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Everything you were too afraid to ask
Perimenopause and Mood
Weather, not climate
What perimenopause actually is, why mood can change in these years, why swings in estrogen seem to matter more than its level, how night sweats and broken sleep feed into low mood, what is happening with anxiety, irritability and brain fog, and what helps
Detailed explains the research and the reasons behind each point. Plain words gives the same main points in short, everyday language. Safety advice and emergency steps are the same in both.
Some women describe it as a change in the weather, and you may know exactly what they mean. Nothing much in your life has changed, and yet for a few days at a time you feel flat, or short-tempered, or close to tears over things that would normally roll off you. Then it lifts, you feel like yourself again, and a few weeks later it’s back.
If you’re in your forties and this sounds familiar, it may have something to do with perimenopause, the years of hormonal change before periods stop for good. It gets far less attention than menopause itself, even though, where mood is concerned, it seems to be the part that matters most.
This article looks at what the research shows about perimenopause and mood: who is more likely to be affected, what seems to drive the change, and what helps. If you’d like everything in plainer words, choose Plain words above. The short version is that the change is real, it’s common, and for most women it passes. It isn’t all in your head, and there are things that help.
WHAT THIS ARTICLE COVERS · SIX PARTS
PART 1What perimenopause actually is12 minspan class=”sec”>4 sections · 3 min
PART 2A window of higher risk21 minspan class=”sec”>3 sections · 2 min
PART 3Weather, not climate32 minspan class=”sec”>4 sections · 3 min
PART 4Night sweats, sleep and mood41 minspan class=”sec”>3 sections · 2 min
PART 5Anxiety, irritability and brain fog52 minspan class=”sec”>4 sections · 2 min
PART 6What helps64 minspan class=”sec”>5 sections · 5 min
What perimenopause actually is
The years of change before the last period, and the signs of each stage
In plain words
Menopause is technically a single day, the date of your last period. You can only know it looking back, once a whole year has passed with no period.
The years of change before that are called the menopausal transition. Perimenopause is the everyday name for those years plus the first year after the last period. For most women it starts somewhere in their forties and usually lasts several years.
It’s easy to miss at first. Your periods may still come every month, just a few days earlier or later than they used to. Changes in sleep, mood or energy are easy to put down to everything else going on at this age, like work, children or aging parents.
Researchers use a set of stages called STRAW+10, and you can use the markers on yourself. The early transition starts when your cycle gets seven days or more longer or shorter from one cycle to the next, and that happens again within ten cycles. A cycle that was always 28 days might be 21 days one month and 30 the next. The late transition starts when you go 60 days or more without a period, and it lasts one to three years on average. After the last period comes postmenopause.
The questions below use these markers to show which stage your periods point to.
Menopause is a single day
Strictly speaking, menopause is the date of your last period. You can only know it looking back, once a full year has passed without another one. Everything before it, from the first noticeable changes in your cycle, is the menopausal transition, and perimenopause is the everyday name for that stretch together with the first year after the last period.
For most women it begins somewhere in their forties. It isn’t a brief phase: taken together, the early and late stages of the transition usually last several years, and the first signs are easy to miss.
Why it is easy to miss
You might not notice perimenopause starting at all. Periods may still arrive every month, only a few days earlier or later than they used to, so nothing seems obviously different. And the changes that are harder to pin down, in sleep, mood or energy, are easy to put down to everything else going on at this age: a demanding job, children, aging parents, a difficult few weeks. Many women only connect the pieces looking back, which is one reason it’s worth knowing what the early markers are.
How to tell where you are
An international group of researchers agreed on a set of stages, known as STRAW+10, so that studies around the world would describe the same thing in the same way. Their markers are simple enough to use on yourself.
The early transition begins when the length of your cycle starts to change by seven days or more from one cycle to the next, and that happens again within ten cycles. A cycle that was reliably 28 days might become 21 days one month and 30 the next.
