Menopause & Mental Health

Too many of us don't know that perimenopause, the beginning of the menopause journey, can trigger mood and anxiety symptoms for many women, even those who have never before had mental health challenges. Knowing that you are not alone and that what you are experiencing is a part of menopause can in itself be helpful.

You do not have to “suffer through it,” as many women do. There is treatment and you can feel better. 

If you experience symptoms that get in the way of your functioning at work or at home and last for more than two weeks, it is important to seek help. If you are having suicidal thoughts, call 911 or the Suicide Prevention Lifeline at 800-273-8255.
Illustration of woman sitting and having mood symptoms


of women in late perimenopause report symptoms of depression such as irritability, mood swings & fatigue.


Women who have never experienced depression are two to four times more likely to experience a depressive episode during the menopausal transition.

Windows of Vulnerability

Mental health professionals have identified puberty, pregnancy, and menopause as three windows of vulnerability for women.

The dramatic hormone fluctuations during these phases can make some women more susceptible to mental health challenges, including anxiety and depression.

illustration of window

Puberty and Periods

From the time young women first get their period, they may experience physical and emotional symptoms after ovulating and before their period, caused by changes in hormones. Some women are more vulnerable to these hormonal changes and may experience PMS or PMDD. Women who have PMDD are at increased risk for perimenopausal depression and anxiety.

illustration of window

Pregnancy and Postpartum

The perinatal phase is the second window of vulnerability. One in five women experiences a Perinatal Mood or Anxiety Disorder (PMAD).

Women who have a PMAD are at increased risk for perimenopausal depression and anxiety.

illustration of window


Perimenopause is the third window of vulnerability for increased depression, anxiety, and other mood disorders.

Much work remains to be done—as was done with perinatal mental health—to understand and research this evolving topic.

The Hormone Factor

It is the roller coaster, the sudden ups and downs (see graph below) in hormone levels, that researchers believe cause these mood symptoms. Serotonin, a brain chemical that helps us feel happy, drops as estrogen drops, resulting in increased sadness and anxiety. 

Progesterone, the calming hormone, also begins to decline in perimenopause. 

Graph to show hormone levels by age

Signs & Symptoms

Changes in mood may be one of the first symptoms of perimenopause. Knowing that these changes are actually symptoms of perimenopause can be helpful because you are less likely to blame yourself for how you feel.

Not feeling like yourself
Crying more than usual
Mood swings
Increased worry/anxiety
Feeling overwhelmed
Difficulty concentrating
Low motivation or energy

These symptoms are unpleasant, to say the least. For many women, mood symptoms are sporadic and ultimately resolve. But whether symptoms last a few weeks, a few months, or longer, there are many ways to seek help and get relief. 

Keep in mind that there is a difference between having mood or anxiety symptoms and having a Major Depressive Disorder (MDD) or any other mood or anxiety disorder. If your symptoms interfere with your functioning and last for more than two weeks, it’s important to seek help.

The Menopause Puzzle

Hot flashes and panic attacks can look and feel similar—racing heart, breaking into a sweat, feeling panic or sense of doom. How can you tell them apart? When having a panic attack, you often feel short of breath, which does not happen in a hot flash.

Puzzle pieces with symptoms on them: Irritability, panic attack, hot flashes, low libido, cognitive changes, sleep difficulties, fatigue, weight gain

The physical symptoms of perimenopause—difficulty sleeping, hot flashes, urinary and vaginal symptoms, low libido, fatigue, etc.—can contribute to the occurrence of mental health symptoms.

Physical symptoms such as low libido, weight gain, sleep difficulties, fatigue, and cognitive changes can also be mental health symptoms.

Night sweats or temperature shifts interfere with quality of sleep, which in turn can affect your mood.

Risk Factors: Who Is at Risk?

History of Depression
Women who have have a history of depressive episodes during a prior window of vulnerability have a 58% greater risk for another episode during perimenopause.

Having Hot Flashes and/or Night Sweats
There is a link between vasomotor symptoms and increased depression and anxiety. Even in women with no prior history of severe anxiety, experiencing hot flashes and night sweats can increase the odds of experiencing anxiety symptoms.

Adverse Life Events
Women with a history of abuse/neglect, family problems, and low childhood socio-economic status, poverty, and unsafe environments have an increased risk of depression during perimenopause and menopause.

Getting Help

Symptoms are treatable. Reproductive therapists and psychiatrists are specialists in hormone-related mental health, and support women during these windows of vulnerability. The North American Menopause Society (NAMS) made treatment recommendations in 2018.

If you have had sensitivity to hormone fluctuations in the past, be sure to tell your doctor.


Watch our Menopause Talk on Depression, Anxiety, Irritability and More During Perimenopause, and Menopause.

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Let's Talk Menopause spoke with Dr. Lisa Weinstock about irritability & menopause. Check out the article.

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Fill out our symptoms checklist!

Please answer the questions to complete the symptoms checklist. While not a diagnostic tool, it is a printable resource to share with your povider to have an informed discussion about perimenopause.

illustration of symptoms checklist