Why Energy, Mood and Libido Can Shift During Perimenopause

Perimenopause is often described as the time when periods become irregular. For many women it is also when energy dips, mood becomes harder to manage, and interest in sex fades, sometimes years before a period stops altogether. These changes can feel confusing, especially when a short appointment or a routine blood test suggests everything is normal. Oestrogen gets most of the attention, but it is not the only hormone involved. This article looks at what shifts during perimenopause, what testosterone does in the female body, which symptoms are worth tracking, and how to describe them clearly to a doctor.

What Happens to Hormones in Perimenopause

Perimenopause is the transition leading up to menopause, which is confirmed after 12 months without a period. It usually begins in the 40s and can last several years. During this time, oestrogen and progesterone do not decline in a smooth line. They rise and fall unpredictably, which is why symptoms can change from one week to the next.

These swings affect more than the menstrual cycle. Oestrogen influences sleep, body temperature, mood regulation, and vaginal and bladder health. Progesterone has a calming effect for many women, so lower levels can contribute to poor sleep and irritability. Broken sleep then feeds into tiredness and low mood, which makes it hard to tell which symptom came first.

The Role of Testosterone in Women

Women produce testosterone too, mainly in the ovaries and adrenal glands, though in much smaller amounts than men do. It contributes to sexual desire, muscle and bone strength, and for some women, mood and motivation.

Levels tend to decline gradually from a woman's twenties and thirties rather than dropping suddenly at menopause. By perimenopause they may already be lower than before, and the other hormonal changes happening at the same time can make the effects easier to notice. Research on testosterone therapy in women is still developing. The strongest evidence relates to low sexual desire after menopause, with less clear evidence for energy and mood.

Common Symptoms Worth Tracking

Perimenopause symptoms vary widely from one woman to the next. Some of the most commonly reported include:

• Irregular, heavier or lighter periods

• Hot flushes and night sweats

• Poor or broken sleep

• Tiredness that rest does not fix

• Low mood, anxiety or irritability

• Trouble concentrating, often described as brain fog

• Reduced interest in sex, or changes in arousal and comfort

Many of these overlap with other conditions, including thyroid problems, iron deficiency and depression. That is one reason to speak to a doctor rather than assume hormones are the cause.

How to Describe Your Symptoms to a Doctor

Appointments are short, so preparation helps. A simple diary kept over a few weeks makes patterns easier to see than memory alone. Note down:

• Sleep, including when you fall asleep and how often you wake

• Energy levels through the day

• Mood, anxiety and irritability

• Period dates, flow and any spotting

• Sexual desire and comfort

• Hot flushes and anything that seems to trigger them

Be specific and plain. "I wake at 3am most nights and feel flat all day" gives a doctor more to work with than "I'm tired". Say how long the changes have lasted, how they affect work and relationships, and what you have already tried. Libido is often left out because it feels awkward to raise, but it is a valid health concern and doctors are used to discussing it.

It also helps to ask directly which tests and treatments are appropriate for your age and medical history.

Treatment Options and Where Testosterone Fits

Treatment depends on your symptoms, age and medical history. Hormone replacement therapy (HRT) is a common first step for symptoms such as hot flushes and night sweats. Other options include cognitive behavioural therapy, lifestyle changes, and non-hormonal medicines for specific symptoms.

Testosterone is a separate conversation. When low libido and persistent fatigue continue despite other changes, some clinicians will discuss prescription testosterone cream for women as part of a wider hormone plan. Menopause guidelines, including those in the UK, suggest doctors consider testosterone for menopausal women with low sexual desire when HRT alone has not helped. Treatment should come with proper follow-up and monitoring, and it should only start after a consultation with a qualified clinician.

Lifestyle Support That Still Matters

Medication works best alongside the basics. Strength training twice a week helps maintain muscle and bone, which matter more as oestrogen falls. A regular sleep routine, less alcohol (which can worsen night sweats and disturb sleep), and enough protein at meals all support energy. Walks, time with friends or counselling can ease the mood changes that often come with this stage.

Looking After Yourself Through the Transition

Perimenopause is common, but women do not have to put up with it in silence. Shifts in energy, mood and libido have physical causes, and they often respond to treatment once they are properly described and assessed. Tracking symptoms, asking direct questions and following up are the steps most likely to get you useful answers.

Medical Disclaimer

This article is for general information only and is not a substitute for medical advice. Speak to a doctor or qualified healthcare professional before starting or changing any treatment, and seek advice about any new or worsening symptoms.