Medically reviewed by Mark Strehlow, MD, Medical Director — September 2026
If you’re thinking about suicide or hurting yourself, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or chat at 988lifeline.org. It’s free, confidential and open 24/7. In a life-threatening emergency, call 911.
Yes, perimenopause can bring on depression. The years of changing hormones before your periods stop are a time of higher risk, including for women who have never been depressed before. In one long-term US study, women were two to four times more likely to have an episode of major depression during perimenopause or just after menopause than before the transition began. Depression at this stage isn’t a weakness, and it’s treatable. Antidepressants and talk therapy are the first-line treatments. Estrogen isn’t approved to treat depression, although in small trials it has eased depression in some women during perimenopause.
Symptoms of perimenopause depression
Depression is more than a bad week. Clinicians look for symptoms like these most of the day, nearly every day, for at least two weeks:
- A sad, anxious or “empty” mood
- Losing interest or pleasure in things you usually enjoy
- Feeling hopeless, worthless or guilty
- Irritability
- Tiredness, or trouble concentrating, remembering or making decisions
- Sleeping too much or too little, or changes in appetite
- Thoughts of death or suicide
In perimenopause, depression can show up as intense irritability or anxiety as much as sadness. Some symptoms also overlap with perimenopause itself: night sweats break up sleep, and poor sleep brings tiredness and poor concentration. That overlap is one reason depression in midlife gets missed, or dismissed as “just hormones”.
Is it depression or perimenopause?
It can be both.
Perimenopause usually starts in your mid-40s, although it can start earlier. It lasts about four years on average, and up to eight. Its signs include irregular periods, hot flashes, night sweats, sleep problems and mood changes such as irritability or mood swings.
Mood swings that come and go are common in perimenopause. Depression lasts. It colors most of the day and gets in the way of work, relationships or everyday life.
A cycle pattern is a third possibility. If low mood arrives in the week or two before your period and lifts within a few days after it starts, it may be premenstrual dysphoric disorder (PMDD). Rating your mood every day for two cycles helps tell these apart.
A blood test can’t sort this out. Hormone levels swing so much in perimenopause that tests aren’t reliable for diagnosing it, and there’s no blood test for depression. A clinician diagnoses depression by talking with you, usually with a short, validated questionnaire. Blood tests are still useful for checking other causes of low mood and tiredness, such as an underactive thyroid.
Why perimenopause raises the risk of depression
Experts call perimenopause a “window of vulnerability” for depression. The exact cause isn’t known. The leading explanation is that big swings in estrogen during perimenopause affect mood in some women. Other things add to the risk:
- Depression earlier in life. Women who have been depressed before are at greatest risk. Most women who have major depression in perimenopause have had an episode in the past.
- Hot flashes and night sweats, in part because night sweats interrupt sleep.
- Stressful life events or circumstances.
Researchers are still looking for the mechanism. A Toronto brain-imaging study of 58 women found about 34% higher levels of an enzyme called monoamine oxidase A (MAO-A), which breaks down mood-related brain chemicals, in women of perimenopausal age than in younger women. None of the women were depressed, and a single study of this kind can’t show cause and effect, but it’s a lead researchers are following.
Does perimenopause depression go away?
The risk often falls after menopause. A University of Pennsylvania study followed 203 women for 14 years around their last period. Depressive symptoms were more likely in the years before it and less likely in the years after. Women with no history of depression had a low risk from about two years after their final period. Women who had been depressed before stayed at higher risk.
That’s no reason to wait it out. Depression responds to treatment now.
How perimenopause depression is treated
The main reference is the 2018 guidelines on perimenopausal depression from The Menopause Society (then the North American Menopause Society) and the National Network of Depression Centers.
- Antidepressants and talk therapy come first. The guidelines name the established depression treatments, antidepressant medicine and psychotherapy, as the front-line treatments in perimenopause, as at any other age. Antidepressants usually take 4 to 8 weeks to work. Never stop one without your prescriber’s help.
- Estrogen may help some women in perimenopause, but it isn’t a depression treatment. In two small randomized trials, estradiol relieved depression in perimenopausal women more often than a placebo. In one, depression lifted in 68% of women using an estradiol skin patch for 12 weeks, compared with 20% on a placebo. Estradiol didn’t help depression in women already past menopause. Estrogen isn’t FDA-approved to treat depression, and the evidence isn’t strong enough to recommend it for preventing depression. It has risks of its own that depend on your age, health history, and the type and dose, so any decision about it belongs with your clinician.
