Perimenopause is a time of significant change, usually featuring symptoms like irregular periods and hot flashes. Women going through perimenopause may be surprised to learn that their moods can change as well. Depression is common during perimenopause and can affect your quality of life, especially if you have experienced it in the past.

“I’m just feeling down and depressed more,” a woman surveyed by ThisIsMenopause commented. Another wrote, “It makes me feel irrational, tired, and mentally crazy.”

Several treatment options may help you feel more like yourself. Here’s what you need to know about depression during perimenopause and how you can feel better.

What Is Depression?

Depression, also called clinical depression or major depressive disorder, is a chronic mental health condition that causes persistent feelings of sadness and hopelessness. Depression affects how you think, process information, and stay motivated in daily life.

Most people feel sad or down sometimes. However, depression is more than an occasional feeling. Possible signs and symptoms of depression include:

• Sadness
• Hopelessness
• Irritability
• Loss of appetite
• Sleeping too much or too little
• Fatigue
• Lack of motivation
• Loss of interest in favorite activities
• Trouble concentrating

If you are experiencing these symptoms for longer than two weeks or if they are disrupting your life, reach out for support from a mental health provider. Seek immediate help if you develop thoughts of suicide or harming yourself. Note: If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or chatting online.

Depression During Perimenopause

Depression is common during perimenopause. Research shows that about 21 percent of women experience major depression at some point in their lives. The risk is higher during times of significant hormonal changes, like pregnancy, postpartum, and perimenopause.

In addition to hot flashes and sleep problems, mood changes and depressive symptoms are common during perimenopause. Severe depression is less common, but many women have milder depression symptoms during this time.

Other mood changes during perimenopause may include:

• Trouble concentrating
• Memory problems
• Anxiety

A 2022 study found that in the United States, Black women are at a higher risk of developing depression during perimenopause than white women. Black women are also less likely to receive treatment.

Study participants who reported experiencing discrimination were also significantly more likely to have depression symptoms in midlife. Those who had limited socioeconomic resources in childhood are also at increased risk. If you have a higher risk of depression, consider sharing your risk factors with your healthcare provider.

How Does Depression Affect Women in Menopause and Perimenopause?

Perimenopause describes the time leading up to menopause (12 months without a period). During perimenopause, your hormone levels fluctuate significantly, which can affect your mood and overall health. Women with a history of depression have a higher risk of going through a depressive episode during perimenopause, so it is important to discuss your mental health history with your healthcare provider.

Hormonal Changes

Estrogen and progesterone levels significantly fluctuate and ultimately drop in perimenopause. Low estrogen levels can affect serotonin, a brain chemical that helps regulate mood. When serotonin levels drop, the risk of depression may increase, and you may feel more irritable than usual.

When progesterone levels change, you may notice mood changes, including sadness, irritability, mood swings, and anxiety. These symptoms may come and go. A woman surveyed by ThisIsMenopause wrote, “My emotions are all over the place, affecting work, life, and everything.”

Sleep Issues

Sleep problems are common during perimenopause and can also affect your mood. People who have trouble falling asleep or staying asleep are up to 10 times more likely to develop symptoms of depression than those who sleep well most nights. “I’m sleeping badly, which puts me in a crappy mood,” a woman surveyed by ThisIsMenopause wrote.

You may also have trouble sleeping because of common symptoms like hot flashes and night sweats.

Life Demands

Perimenopause usually begins in your 40s, which can be a demanding time of life. You may find yourself caring for children, parents, or other family members. Work pressure and health problems can also occur during this stage of life. These stressors can increase the risk of depression and make it harder to cope with perimenopause. “I am miserable, exhausted, and stressed,” one woman shared in the survey.

How Can You Treat Depression?

Emotional ups and downs are normal during perimenopause. However, if you are experiencing persistent depression symptoms, talk with your healthcare provider.

Seeking treatment for your depression symptoms is important for both your mood and your overall health. Depression increases the risk of chronic health conditions, including heart disease and diabetes.

Below are some treatment options that may help you feel better.

Hormone Therapy

Because many perimenopause symptoms are caused by hormonal changes, taking medication with estrogen or other hormones may improve your mood. Hormone therapy, also known as hormone replacement therapy (HRT) or menopause hormone therapy, involves taking medications that contain hormones. These medications may come in the form of a pill, patch, cream, gel, spray, or ring.

A 2018 study found that wearing a patch with topical estrogen while taking oral progesterone may prevent the symptoms of depression in perimenopause. While hormone therapy may be effective, like all medications, it may have side effects or come with health risks for certain women. Talk with your healthcare provider about your individual risk factors and potential benefits to learn if hormone therapy could be right for you.

Antidepressants

Antidepressants are a common treatment for depression. There are many types of antidepressants available to help you feel better. Your healthcare provider may refer you to a psychiatrist for treatment. Antidepressants are most effective when combined with therapy.

Therapy

Research shows that cognitive behavioral therapy (CBT) is an effective treatment for perimenopause-related depression. CBT is a type of psychotherapy that teaches you to recognize unhelpful thinking patterns and develop effective coping skills. Gaining new coping skills can help you manage stress from life events outside your control.

Lifestyle Habits

Making changes to your everyday habits may also improve your depression symptoms. The following habits may help:

• Eat a nutrient-dense diet and exercise most days.
• Avoid smoking and limit caffeine and alcohol.
• Avoid exercising late in the evening.
• Aim to go to bed around the same time each night, and keep your bedroom cool and dark.

Does Depression Improve When You Reach Menopause?

Many women who develop depression during perimenopause experience an improvement in their symptoms once their hormone levels stabilize. A 2024 study found that there is a higher risk of depression during perimenopause than after menopause. When you reach menopause (no menstrual periods for 12 months), you may notice that your mood improves.