The late transition begins when there’s a gap of 60 days or more between periods. This stage lasts, on average, one to three years. After the last period comes postmenopause, and its early stage, when the body is still settling, lasts roughly five to eight years.
Where am I?
Up to three questions, based on the STRAW+10 stagesUp to three questions about your periods, based on the STRAW+10 stages
By these markers
This is a guide to the stages, not a diagnosis. It does not work if something else controls your periods, such as hormonal contraception, a hormonal IUD (coil), a hysterectomy, endometrial ablation or pregnancy. If your periods do not tell you much, your doctor can help.
In plain words
Estrogen is one of the main hormones your ovaries make. It rises and falls in a regular pattern each month, and that pattern drives your cycle. Estrogen also acts on the brain, where it affects chemical messengers involved in mood, sleep and memory.
Over the years of perimenopause, estrogen slowly goes down. From month to month, though, it gets much less predictable. It can go higher than usual one month and very low the next. Most studies measure estradiol, the main form of estrogen before menopause. The difference between the slow fall and the swings seems to matter a lot for mood, and part three explains why.
Uneven, not simply lower
Estrogen is one of the main hormones made by the ovaries. Through the reproductive years it rises and falls in a regular pattern each month, and that pattern is what drives the menstrual cycle. Estrogen also acts on the brain, where it influences chemical messengers involved in mood, sleep and memory, which is why you can feel changes in it as well as measure them. In perimenopause the ovaries become less regular, and so does the estrogen they make.
You might picture this as a slow, steady decline, like a dimmer switch being turned down over a decade. Over the long run, that’s roughly what happens. From month to month, though, estrogen becomes much less predictable: it can rise higher than usual in one cycle and fall very low in the next, and the regular rhythm that used to shape each month gets harder to find. Most studies measure estradiol, the main form of estrogen before menopause.
That difference, between the long, slow trend and the short, unpredictable swings, seems to matter a great deal for mood. Part three explains why.
A window of higher risk
What the large studies found, and who is most likely to be affected
In plain words
Most women don’t become depressed during perimenopause. That’s worth saying first, because this topic can sound scarier than it is.
The chance of low mood does go up. In SWAN, a long-running US study that has followed thousands of women through their forties and fifties, women were about 1.3 to 1.7 times as likely to score high on a depression questionnaire during and after the transition as before it. Even so, the researchers concluded that most midlife women don’t develop high levels of depressive symptoms.
This doesn’t only happen to women who were depressed before. Two US studies followed only women who had never been depressed. In one, women in perimenopause were twice as likely to develop significant depressive symptoms as women who hadn’t reached it yet. In the other, a diagnosed depression was two and a half times as likely during the transition as before it. So low mood that shows up for the first time in these years isn’t just a sign that you were always prone to it. The transition itself seems to play a part.
If you’ve been depressed before, that history is still the strongest single signal of risk. In one SWAN group, women were two to four times as likely to have an episode of major depression, the kind a doctor diagnoses, during perimenopause or the first years after it as before it. A past episode strongly predicted another.
So if depression is part of your history, that isn’t a reason to expect the worst. Take early changes seriously, rather than waiting to see whether they pass.
Most women do not become depressed
This topic can easily sound more alarming than it is, so it’s worth starting here. The Study of Women’s Health Across the Nation, known as SWAN, is a long-running US study that has followed thousands of women through their forties and fifties. Women in it were about 1.3 to 1.7 times as likely to have high scores on a questionnaire about depressive symptoms during the transition and after it as before it.
The researchers concluded that most midlife women do not develop high levels of depressive symptoms. So the risk goes up, and for most women it doesn’t turn into depression.
Even without a history of depression
If you’ve never been depressed before, you might wonder whether this happens mainly to women who were already prone to low mood. Two American studies were designed to answer exactly that, and both followed only women who had never been depressed.
