There was a popular Australian TV series “Puberty Blues,” which aired in the previous decade. It was based on an acclaimed book of the same name and focused on the lives in transition of two teenage girls in Sydney going through puberty. But let’s have a quick show of hands: Have you ever contemplated the term “reverse puberty blues”? It’s a nickname sometimes used to describe the difficulties experienced when women are going through perimenopause – the transitional period leading into menopause – and let me tell you, calling it “the blues” is pretty spot-on. Just like puberty, your body is undergoing massive changes when reverse puberty shows up. Your reproductive years are winding down (officially, menopause is defined as an entire year without a period), and your hormone levels are all over the place. Remember those intense mood swings and bouts of rage as a teenager? Well, welcome to the midlife version.
Many women experiencing “the blues” say that they feel off – not quite like themselves during these years. Some snap more easily. Others feel their sex drive has disappeared. Brain fog becomes a real struggle. Anxiety and depression creep in. As a mental health adviser specializing in menopause, I see these patterns of reverse puberty blues every day. But as much as hormones play a major role, we can’t ignore everything else that’s going on at this stage of life.
Midlife is stressful. You may juggle demanding careers, caring for aging parents, raising teenagers, or all of the above. On top of that, you’re navigating an aging body that doesn’t always cooperate. It’s no wonder so many women tell me they feel exhausted, overwhelmed, or just plain different from who they used to be.
But does menopause actually change your personality? And, more importantly, what can we do to manage these big feelings? Let’s break it down.
How perimenopause affects your brain and your mental health
Hormones play a huge role in mood shifts during perimenopause. As estrogen, progesterone, and testosterone fluctuate, emotions can feel like they’re on a wild rollercoaster ride. And in my years of working with patients, I’ve noticed a pattern.
In early perimenopause, the problem isn’t so much that hormone levels are dropping—it’s that they’re surging and crashing unpredictably. You might have sky-high estrogen levels when you ovulate, then experience a sharp drop later in the cycle. That can trigger intense mood swings, irritability, and even anger.
Then, as perimenopause progresses and estrogen levels actually start to decline, a new set of symptoms takes center stage. Patients describe feeling mentally sluggish, anxious, or just generally off. Some even say it feels like a cloud is hanging over them. They might not identify it as classic depression but rather a persistent weight pressing down.
But here’s something I always remind people coming to me for help: hormones aren’t the whole story.
Other perimenopausal symptoms, like hot flashes and night sweats, can have a ripple effect on mental health. Imagine waking up drenched in sweat at 3 a.m. night after night. How rested are you going to feel the next day? Not very. And if you’re suddenly sweating during an important work meeting or first date? That anxiety spike is completely understandable.
Many women don’t even realize that menopause could be fueling their reverse puberty.
According to the Australasian Menopausal Society, “The menopausal transition is a time of increased risk of mood disturbance. Even women with no previous history of depression… are at increased risk of depressive symptoms compared to premenopausal women.” I often see patients who come in feeling anxious or depressed but have no idea that perimenopause might be a factor. My job is to help them connect the dots. While fluctuating hormones may be partly responsible, researchers also suspect that other menopause-related symptoms, like poor sleep and stress, could play a major role.
And if you’ve had a history of major depression? The menopausal transition can sometimes trigger a recurrence. It’s not your imagination. You’re not just “being emotional.” These changes are real, and they deserve attention.
Are these personality changes permanent?
This is one of the biggest concerns about reverse puberty that women have. They want to know: Am I going to feel this way forever? Will I ever get back to “normal”?
Here’s the reassuring truth: Your core personality isn’t changing.
While menopause is a major life event that can leave its mark, it doesn’t fundamentally redefine who you are. And the good news? Many of the symptoms you’re experiencing – especially brain fog and mood swings – often improve once you’re fully postmenopausal.
The brain has an incredible ability to adapt. For most of us, within a couple of years after our final period, things tend to stabilize. Our thinking becomes clearer. We may not multitask exactly the way we used to, but our brain finds new ways to be efficient.
As for depression? Research on whether symptoms improve after menopause is mixed. Some studies show a decrease in risk, while others suggest the opposite. What I can say from experience is that with the proper support, most women find their emotional footing again.
