Does Perimenopause Cause Mood Changes?
Yes. Perimenopause can cause mood changes and depression.
Even if you have never experienced it before. Welcome back to my blog series on all things perimenopause! This is the second post of the series where we’ll explore mood changes that can happen in perimenopause. In case you missed the first post on Mental Health Changes During Perimenopause, just click here! In the next few posts, we’ll dive deeper into:
DOES PERIMENOPAUSE CAUSE ANXIETY? UNDERSTANDING SYMPTOMS AND TRIGGERS
NERVOUS SYSTEM DYSREGULATION AND PERIMENOPAUSE: WHY YOUR BODY FEELS “ON EDGE”
WOMEN, PERIMENOPAUSE AND ADHD: WHY SYMPTOMS OFTEN GET WORSE
But first, Hi, I’m Nikki! A therapist and licensed clinical social worker (LCSW) with nearly 20 years of experience. In my online therapy practice, I support women in midlife and the struggles that come with it- perimenopause, anxiety and stress, ADHD and inattention, depression, grief and loss, and those unexpected life events that throw you off course.
Ok, let’s get back to the question at hand. Yes—perimenopause can cause mood changes, and sometimes depression, even if you’ve never experienced issues with your mood before. Or maybe you have experienced fluctuations in your mood before, but not to the degree that it starts to interfere with your functioning- the tipping point where depression becomes pathological or a diagnosable by a mental health professional.
The perimenopause transition can last 7-10 years, on average, before the onset of menopause, which, for most women, happens in her late 40s-early 50s. Hormonal fluctuations during the perimenopause transition affect hormone levels, brain chemistry, and the body’s stress response, which can cause or intensify symptoms of depression.
This informed guide explains why it happens, what symptoms look like, what helps, and when to seek professional care.
Why Does Perimenopause Affect Mood?
Perimenopause causes mood changes because hormone fluctuations (especially estrogen and progesterone) can affect neurotransmitters in our brains like:
Serotonin, which helps regulate mood and emotional stability
Dopamine, which affects motivation and pleasure
As hormone levels rise and fall unpredictably during perimenopause, the brain’s ability to manage mood can be disrupted—leading to new or intensified depressive symptoms. Medical and mental health professionals recognize mood symptoms as a common and normal part of the perimenopausal transition, even in people with no history of depression. But just because it’s normal doesn’t mean you have to suffer through. You have options!
What Mood Changes Are Common During Perimenopause?
There are 34 documented symptoms of perimenopause. Seven of them can be associated with depression: 1) depressed mood, 2) difficulty concentrating, 3) fatigue, 4) irritability, 5) libido changes- related to motivation, pleasure, interest, 6) mood swings, and 7) sleep issues.
Mood changes and depressive symptoms during perimenopause can be experienced as cognitive (thoughts), emotional (feelings), behavioral (how we act, react), or physical (how we feel in our body), or any combination. These symptoms may appear suddenly and vary in intensity over time.
Symptoms of perimenopause depression can include:
Changes in mood (depressed mood) or mood swings
Increased sadness and tearfulness
Increased irritability or irritable mood
Loss of interest or pleasure in activities you used to enjoy
Weight loss or gain, decreased or increased appetite
Insomnia and consequent fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Difficulty concentrating or indecisiveness
Are Perimenopause Mood Changes the Same as Depression?
Yes… and no. Perimenopausal mood changes (e.g. depressed mood) can be symptoms of diagnosable depressive disorders, but among other diagnostic criteria, experiencing a depressed mood here and there is not the same as experiencing depressed mood coupled with feelings of coupled with feelings of sadness, emptiness, or hopelessness consistently for a period of at least two weeks, which represent a change from previous functioning and is accompanied by several other symptoms in that same two-week time frame.
Perimenopause-related mood changes are not always the same as depression in that they:
Fluctuate over time
Are often linked to hormonal shifts
May improve as hormones stabilize
Can respond positively to hormonal or lifestyle support
Three common depressive disorders that women can experience in perimenopause
Clinical depression aka Major Depressive Disorder:
Five or more of the following symptoms are present during the same two week period and represent a change from previous functioning: depressed mood, loss of interest or pleasure in activities, weight loss/gain or decrease/increase in appetite, insomnia/hypersomnia, agitation or feeling slowed down, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating or indecisiveness, and/or recurrent thoughts of death or suicidal ideation.