The Harvard Study of Moods and Cycles followed women in the Boston area. Those who entered perimenopause were twice as likely to develop significant depressive symptoms as those who hadn’t reached it yet, even after taking age and difficult life events into account. The risk was somewhat higher for women who also had hot flashes.
The Penn Ovarian Aging Study, based in Philadelphia, compared each woman with herself, before and during the transition. High depressive scores were more than four times as likely during the transition, and a diagnosed depressive disorder was two and a half times as likely. So low mood that shows up for the first time in these years isn’t just a sign that you were always prone to it; the transition itself seems to play a part.
When depression has happened before
If you’ve been depressed before, that history is still the strongest single signal of risk. A smaller SWAN study at one site used clinical interviews rather than questionnaires. The women in it were two to four times more likely to have an episode of major depressionmajor depressionA diagnosis made when low mood or a loss of interest lasts most of the day, nearly every day, for at least two weeks, together with other changes such as in sleep, appetite, energy or concentration. during perimenopause or the first years after it than before, and a past episode strongly predicted another one.
Guidelines published in 2018 by the North American Menopause Society, which has since been renamed The Menopause Society, and the US National Network of Depression Centers make the same point: most midlife women who have major depression during perimenopause have had an episode before.
So if depression is part of your history, that isn’t a reason to expect the worst. Take early changes seriously, rather than waiting to see whether they pass.
Weather, not climate
What happens when studies track hormones and mood over time
In plain words
Climate is what a place is like over years. Weather is what happens this week. Your hormones in perimenopause can be described the same way. The climate is the slow fall in estrogen across the whole transition. The weather is how much it goes up and down from week to week and month to month. The research more and more suggests that mood follows the weather more closely than the climate. How much your estrogen moves seems to matter more than how low it goes.
The chart below draws the climate and the weather across the four stages.
Two ways of describing the same sky
Climate is what a place is like over years: the average temperature, the usual rainfall. Weather is what happens this week: the sudden cold spell, the three wet days in a row. A town can have a mild climate and still have days that knock you sideways.
Your hormones in perimenopause can be described in the same two ways. The climate is the long, gradual fall in estrogen across the transition. The weather is how much it rises and falls from week to week and month to month. The research increasingly suggests that mood follows the weather more closely than the climate. It’s less about how low your estrogen goes, and more about how much it moves.
Weather, not climate
Estrogen across the transition: the long trend, and the swings around itEstrogen over these years: the slow fall, and the ups and downs around it
Choose a stage to see what it looks like and what the research found.
How you might notice it
What the research found
In plain words
One long US study, the Penn Ovarian Aging Study, measured women’s hormones again and again over the years. The more a woman’s hormones moved around her own usual levels, the more likely her mood was to drop.
Swings may also make stress hit harder. In a small study, women whose estradiol varied more went on to have more symptoms of depression, but only if they had also been through more very stressful events lately. The researchers suggested that hormone swings may make women more sensitive to stress, especially to feeling left out or turned away. That fits what many women describe: ordinary difficulties, like a sharp comment or a friend who doesn’t call back, land harder than they used to.
Women differ a lot in this. When the same team checked hormones every week for twelve weeks, how closely mood followed those weekly changes varied greatly from one woman to the next, both in strength and in direction. For some women mood moved with their hormones, and for others it barely moved at all. If a sister or a friend sailed through these years and you haven’t, that doesn’t mean you’re handling it badly.
A small US experiment shows how big that difference can be. It involved women who were past menopause and well, but who had been depressed during perimenopause and had recovered while taking estradiol. Without knowing it, some of them were switched from estradiol to a placebo, a dummy treatment. In those women, depression symptoms came back within weeks. Women with no such history went through the same drop in estradiol and stayed well. Their hormone levels were similar. What differed was how each woman’s brain responded to the change.
Your cycle may give a clue as well. In one small study, about one in five women with depression in perimenopause also had premenstrual dysphoria, a severe form of low mood before a period. Among perimenopausal women without depression, it was three in a hundred. It’s only a link, but if your mood has always been affected by your cycle, it may be affected again now.
