Perimenopause and Mood: What the Research Shows
Mood that has changed for weeks is worth mentioning, because there are several kinds of help.
Picture a woman named Elena, 49. For two years she has felt more anxious and sad than usual. Her periods are less regular. Her mother never mentioned any of this, and Elena is not sure what to call it.
When it happens
The average age of menopause is 51, according to ACOG. The NHS says it usually affects women between 45 and 55, and symptoms can last seven to nine years, sometimes longer. Symptoms can shift toward low mood and anxiety as they go on.
What studies found
Several long-running studies followed women through the change.
| Study | Finding |
|---|---|
| Penn Ovarian Aging Study | High depressive-symptom scores were about 4.3 times as likely during the transition as before it |
| Same study | A diagnosed depressive disorder was about 2.5 times as likely |
| Harvard cohort | About twice as likely |
| SWAN, Pittsburgh | Two to four times as likely to have a major depressive episode (a small group of 221 women) |
Most midlife depressive episodes happen in women who have had one before. For women with no history, the risk still goes up, though by less.
What treatment is named
A 2018 guideline from the Menopause Society and a network of depression centers calls antidepressants and psychotherapy the first-line treatments for depression at this stage. It says estrogen is not approved to treat perimenopausal depression, though there is evidence of antidepressant effects, especially in women who also have hot flashes. In the UK, NICE says to consider hormone therapy for low mood that comes with menopause but falls short of a depression diagnosis.
One trial of women in perimenopause gave estradiol patches with progesterone for a year. The share who developed depressive symptoms fell from 32.3 percent to 17.3 percent. It is one trial, and about prevention.
Why it can go unnoticed
The same guideline says menopause symptoms can "complicate, co-occur, and overlap" with depression. A doctor can look at all of these together.
You could…
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Keep a short note of mood, sleep and periods for two months.
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Tell your doctor about mood first, and not only hot flashes.
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Ask what the options are for mood, with and without hormones.
What did you wish you had been told about this stage? Share it here. Another reader may be starting it now.
Sources: Freeman et al. 2006 (Penn Ovarian Aging Study); Cohen et al. 2006; Bromberger et al. 2011 (SWAN); Menopause Society and National Network of Depression Centers 2018; NICE NG23 (2024); Gordon et al. 2018 (JAMA Psychiatry); ACOG; NHS. Figures are estimates for planning, based on public data.
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