Persistent Depressive Disorder (Formerly Dysthymia)
While a major depressive episode can come on abruptly, intensely, and last no less than two weeks, the symptoms of persistent depressive disorder are bothersome more days than not for at least two years. Symptoms accompanying depressed mood can include: Poor appetite or over, eating, insomnia, or hypersomnia, low energy, or fatigue, low self-esteem, poor concentration, or difficulty making decisions, feelings of hopelessness.
Premenstrual Dysphoric Disorder
In the majority of a woman’s cycles, at least five symptoms must be present in the final week before the onset of her period, and become minimal or absent in the week after her period ends: mood swings; irritability or anger, depressed mood, feelings of hopelessness, or self-deprecating thoughts; anxiety, tension, or feeling on edge; decreased interest; difficulty concentrating; lethargy, or lack of energy; changes in appetite; hypersomnia, or insomnia; feeling, overwhelmed or out of control; and physical symptoms like swelling, pain, bloating or weight gain.
If you have experienced any combination of any of the above symptoms during the perimenopause transition, it likely means you’ve experienced some normal mood changes associated with this time of life. A mental healthcare provider can help distinguish between normal perimenopause mood changes and diagnosable depressive disorders.
When Are Mood Changes During Perimenopause Considered Normal?
Experiencing emotional changes during perimenopause does not mean something is “wrong.” Mood changes during perimenopause are generally considered normal when they:
Come and go rather than stay constant
Occur in tandem with cycle changes
Improve with rest, stress reduction, or support
Do not interfere with daily life or functioning
How to manage mood changes and depression in perimenopause
If your symptoms are fleeting, or come and go throughout your cycle, below are some suggestions that may help. But if your symptoms are persistent, overwhelming, unmanageable, or interfering with your life at home, work, or school, it’s time to seek out professional support.
If your mood is intermittently depressed, exercise, time in nature, meditation, quality time with a good friend, a date night with your partner and be easy ways to boost your mood.
If you have experienced loss of interest or pleasure in activities, which ones? If you’re able to derive joy from some of your daily activities, focus on doing more of those activities during times in your cycle when your mood is at a low point.
If you’re not sleeping well and waking up feeling tired or slowed down in the morning, taking a sleep inventory can help. Is your bed, pillow, and bedding comfortable? Is your room dark enough? Is your room quiet enough? Is your room cool enough (estrogen is like our internal thermostat, so when it fluctuates, it can have a harder time helping us regulate body temp).
Simple changes like changing your sheets, adding an eye mask, or turning down the temp may help. And sleep deprivation on its own can contribute to low mood, irritability, and brain fog, making a good night’s rest all the more important.
If you’re having difficulty concentrating or having a hard time making decisions, what can you take off your plate?
What can you delegate (asking for help can take stress off your plate and make you feel closer and more supported by loved ones), automate (grocery delivery, bill pay, etc), or let go (do you really need to fold the laundry tonight?). These suggestions are not curative, but when we’re having a hard time concentrating or have decision fatigue, its often because you have too much on your plate.
When Should You See a Mental Healthcare Professional for mood changes and depression in perimenopause?
There is never a “wrong” time to see a therapist. You should talk to a therapist or healthcare professional if mood changes:
Interfere with functioning at home, in your relationships, at work, or at school
Feel overwhelming or unmanageable
Last most days for more than two weeks
Are accompanied by severe anxiety or emotional withdrawal
Working with a therapist can help you determine whether symptoms are hormonally driven, mental health–related, or both.
How to find a therapist for mood changes and depression in perimenopause?
Googling “therapist near me” can offer overwhelming results. A platform like Therapy Den or Psychology Today can help you narrow down your search based on your criteria including office-based or virtual visits, what issues a therapist treats, treatment techniques a therapist uses, among other search features. Here are some other resources that might help in your search:
Finding a psychologist, counselor, or therapist in Michigan
Ready to start therapy? 5 questions to ask a therapist
Deciding between online or office based therapy? Is therapy in the office better than online therapy?
Hi again, I’m Nikki! A therapist and licensed clinical social worker (LCSW) with nearly 20 years of experience. In my online therapy practice, I support women in midlife and the struggles that come with it- perimenopause, anxiety and stress, ADHD and inattention, depression, grief and those unexpected life events that throw you off course.
Reach out to me to schedule your FREE 15-minute phone consultation. Serving women in the Upper Midwest: Michigan, Illinois, Indiana, Ohio & Wisconsin, as well as Connecticut.