What the Penn study saw
The Penn Ovarian Aging Study measured hormones again and again over the years it followed women. Several things went with high depressive scores: moving into the transition itself, rising levels of two other hormones that regulate the cycle, and how much each woman’s estradiol and those two hormones varied around her own usual average. That last link is the weather: the more a woman’s levels moved, compared with her own normal, the more likely her mood was to drop.
Swings and stress together
Maybe you’ve noticed that a sharp comment, or a friend who doesn’t call back, hurts more than it used to. A small study that measured estradiol in women over fourteen months points to one reason. Women whose estradiol varied more went on to have more depressive symptoms, but only if they had also been through a larger number of very stressful events recently. Greater variation also went with stronger feelings of rejection in a laboratory task.
The researchers suggested that hormonal swings may make women more sensitive to stress, especially to the feeling of being left out or turned away. That fits what many women describe: ordinary difficulties land harder than they used to.
Some women are more sensitive than others
If a sister or a friend sailed through these years and you haven’t, that doesn’t mean you’re handling it badly. In a later study, the same research team measured hormones every week for twelve weeks in women in perimenopause. How closely mood followed those weekly changes varied greatly from one woman to the next, both in strength and in direction. For some women mood moved with their hormones, and for others it barely moved at all.
A small experiment at the US National Institute of Mental Health shows how strong that difference can be. It involved women who were past menopause and well, but who had been depressed during their perimenopause and had recovered on estradiol. They took estradiol for three weeks and were then switched, without knowing it, to either estradiol or a placebo. Among those switched to placebo, depressive symptoms came back within weeks.
Women with no such history went through exactly the same drop in estradiol and stayed well. Their hormone levels were similar. What differed was how each woman’s brain responded to the change.
There are also signs that this sensitivity can be tied to the monthly cycle. In one small study that tracked daily ratings over a cycle, about one in five women with perimenopausal depression met the criteria for premenstrual dysphoria, a severe form of premenstrual low mood, compared with three in a hundred perimenopausal women who were not depressed. It looked at one point in time, so it shows a link rather than a prediction. Still, it matches what many women notice: if your mood has always been affected by your cycle, it may be affected again now.
Night sweats, sleep and mood
How hot flashes at night, broken sleep and low mood are connected
In plain words
Hot flashes and night sweats are the best-known signs of the transition, and they often last longer than people expect. In the SWAN study, women who had frequent hot flashes typically had them for 7.4 years in total. Women whose hot flashes started early in the transition typically had them for more than eleven years.
For mood, when they happen matters too. In one experiment, healthy young women took a medicine that stops the ovaries from making estradiol for a while. Their levels fell and stayed low, and within four weeks most of them had hot flashes. Their mood got worse the more their sleep was broken and the more hot flashes they had at night. Hot flashes during the day made no measurable difference. The study was small and short, but what a hot flash does to your mood seems to depend on whether it wakes you up.
A much bigger analysis pooled eight studies from several countries. Women with frequent or severe hot flashes were more likely to report low mood later on. Once the researchers took sleep problems into account, most of that link disappeared. The chain ran from hot flashes to broken sleep, and from broken sleep to low mood.
It ran the other way too. Women with low mood were more likely to report hot flashes later, so it’s a loop. That’s one of the more hopeful findings, because sleep is something you can protect, and improving your sleep, including sleep broken by night sweats, may take some of the weight off your mood!
Hot flashes last longer than most people expect
If you’re waking up drenched at 3am, you might be hoping it will all be over in a few months. Hot flashes and night sweats are the best-known signs of the transition, and in SWAN, women who had frequent hot flashes typically had them for 7.4 years in total. Women whose hot flashes began early in the transition had them for longer, typically for more than eleven years.
For mood, the question isn’t only how long they last, but when they happen.