How to manage – even harness – this period of change
If you’re struggling with mood shifts, know this: There are options. And as I always remind myself, we shouldn’t rely on just one solution. It’s better to take a whole-body approach.
Step one. Lifestyle changes.
Now is the time to focus on what I call modifiable stressors. Can you set firmer boundaries at work? Can you carve out time for movement and nourishing foods? How can you prioritize yourself amid all the chaos? These small shifts have a huge impact on emotional well-being.
Therapy can also be incredibly beneficial. When I try to help perimenopausal women, I encourage them to explore what’s making them feel this way. Is it anxiety? Then, let’s try meditation, box breathing, or journaling. Is it a sense of loss? Then, let’s talk about how to reclaim joy. You may not be able to control every symptom, but you do have tools to navigate them. 
Step up for your meds.
Yes, for some women battling reverse puberty, hormone replacement therapy can be a game-changer. Depending on your symptoms, your doctor might recommend estrogen, progesterone, or even testosterone to help stabilize your mood.
When it comes to easing the transition through perimenopause, hormone therapy is often one of the most effective tools in a doctor’s arsenal. Estrogen replacement therapy (ERT) via oral medications like Premarin, Prempro, or Duavee can significantly reduce symptoms like hot flashes, night sweats, mood swings, and brain fog. Because estrogen levels drop dramatically as menopause approaches, supplementing with estrogen can help restore a sense of balance. However, estrogen alone isn’t always the answer, especially for women who still have their uterus intact. Unopposed estrogen can increase the risk of endometrial cancer, which is why doctors often pair it with progesterone, either in ointment forms, such as ProFeme, or oral meds, like Prometrium, to protect the uterine lining.
Another key hormone to consider is testosterone, which plays a crucial role in energy levels, libido, and cognitive function. Many women experience a decline in testosterone during perimenopause, leading to fatigue, brain fog, and a diminished sex drive. While testosterone therapy can help address these issues, it must be carefully balanced with estrogen. One of the easiest ways of doing this, without disrupting the body’s hormone balance, is with the externally applied cream AndroFeme, which delivers the correct dose when perimenopause sets in.
Be aware…too much testosterone without enough estrogen can lead to unwanted side effects like acne, hair loss, or mood instability, while too much estrogen without the right balance of testosterone may increase cancer risk. This delicate balancing act is why hormone therapy should always be personalized and closely monitored by a healthcare provider.
For those who aren’t candidates for hormone therapy or prefer non-hormonal approaches, doctors may prescribe selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) like Celexa (citalopram), Prozac (fluoxetine), Zoloft (sertraline), Lexapro (escitalopram), Trintellix (vortioxetine), Paxil (paroxetine), and Luvox (fluvoxamine), to help manage mood swings, anxiety, and even hot flashes. Additionally, newer non-hormonal medications like Vezoah, a neurokinin-3 receptor antagonist, have shown promise in reducing hot flashes by targeting the brain’s temperature regulation system. Some women also find relief through low-dose birth control pills during early perimenopause, which can help regulate hormone fluctuations before transitioning to traditional menopause treatments.
Ultimately, the best approach is highly individualized. Before recommending a treatment plan, a good doctor will assess a woman’s unique symptoms, medical history, and risk factors. Whether it’s hormone therapy, non-hormonal medications, or a combination of both, the goal is to make this transition as smooth as possible so women can feel like themselves again, with their vitality and well-being intact.
Menopause isn’t just the ending. It’s the beginning of the rest of your life
I get it. It’s easy to focus on the struggles of reverse puberty. But let’s not forget the benefits. If you’ve spent decades managing birth control or suffering through brutal periods, that chapter is finally closing. And for many women, this is also a time of personal rediscovery.
Your kids may be more independent. You will have more time to actually think about yourself. And yes, your body is changing, but you’re also becoming more in tune with what it needs.
This can be an incredibly freeing time.
I see it all the time – women who, after years of putting everyone else first, finally turn inward and ask, What do I want? What makes me feel good? That’s powerful.
And most importantly? You are not alone. Millions of women are navigating this transition through reverse puberty right alongside you. Let’s talk about it, let’s normalize it, and if we can, let’s even embrace it.
If we can be positive about it – let’s do that.
