Mental Health Changes During Perimenopause: Symptoms, Causes, and Support
Welcome to my blog series on all things perimenopause. This is the first post of the series where we’ll explore a general overview of perimenopause and its impact on mental health symptoms. In the next few posts, we’ll dive deeper into:
Does Perimenopause Cause Mood Changes and Depression
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.
What Are Mental Health Changes During Perimenopause?
If you’re a woman in perimenopause, no doubt you’ve had moments of not feeling yourself, more anxious, more edgy, annoyed or irritable, more emotional or tearful, not to mention physical changes like unexpected weight gain or difficulty losing weight, hair thinning, and I could go on…and on…
But let’s get back to those mental health changes, and why they happen. 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. Declining estrogen and progesterone, can lead to mood swings, irritability, anxiety, and depression, as estrogen normally boosts serotonin production.
Dopamine, which affects motivation and pleasure. Declining estrogen directly affects dopamine activity, leading to reduced motivation, focus, pleasure, and energy. It can also contribute to "brain fog," irritability, and mood swings. These changes disrupt the brain's reward system and executive functions, creating symptoms like difficulty concentrating, loss of joy, and fatigue.
GABA, the brain's calming neurotransmitter. Hormone fluctuations, especially progesterone, can reduce its calming effects leading to increased anxiety, insomnia, irritability, and mood swings.
As hormone levels rise and fall unpredictably during perimenopause, the brain’s ability to manage anxiety, stress, mood, even multi-tasking, can be disrupted—leading to new or intensified mental health symptoms.
These mental health changes during perimenopause can be:
Emotional- how we feel.
Cognitive- how we think and process our thoughts.
Behavioral- how we act, react, and behave.
The biggest concerns women in perimenopause related to mental health are related anxiety and panic attacks, low or depressed mood, mood swings, irritability, emotional reactivity and sensitivity, brain fog, difficulty concentrating, difficulty juggling too many tasks, becoming overwhelmed, and struggling with sleep.
These changes are common, biologically driven, nothing is “wrong” with you, and often temporary, but that certainly doesn’t make them comfortable or tolerable in the moment!
Today, 34 symptoms of perimenopause have been identified. Of them, seven can be attributed to anxiety:
anxiety
difficulty concentrating
fatigue
heart palpitations
irritability
memory lapses
panic attacks
Researchers found perimenopause is associated with an increased risk of anxiety disorders, largely due to hormonal changes affecting the body’s regulatory feedback mechanisms. You can read more here.
Seven perimenopause symptoms can be associated with depression:
depressed mood
difficulty concentrating
fatigue
irritability
libido changes- related to motivation, pleasure, interest
mood swings
sleep issues
Women with a history of major depressive disorder or bipolar disorder are at risk for relapse during perimenopause. But research also demonstrates that women without a history of a mood disorder are at elevated risk of developing first-onset depression during this time, due to a combination of factors including variability of hormones, inflammatory markers, diet, and structural changes in the brain. You can read more here.
And four perimenopause symptoms can be attributed to ADHD:
brain fog and memory lapses
difficulty concentrating
fatigue
irritability
Considering the interaction between estrogen and dopamine levels with ADHD symptoms, it is thought perimenopause can exacerbate existing ADHD symptoms or could even lead to a diagnosis of previously unrecognized ADHD. You can read more on that here.
When Do Mental Health Changes Start in Perimenopause?
Perimenopause typically begins in a woman’s late 30s/early 40s and lasts an average of 7-10 years until menopause. Its impossible to predict exactly when they will start, but if you’re in your late 30s/early 40s and starting to experience random symptoms that you’ve never experienced before OR if you begin to experience intensified symptoms of a previously diagnosed mental health condition, Perimenopause may be the culprit.
What Causes Mental Health Changes During Perimenopause?
Several overlapping factors contribute, to review:
Hormone fluctuations: Specially estrogen and progesterone and there impact on…
Neurotransmitters: like serotonin, dopamine, and GABA, and their combined influence on…
Sleep patterns: Night sweats and insomnia can worsen mood regulation, cognitive function, and make us more sensitive to…
Stress: Hormonal shifts amplify the stress response, not to mention…
Life-stage pressures: Whether it be partners, children, aging parents, caregiving demands are real. And those demands often compete with career demands, your own health changes, and identity shifts in parenting and partnership
Are Mental Health Changes During Perimenopause Normal?
Absolutely. These changes are rooted in biology and can tax or overwhelm your system, they’re not psychological weakness. The biological changes and the cascading symptoms that come as a result are very common for women in midlife and perimenopause and they are medically recognized.
How to Support Mental Health During Perimenopause
Lifestyle & Emotional Support Strategies during Perimenopause
Prioritize consistent, restorative sleep
Reduce caffeine (especially after noon) and alcohol as both can worsen anxiety and disrupt sleep
Engage in regular movement, prioritizing walking, yoga, pilates, and strength training. High intensity workouts in perimenopause may not be the best approach during perimenopause as they can amplify the body’s stress response.
Practice stress-reduction techniques (breathing, mindfulness, journaling)
Build emotional resilience through social support and connection
Brain & Emotional Resilience Habits during perimenopause
Maintain a consistent routine, routines make like feel more predictable. Whereas stress and anxiety thrive in chaos and disorganization
Set boundaries for yourself. You can say no. Limit overstimulation and multitasking
Use emotional tracking to identify patterns in your mood and anxiety
Practice self-compassion and adjust your daily expectations you put yourself
Psychotherapy to help Manage anxiety and depression in Perimenopause
You don’t have to go it alone. If your social support system is lacking, a therapist…
If you’re struggling to prioritize yourself or hold yourself accountable to your goals, a therapist can help
If you’re struggling with setting boundaries in your relationships… therapy can help
Practice self-compassion and adjust your daily expectations you put yourself
Medical & Hormonal Options for Perimenopause
Hormone therapy: To be clear, I am not an MD, DO, APRN, or PA and am not offering medical advice. But you can talk to your women’s healthcare provider about hormone therapy, which can help stabilize some of these symptoms.
Non-hormonal treatments: Again, I am not an MD, DO, APRN, or PA and am not offering medical advice. But, many of my clients have benefited from medications for depression and anxiety, like SSRIs.
Can Mental Health Changes During Perimenopause Be Prevented?
While not always preventable, symptoms may be reduced with:
Addressing symptoms early rather than waiting
Proactive stress management
Maintaining routines around sleep and movement
Hormonal health monitoring or hormone replacement
Speaking with a therapist
Early support often leads to better long-term outcomes.
Frequently Asked Questions About Perimenopause and Mental Health
Are perimenopause mood changes permanent?
No. Most improve as hormones stabilize, especially with support.
Can hormone therapy help anxiety or depression during perimenopause?
For some individuals, yes—especially when symptoms are hormonally driven. You can discuss your options with your women’s healthcare provider.
Does perimenopause cause mental illness?
No. It can temporarily affect mood regulation and stress response, causing symptoms of depression and anxiety, but does cause lifelong mental illness.
Should I see a mental health professional or a menopause specialist?
Often, a combination of both provides the most comprehensive care. If you’re looking for a medical provider who is a menopause specialist, you can use this site to find board-certified menopause physicians in your area.
Final Thoughts on Perimenopause and Mental Health
Mental health changes during perimenopause are real, common, and rooted in biology—not personal failure. With informed support, medical guidance, and compassionate self-care, most people experience significant improvement and regain emotional stability.
therapy Can help You Manage Your Mental health in Perimenopause
If you’re a woman looking for support in perimenopause, let’s connect for a FREE 15-minute call to talk through how I can support you! I’m a 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.