Night is where it matters
One experiment separated the effects of estrogen, hot flashes and sleep in a way that everyday life never does. Healthy young women were given a medication that temporarily stops the ovaries from making estradiol, so their levels fell and stayed low, without the swings of the transition. Within four weeks, most of them had hot flashes.
Their mood got worse in step with how broken their sleep became and with how many hot flashes they had at night. Hot flashes during the day made no measurable difference. The study was small and short, but the pattern is clear: what a hot flash does to your mood seems to depend on whether it wakes you up.
Sleep carries most of the link
A much larger analysis pooled eight studies from several countries. Women with frequent or severe hot flashes were more likely to report low mood later on. Once the researchers took sleep difficulties into account, most of that link disappeared: the chain ran from hot flashes to broken sleep, and from broken sleep to low mood.
The chain also ran the other way. Women with low mood were more likely to report hot flashes later, so this is a loop rather than a straight line. That makes it one of the more hopeful findings in this area, because sleep is something that can be protected, and improving your sleep, including sleep broken by night sweats, may take some of the weight off your mood!
Taking sleep into account
What happens to the link between hot flashes and low mood once sleep is includedWhat happens to the link between hot flashes and low mood once sleep is counted in
The loop runs back too: low mood also predicted more hot flashes later.It works the other way too. Low mood also went with more hot flashes later.
how many times as likely to report low mood later
Women with frequent or severe hot flashes were 1.56 times as likely to report low mood later on (likely range 1.27 to 1.92).
Anxiety, irritability and brain fog
What women notice, and what the research shows about each
In plain words
Anxiety can rise in these years too. In SWAN, women who weren’t very anxious to begin with were about 1.6 times as likely to have high anxiety during and after the transition. Women who were already quite anxious tended to stay that way, but their anxiety didn’t go up further.
You snap at someone you love, and a moment later you wonder where that came from. Many women say the change they notice most is a shorter fuse. They flare up faster and have less patience than they’re used to. In one small study of women who were already mildly depressed, irritability came and went from week to week, and it went with smaller swings in estradiol, not bigger ones. So the weather idea explains a lot, but not everything. Different symptoms may have different causes, and hormones are only one of them.
Brain fog is real, and it lifts. Forgetting words, or walking into a room and not knowing why, can be unsettling, partly because it can feel like the start of something worse. SWAN tested women’s memory and thinking again and again over four years. People usually get a little better at the same tests each time, just from practice. During the transition, that improvement stalled, for memory and for processing speed, how quickly you take in simple information and respond. After menopause, it came back.
The researchers concluded that the difficulties may be limited to the transition itself. So if you’ve been worried about your memory, this is reassuring. What the tests show looks like a temporary dip in learning, and not the start of a decline. A 2026 review of 26 studies agrees that thinking-test scores are lower in perimenopause than before it, but it could not show clearly that they recover afterward, so this is a hopeful sign rather than a promise. If your memory is getting worse or getting in the way of daily life, mention it to a doctor.
Not every change at this age is hormones. Perimenopause often comes at a crowded time of life, with children or teenagers, aging parents, work and changes in your own health, sometimes all at once. In SWAN, health and life circumstances were sometimes more important for mood than menopausal stage. The hormonal part is still real. The two usually arrive together, so a change in mood deserves to be looked at from both sides. If the pressure of these years is a big part of the picture, it may help to read about what stress does to the brain and body.
Anxiety rises too
Feeling on edge without a clear reason can be part of these years as well. Low mood gets most of the attention, but anxiety follows a similar pattern. In SWAN, women who started out with little anxiety were about 1.6 times as likely to have high anxiety during and after the transition, even after accounting for stress and hot flashes. Women who were already quite anxious at the start tended to stay that way, but their anxiety didn’t rise further as they moved through the stages.
