Perimenopause rage: what it actually feels like, and why you're not becoming a different person

You're 39, or 43, or 46. Something small happened this morning. A question asked twice. A cupboard left open. A shoe that wasn't where it was supposed to be.

And you heard your own voice come out too loud.

Not a raised voice. Not a sharp tone. Something with heat in it that had already arrived before you'd decided anything, moving through your chest and your arms while the thinking part of you was still catching up.

Then it was over. And you were standing in the kitchen with your hands on the bench, wondering who that just was.

If you're reading this in the car with the engine off, still going over it, you're in the right place.

I've done it too. I'm 44. It started when I was 39 and I didn't have a name for it until I was 41.

This isn't a bad temper. It's rage.

I want to be precise about the word, because the wrong word is part of why this goes unnamed for years.

Irritability is being short with someone in traffic. Being snappy. Having a day. We already have words for those, and they're not this.

This is the disproportionate kind. The frightening kind. The size of the reaction has nothing to do with the size of the thing, and you know that while it's happening, which somehow makes it worse.

Because you've managed your own temper perfectly well for twenty years. You know how to be annoyed and not act on it. There's normally a gap between the thing happening and you responding, a half second where you choose.

And now there isn't.

It's already underway, and you're watching it from somewhere slightly behind your own eyes. Hearing the volume. Noting, quite calmly, that this is too much. And unable to get in front of it.

And what comes out isn't even about the shoe. You both know that. Neither of you says it.

Then the twenty minutes afterwards, which nobody warns you about at all.

The quiet in the room. Someone you love standing very still. The careful look on a face that's working out whether it's safe to speak yet. And you, cleaning something that doesn't need cleaning, because your hands need somewhere to be.

You apologise. You mean it.

And underneath the apology you're doing the maths. That's twice this month. Three times. Was it four? You don't write it down anywhere, but you're keeping count, privately, the way you'd keep count of something shameful.

Then comes the thought that actually frightens you, the one you haven't said out loud to anybody.

What if this is just who I am now.

What if the version of me that was patient was the effort, and this is what's underneath.

That's the loneliest part. Not the shouting. The fact that you can't explain it to the person you just did it to, because you don't understand it yourself, and "I don't know why I did that" sounds like an excuse even when it's the most honest sentence you have.

I hid it for two years. Not to protect my family. Because I was ashamed.

Why it's the people you love who get it

There's no study I can hand you for this part. Just the pattern, and I've lived it.

It doesn't happen at work. It doesn't happen at school pickup. It doesn't happen to the driver who cut you off on the Princes Highway, who genuinely deserved it.

It happens at home.

All day you hold a version of yourself together, and that holding costs something. Then you walk through your own front door, where the people who've seen you at your worst and stayed anyway are standing, and you put it down.

The safest room in your house is the one with the least insulation.

Which is a horrible trade, and I know how it sits in your chest. The people who get it are the ones who did nothing to earn it. They're also the ones you most need not to be frightened of you.

If this is sitting on top of months of broken nights, and for most of us it is, that isn't a coincidence either. Read why you can't sleep in perimenopause alongside this one. A body running on four broken hours has nothing left to absorb anything.

You're not becoming a different person

Here's what I wish somebody had said to me at 39, and I'll keep it short, because you don't need a biology lesson at 9am in a car park.

Researchers at Monash built a scale specifically for this, because what women describe in perimenopause doesn't look like ordinary depression. It isn't mostly sadness. Anger and irritability are on the list, and the mood can turn up years before anything physical does, while your cycle still looks completely normal.

So it's a known thing, with a name, written down in a paper for Australian GPs. You didn't imagine it and you're not the only one.

The short version of why: when you ovulate, you make progesterone, and progesterone turns into something that settles your brain down. Your own built-in buffer, made fresh about once a month for most of your adult life.

In perimenopause you stop ovulating reliably. Some months you do, some months you don't, with no warning either way. So the buffer stops turning up reliably.

Not gone. Unreliable, which is harder to live with, because some months you're fine and some months you're not and you cannot work out what you did differently.

That's the half second you've lost. It isn't character. It's a buffer that didn't arrive.

And I'll be honest about the edge of what's known. Nobody can tell you exactly why it comes out as rage in some of us and as flatness or tears in others. Anyone selling you certainty about that is selling you something.

I was offered antidepressants before anyone mentioned hormones

I've mentioned this in passing before and never properly told it.

I was in my late thirties. I went in with what I was living with, and within about ten minutes we'd arrived at a prescription for an SSRI. The doctor was kind. Nothing about it was careless. What I brought fits the shape of depression if nobody asks what else it might fit.

Nobody asked.

I didn't fill it. Not because I knew better, because I knew nothing. I just had a feeling that whatever this was, it wasn't a sadness, and what I'd been handed was for a sadness.

Antidepressants are the right treatment for a lot of women, including women in perimenopause, and I'd never talk anybody off something that's working. What I'm objecting to is the order. Hormones were never raised.

Two years later my mum said "that's perimenopause" on a WhatsApp call from Italy, with my sister sitting beside her, and I understood more in that one sentence than in two years of appointments. The rest of what was going on in those years is in the perimenopause symptoms nobody warns you about.

And this happens to women everywhere, for reasons bigger than one appointment. The Senate inquiry into menopause heard women describe being called irrational, emotional, hysterical, crazy. It also heard that some Australian medical degrees contain as little as one hour of menopause teaching.

