts, thyroid changes, adrenal load. But look deeper. Many women are exhausted because they have become experts at ignoring their own biology for decades.
Our culture rewards pushing through, ignoring cycles, living as though the body were a machine. By midlife, the bill comes due. Chinese medicine would say the Yin has been depleted, the Kidneys overdrawn. The answer is not more pushing. The exhaustion is the body’s sacred invitation to rest, to restore, to realign with nature’s rhythms. It’s not failure—it’s opportunity.
CHINESE MEDICINE AND DAOIST PHILOSOPHY: INITIATION, NOT DECLINE
Perimenopause and menopause are not just biological declines. In Chinese medicine, they are initiatory thresholds. The Kidneys, storehouse of Jing, are shifting. The Chong Mai destabilises. The Heart and Shen become more vulnerable to disturbance. This can look like dread, panic, and mood swings. But in Daoist philosophy, the freeing of energy from reproduction opens the path to spiritual cultivation. The menopausal years are the gateway into wisdom, elderhood, and deeper power.
The spirits of the five Zang guide this transition:
The Shen (Heart spirit) feels the overwhelm, the dread, the existential alarm.
The Hun (Liver spirit) dreams the future and carries vision—this is where rage becomes creative action.
The Po (Lung spirit) grieves for what is lost—fertility, ecosystems, ways of being.
The Yi (Spleen spirit) gathers focus, sustaining care and labour.
The Zhi (Kidney spirit) holds the will to endure, to transform, to rise.
When the spirits work together, the turbulence of this transition becomes initiation into elderhood. You are not breaking down—you are becoming.
MHT, NATURAL SUPPORT AND WHOLE-PERSON CARE
At Vessel, we celebrate the profound shifts that can occur when a woman is finally heard by a menopause-informed GP and finds the right medical treatment, including MHT (menopausal hormone therapy). We don’t believe women should suffer through this time simply to glean meaning from it. Relief matters, and we recognise the destabilising effects that these mood experiences can have. We never judge the choice of chosen treatment intervention; in fact, we often guide women toward MHT when it fits their needs. But we also don’t believe it is the full answer.
MHT and other pharmaceuticals can be a tool. But even with hormones supported, the bigger questions remain: what is this stage asking of you? What new role are you stepping into? How will you tend your body, your soul, your community, and the natural world? Our approach is holistic: we support women whether they use MHT or not, helping them integrate body, mind, and spirit.
SUPPORT, STORIES AND CULTURE
In order to cross the shaky ground of perimenopause, we need more than prescriptions. We need stories, archetypes, and community. Just as we celebrate the maiden becoming mother*, we need to revere the turning of mother* into crone. Without cultural scaffolding, dread and rage feel like personal malfunctions. With scaffolding, they reveal themselves as universal thresholds.
Learning how to feel pain without collapsing into suffering is a spiritual practice. Many of us begin this practice only when the pain becomes unbearable. But it is never too late. We need support, care, and compassion. We need to be woven into cultures that honour women at every stage. We need power and empowerment, not pathologising.
A NEW WAY OF UNDERSTANDING AND EXPERIENCING
Mood changes in menopause are real. Biochemical, psychosocial, cultural—all at once. But they are not simply signs of a failing hormone system. They are invitations. The dread may be the Earth speaking through you. The rage may be the fuel for cultural change. The exhaustion may be your body's way of inviting you to remember how to rest. Chinese medicine teaches us that perimenopause is not a decline but a transformation. Daoism & spiritual practices remind us that initiation is never comfortable.
So what if, instead of asking how do I fix this?, we ask: what is this calling me toward?
SOUND LIKE A THREAD YOU’D LIKE TO EXPLORE WITH SUPPORT?
If this thread feels like one you’d like to explore with support, we would love to welcome you to Vessel Acupuncture and Chinese Medicine in Paddington. We work with women and people moving through perimenopause every day on these very experiences—bringing relief, clarity, and new possibilities. You can read more about how we support perimenopause and beyond by following this link: Brisbane Acupuncture for Perimenopause.
Book online today, we cannot wait to welcome you, exactly as you are.
*We recognise that not all women are mothers, and not all mothers are women and we celebrate the multitude of ways that we can give and nurture life.