Irritability deserves its own mention
You snap at someone you love, and a moment later you wonder where that came from. Many women say the change they notice most isn’t sadness but a shorter fuse: feeling crowded, flaring up faster, having less patience than they recognize in themselves. In a small study of women in perimenopause who were already mildly depressed, most had moderate or severe irritability at least once over eight weeks, and it came and went from week to week.
In that study, though, irritability went with less variation in estradiol, not more. It’s a small study, but it’s a useful reminder that the weather image from part three explains a good deal without explaining everything. Different symptoms may have different causes, and hormones are only one of them.
Brain fog is real, and it lifts
Forgetting words, walking into a room and not knowing why, reading the same paragraph twice: these are some of the most unsettling changes, partly because they can feel like the start of something worse. SWAN tested women’s memory and thinking again and again over four years. Normally people get a little better at the same tests each time they take them, just through practice. During the transition, that improvement stalled, for processing speedprocessing speedHow quickly you can take in simple information and respond to it, measured with short timed tasks. late in the transition and for verbal memory, how well you remember something you’ve heard, throughout it.
After menopause, the usual gains from practice returned to the level seen before the transition. The researchers concluded that the difficulties may be limited to the transition itself. So if you’ve been worried about your memory, this is reassuring: what shows up in the tests looks like a temporary dip in learning, not the beginning of a decline. A 2026 review of 26 studies agrees that thinking-test scores are lower in perimenopause than before it, but it could not show clearly that they recover afterward, so this is a hopeful sign rather than a promise. If your memory is getting worse or getting in the way of daily life, mention it to a doctor.
Not everything at 47 is hormones
Perimenopause arrives at a crowded time of life. You may be raising children or teenagers, caring for aging parents, carrying responsibility at work, and noticing changes in your own health, all at once. The SWAN researchers found that health and life circumstances were sometimes more important for mood than menopausal stage.
The hormonal part is still real. The two usually arrive together, and a change in mood deserves to be looked at from both sides. If the pressure of those years is a large part of the picture, it may help to read about what stress does to the brain and body.
What helps
When to talk to a doctor, which treatments have evidence, and what you can do day to day
In plain words
If you’ve been putting off an appointment because you’re not sure it’s bad enough, you don’t have to wait for a change in mood to become severe before raising it with a doctor. Guidelines published in 2018 by the North American Menopause Society, now called The Menopause Society, and the US National Network of Depression Centers described perimenopause as a window of vulnerability for depression, a time when it’s more likely.
Start with a conversation
If you’ve been putting off an appointment because you’re not sure it’s bad enough, you don’t have to wait for a change in mood to become severe before raising it with a doctor. The 2018 guidelines described perimenopause as a window of vulnerability for depression.
It’s useful to know where the line is. Mood that dips for a few days and then lifts is the kind of weather this article describes. Low mood or a loss of interest that lasts most of the day, nearly every day, for two weeks or more is different: it’s what doctors look for in an episode of depression, and it needs treatment whatever your hormones are doing.
If there’s no doctor you can see soon or afford, or you’ve felt brushed off before, a women’s health or menopause clinic or a nurse line can be where the first conversation happens. And if your mood is that low or you’re having thoughts of harming yourself, please don’t wait: you can find the crisis lines and emergency numbers for your country on our helplines page. If you’re in immediate danger, call your local emergency number.
The guidelines also point out that the symptoms of the transition can overlap with those of depression, and poor sleep and low energy can belong to either. A few weeks of notes often show a pattern that’s hard to describe from memory.
BEFORE YOUR APPOINTMENT
- Note how your mood has changed, and whether it comes and goes.
- Write down how you’re sleeping, and whether hot flashes or night sweats wake you.
- Keep track of your periods and how your cycle has changed.
- Take the notes with you, and mention anything that has lasted two weeks or more.
A weather diary
Four weeks of mood, night sweats and periods, one tap a day
This diary is kept only in this browser, on this device. Nothing is sent anywhere.