One hour. For something every woman who lives long enough goes through.

One more thing worth knowing about yourself before you go in. If you've had PMDD, or PMS that flattened you every month, or postnatal depression, both Jean Hailes and healthdirect name that as something that raises your risk here. If your mood has always been sensitive to your hormones, this is the biggest hormonal event since your last baby.

How to get an appointment that actually helps

This is the part I'd have wanted at 2am.

Don't go in asking for a blood test. I know that's the opposite of what the internet tells you. The diagnosis is made from your symptoms, not your bloods. One reading taken in a phase defined by swinging can come back perfectly normal while you're in the thick of it, and that hands a busy GP an easy place to end the conversation.

Ask for item 695 by name. There's a Medicare item now just for menopause and perimenopause. A longer appointment instead of a rushed ten minutes. Ring the practice, book under item 695, and ask which GP does them.

Fill in the questionnaire before you go. That Monash scale is free and public through Jean Hailes. Twelve questions at your kitchen table. It doesn't diagnose you. What it does is give you a number and some language instead of trying to describe a feeling to someone watching the clock.

Nobody offered it to me. That's the only reason it's on this page.

If you get nowhere, change doctors. Don't give up, change doctors. The Australasian Menopause Society keeps a directory of practitioners who've said this is their area. Being dismissed once is a fact about those ten minutes, not about you.

And know this before you walk in. The guidelines in this country don't agree with each other. One says hormones should be the first thing tried for mood that starts in perimenopause. The other says mood isn't a reason to prescribe them. So if your GP says something different to what you've read, that's why. It isn't you being fobbed off.

One last thing, because it's marketed at women our age relentlessly. If anyone steers you toward hormones made up specially by a compounding pharmacy, the Australasian Menopause Society can't endorse them: not regulated the same way, and documented cases where the lining of the womb wasn't properly protected. Regulated body-identical hormone therapy exists, and ordinary GPs prescribe it.

I'm not a doctor. My background is pharmaceutical sales and product development: I can read a paper, I can't treat a patient. None of this is medical advice. Every decision in it belongs with a doctor who knows you.

What helped me

I'm on HRT. I'll say that plainly, because being vague about it does women no favours, and there's more on what the research says about HRT elsewhere. What worked for me isn't a prescription for you.

What I can tell you is that the gap came back. That half second between something happening and me responding to it. I hadn't understood until it returned that its absence was the whole experience.

The other thing that helped sounds too small to count. Having a name for it.

Between 39 and 41 I thought I was becoming harder and meaner than the woman I used to be. After 41 I knew my buffer had gone unreliable. Same rage, completely different meaning, and the shame drained out of it. Which is the only reason I could finally talk to my family about it instead of just apologising to them over and over.

Beyond that: sleep, protected like it's medication. Alcohol almost entirely gone. Long exhales, which sound like nothing and do something real to a body that's already lit up. None of that is treatment and I won't sell it as such, but a nervous system that isn't already at capacity has somewhere to put a surge. There's more in what stress does to all of this.

Questions I get asked constantly

Is perimenopause rage normal?

It's recognised, which I think is a better word. Anger and irritability sit on a scale Australian researchers built for perimenopausal mood, because women kept turning up with exactly this. You didn't imagine it. It doesn't happen to every woman. It happened to me.

Why am I so angry in perimenopause?

Most likely your buffer. You only make progesterone after you ovulate, and it turns into the thing that settles your brain down. In perimenopause you stop ovulating reliably, so the calm stops arriving reliably, and the gap between something happening and you reacting gets very thin.

How long does perimenopause rage last?

Two answers, because there are two questions in there. The episode itself is usually minutes to an hour, then it lifts completely, which is part of what makes it so disorienting. The phase is longer and nobody can give you a date. But it's a passage, not a personality, and passages end.

Why is the rage worst with my partner?

Because home is where you stop performing. Your partner isn't the trigger, they're just in the room when the holding stops. Tell them on a calm day rather than in the aftermath. It won't prevent the next one. It stops them reading it as a verdict on the relationship, which is what they'll do otherwise.

Should I take antidepressants for perimenopause rage?

That's a conversation with your doctor, not with me. What matters is that the Australian guidelines disagree about this, so a no from one doctor isn't necessarily the end of it. For some women antidepressants are exactly right. What I'd push back on is nobody asking about your hormones first.

Will HRT stop the rage?

For some women it helps a great deal. Nobody has run the trial on rage that's already arrived, so I can't give you a number and I won't pretend otherwise. I'm on HRT and it helped me. That's one woman's experience, not evidence.

Is it perimenopause or is it my life?

Usually both, and that isn't a dodge. Most of us are at peak load: work, teenagers, ageing parents, no sleep. The hormones don't invent the anger, they take away what used to absorb it. That same emptied-out feeling is what quietly flattens desire in the same season.

What I'd want you to know

You're not turning into someone worse. You're a woman whose own calm has gone unreliable, in a window that ends.

Print the questionnaire. Book the longer appointment and ask for item 695 by name. Go in knowing the guidelines disagree, so an older answer doesn't leave you thinking you imagined all of it.

And say it out loud to someone. That's the part I got wrong for two years. I thought the rage was evidence of who I really was underneath, so I hid it, and hiding it made the shame heavier than the symptom ever was.

It wasn't who I was.

It was a symptom. Symptoms can be treated.