- Some antidepressants also ease hot flashes. Certain SSRI and SNRI antidepressants give mild to moderate relief from hot flashes and night sweats, which can help when you have both problems.
- Protect your sleep. Night sweats and insomnia are worth treating in their own right.
If you take hormone therapy or hormonal birth control and your mood changes, tell the clinician who prescribes it.
Where to get help
- Your primary care doctor or gynecologist can check for depression, start treatment or refer you.
- A psychiatrist, psychologist or licensed therapist provides talk therapy, and a psychiatrist can also manage medicine.
- Right now: call or text 988, or call 911 in a life-threatening emergency.
Where Rock Creek Wellness fits
We’re a physician-led hormone and longevity clinic in Leawood, Kansas, not a mental-health practice, and hormone therapy isn’t a substitute for depression treatment. If you have symptoms of depression, start with your primary care doctor or a mental-health professional. If you’re struggling today, call or text 988.
Where we can help is the menopause part. If you’re in perimenopause and dealing with hot flashes, night sweats, broken sleep or changing periods, we start with an evaluation of your symptoms, history and medicines, then comprehensive blood testing that includes a full thyroid panel. If hormone therapy may suit you, your provider goes through the benefits and the risks with you, and follows up with repeat labs. If something points outside our care, we’ll tell you and help you take the next step.
Read more about BHRT for women. We’re a cash-pay clinic. Consultations are free, and we give you the price at your consultation.
Common questions
Can perimenopause cause depression and anxiety?
Yes. The National Institute of Mental Health describes perimenopausal depression as intense irritability, anxiety, sadness or loss of enjoyment. Anxiety that is new or worse in midlife deserves the same attention as low mood.
Can HRT help perimenopause depression?
In small trials, estrogen eased depression in some women during perimenopause. But it isn’t approved to treat depression, it isn’t a first-line treatment, and it hasn’t helped depression after menopause. If you’re considering it, decide with your clinician, alongside treatment for the depression itself.
Should I get my hormones tested?
Not to diagnose perimenopause or depression, because hormone levels swing too much. Blood tests are useful for checking other causes of symptoms, such as thyroid problems, and for monitoring hormone therapy if you take it.
Help, any time: call or text 988, or chat at 988lifeline.org. In a life-threatening emergency, call 911.
This article is general education, not medical advice.
Sources
- Maki PM, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause 2018. PubMed 30179986
- The North American Menopause Society. The 2022 hormone therapy position statement. Menopause 2022. Full text (PDF)
- The North American Menopause Society. The 2023 nonhormone therapy position statement. Menopause 2023. Full text (PDF)
- The Menopause Society. Mental health.
- Bromberger JT, et al. Major depression during and after the menopausal transition: Study of Women’s Health Across the Nation (SWAN). Psychol Med 2011. PubMed 21306662
- Freeman EW, et al. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry 2006. PubMed 16585466
- Cohen LS, et al. Risk for new onset of depression during the menopausal transition: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry 2006. PubMed 16585467
- Freeman EW, et al. Longitudinal pattern of depressive symptoms around natural menopause. JAMA Psychiatry 2014. PubMed 24227182
- Rekkas PV, et al. Greater monoamine oxidase A binding in perimenopausal age as measured with carbon 11-labeled harmine positron emission tomography. JAMA Psychiatry 2014. PubMed 24898155
- Soares CN, et al. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry 2001. PubMed 11386980
- Schmidt PJ, et al. Estrogen replacement in perimenopause-related depression: a preliminary report. Am J Obstet Gynecol 2000. PubMed 10942479
- Gordon JL, et al. Efficacy of transdermal estradiol and micronized progesterone in the prevention of depressive symptoms in the menopause transition: a randomized clinical trial. JAMA Psychiatry 2018. PubMed 29322164
- Morrison MF, et al. Lack of efficacy of estradiol for depression in postmenopausal women: a randomized, controlled trial. Biol Psychiatry 2004. PubMed 14960294
- National Institute of Mental Health. Depression and Depression in women: 4 things to know.
- 988 Suicide & Crisis Lifeline. Talk to someone now.
- American College of Obstetricians and Gynecologists. Management of premenstrual disorders (Clinical Practice Guideline No. 7). Obstet Gynecol 2023. PubMed 37973069
- Cleveland Clinic. Perimenopause.
- Endocrine Society. Understanding your menopause diagnosis.
- National Institute of Diabetes and Digestive and Kidney Diseases. Hypothyroidism.
- MedlinePlus. Antidepressants.