In plain words
If you’re wondering about hormones or an antidepressant, the guidelines give a clear starting point. For depression in perimenopause, they start with what’s already proven to work for depression in general, which is antidepressants and talking therapy. Estrogen is not approved as a treatment for perimenopausal depression. It has shown antidepressant effects in women in the transition, especially those who also have hot flashes. For estrogen taken together with a progestin, a lab-made hormone that acts like progesterone, the evidence was described as sparse and inconclusive.
One trial tested whether hormone therapy could stop low mood before it started. It followed women without depression for a year. Among women given a placebo, about one in three developed significant symptoms of depression, compared with about one in six of those given estradiol with progesterone. The benefit showed up in women early in the transition, and not in those further along.
It’s one trial at one site, and it isn’t a reason to start hormone therapy to prevent low mood. It does support the idea that the transition itself is the sensitive time. The International Menopause Society’s 2025 recommendations are just as cautious. Estrogen may ease depression during perimenopause, but the evidence is still limited, and more is needed before hormone therapy could be recommended to prevent it. In the UK, doctors are advised to consider hormone therapy for low mood that starts around the same time as other menopause symptoms, and a talking therapy called CBT when low mood comes with hot flashes. Decisions about hormone therapy depend on your health history, so they belong in a conversation with your doctor.
There’s also talking therapy designed for this stage. Cognitive behavioral therapy, or CBT, is a structured talking therapy that works on the links between your thoughts, feelings and behavior, and its version adapted for menopause is called CBT-Meno. In a Canadian trial, depression symptoms improved more in women who had it than in women who were waiting for it. Their sleep improved too, and the gains were still there three months later. An earlier British program focused on hot flashes and night sweats. The hot flashes didn’t necessarily go away, but they caused less trouble, and mood and quality of life improved as well.
Low mood and a short temper often land first on the people closest to you. Telling a partner, a friend or your family what’s going on, even in a few words, helps them understand a short temper or a quiet week without blaming themselves or you. You could say you’re having a hard stretch that seems partly hormonal, and tell them what helps on a bad day.
If you’re the partner or family member reading this, you may be feeling the strain too. If things between you have become strained, support for the two of you can sit alongside support for her.
When you’re tired and low, exercise can sound like one more thing on the list. Still, a review of 21 trials in women in or after the transition found that physical activity reduced both depression and anxiety symptoms. The studies varied a lot, so how big the effect is isn’t clear, but the direction was consistent, and how hard people exercised didn’t seem to matter much. The best form of movement is the one you’ll keep doing!
Part four showed how night sweats and broken sleep feed into low mood, so protecting your sleep isn’t a side issue. A few things that help are below.
What the guidelines say about treatment
If you’re weighing hormones against an antidepressant, the guidelines give a clear starting point. For depression in perimenopause, the guidelines recommend starting with the treatments already proven for depression in general: antidepressants and psychotherapy. Estrogen is not approved as a treatment for perimenopausal depression, although it has shown antidepressant effects in women in the transition, particularly those who also have hot flashes. The evidence for estrogen combined with a progestinprogestinA synthetic hormone that acts like progesterone. In hormone therapy it is usually given alongside estrogen to protect the lining of the uterus. was described as sparse and inconclusive.
One trial asked whether hormone therapy could prevent depressive symptoms in the first place. It followed women without depression for a year. Among those given a placebo, about one in three developed significant depressive symptoms, compared with about one in six of those given estradiol with progesterone. The benefit showed up in women in the early transition, and not in those further along.
It’s one trial at one site, and it isn’t a reason to start hormone therapy to prevent low mood, but it supports the idea that the transition itself is the sensitive window. The International Menopause Society’s 2025 recommendations reach the same cautious conclusions: estrogen may ease depression during perimenopause, but the evidence is still limited, and more is needed before hormone therapy could be recommended to prevent it. In the UK, the national guideline (NICE) suggests considering hormone therapy for low mood that begins around the same time as other menopause symptoms, and CBT when low mood comes with hot flashes. Depression itself is treated with the usual depression care, alongside menopause care. Decisions about hormone therapy depend on your health history, so they belong in a conversation with your doctor.
Therapy designed for this stage
Cognitive behavioral therapy, a structured form of talking therapy that works on the links between thoughts, feelings and behavior, has been adapted for menopause. In a Canadian trial of a program called CBT-Meno, women in or after the transition either had the therapy or waited for it. Depressive symptoms improved more in those who had the therapy, their sleep improved as well, and the gains were still there three months later.
An earlier British program focused on hot flashes and night sweats. In its trial, both group sessions and a self-help version reduced how much trouble the hot flashes caused, and mood and quality of life improved as well. The hot flashes didn’t necessarily disappear, but they became easier to live with.
Let the people close to you know
The irritability and low mood of these years often land first on the people closest to you, and they may notice the change before you’ve found the words for it. Telling a partner, a friend or your family what you’re going through, even briefly, gives them a way to understand a short temper or a quiet week without blaming themselves or you.
WHEN YOU TALK TO THEM
- Say that you’re having a hard stretch, and that it seems to be partly hormonal.
- Tell them what helps on a bad day, whether that’s some space, practical help or simply being asked how you are.
- Keep it short if that’s easier; a few words already give them something to go on.
And if you’re the partner or family member reading this, you may be feeling the strain too. Changes in mood can make ordinary friction feel bigger on both sides, and if the relationship itself has become strained, support for the two of you can sit alongside support for her.
Movement and sleep
When you’re tired and low, exercise can sound like one more thing on the list. Still, a review of 21 trials in women in the transition or after it found that physical activity reduced both depressive and anxiety symptoms. The studies varied a lot, so the size of the effect is uncertain, but the direction was consistent, and the intensity of the exercise didn’t seem to matter much. The best form of movement is the one you’ll keep doing!
Given what part four showed about hot flashes and broken sleep, protecting sleep is not a side issue either.
WHAT HELPS WITH SLEEP
- Keep your bedroom cool.
- Wear layers that are easy to take off.
- Get up at a steady time each day.
- If night sweats are waking you regularly, mention them to a doctor, because they can be treated.
A change in the weather is not a change in who you are. For most women these years are a stretch to get through with good support, not a new climate to live in for good.
WHAT THE RESEARCH SUPPORTS
A 2024 meta-analysismeta-analysisA study of studies: it pools the results of many studies on the same question to estimate how large an effect usually is, rather than relying on any single result. reviewed 17 long-term studies and combined the results of the seven that could be pooled. Women in perimenopause were about 1.4 times as likely to have depressive symptoms or depression as women before it, with no significant increase once menopause was past. Following women over fourteen years, the Penn Ovarian Aging Study found that high depressive scores became about 15% less likely each year, from ten years before the last period to eight years after it.
WORTH BEING CLEAR ABOUT
Most of this research is observational, which means it shows what tends to happen together rather than proving what causes what. Several of the key studies are small, and many were done in the United States. A single blood test captures one moment, so it says little about how much your hormones are moving from week to week. The findings also describe groups, and your experience of the transition is your own.
REFERENCES
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BOOKS FROM OUR SHELF
Last reviewed October 2026
This article is general information, not medical advice. It cannot diagnose or rule out any condition. Changes in mood, sleep, memory or your cycle around perimenopause deserve proper medical assessment, particularly when they are severe, new or getting worse. If any of this sounds like your experience, please speak to your doctor or gynecologist, and talk with them before starting, stopping or changing any hormonal treatment or antidepressant. Psychological support is intended to work alongside appropriate medical care, never to replace it.
WORKING WITH THIS
When your mood no longer feels like your own
If these years have brought changes in mood that are wearing you down, you do not have to work out alone how much is hormones and how much is everything else. Talking it through can help you see the pattern more clearly and decide what kind of support would help.
