Depression & Anxiety in Perimenopause
Why Mood changes in Perimenopause, and What You Can Do About It
written by Dr. MAdeleine clark, ND MSCP
If you’ve ever noticed your mood changed or dropped in puberty, before your period, after you gave birth, or now in your 40s, there’s a biological reason. Research shows that some people have a brain that’s more sensitive to hormonal changes in what’s called a window of vulnerability.
This sensitivity helps explain why women are about twice as likely to experience depression during their reproductive years compared to men. And during perimenopause, the years leading up to your final period, that risk climbs even higher.
The Numbers You Need to Know
45% of perimenopausal women experience depression, compared to 25–30% of premenopausal women.
Around the two years surrounding the final menstrual period, the risk of depression is 14x higher than in the decades before.
The SWAN study found that depression risk rises 1.5-fold in early perimenopause and 1.8–2.5-fold in late perimenopause.
Women entering perimenopause are twice as likely to develop depression as those who remain premenopausal, even if they’ve never had depression before. The risk is even higher if hot flashes are severe or life stress is high.
Why This Happens
Perimenopause is not just about changing estrogen and progesterone. Midlife often brings shifts in metabolism, body composition, relationships, caregiving roles, work demands, and sexuality. Each of these changes can affect mood, energy, and overall quality of life.
Sleep changes make it worse — depression in midlife is linked to:
Taking longer to fall asleep.
Sleeping fewer hours overall.
Lower sleep efficiency (more time awake at night).
💡 Want to understand more about how depression develops and the role brain chemistry plays? Read our full guide on understanding depression and brain health.
Anxiety in Midlife: Another Window of Vulnerability
Depression isn’t the only mood change that can surface during perimenopause, anxiety is also highly prevalent. Across the lifespan, about 30% of women experience an anxiety disorder compared to 19% of men.
Women with a history of both depression and anxiety tend to have a lower quality of life in midlife, regardless of other symptoms like hot flashes or sleep problems.
While fewer studies have explored anxiety in menopause, patterns are emerging:
A history of anxiety is a strong predictor of a new episode during the late premenopausal stage.
Anxiety sensitivity (a heightened awareness of physical sensations) and neuroticism are predictors of both new and recurrent anxiety.
In some studies, women who started perimenopause with anxiety experienced a surge in symptoms in late perimenopause, suggesting another “window of vulnerability” similar to depression.
Hot flashes can make anxiety more complex — the sudden physical sensation, especially in a social or public setting, can trigger anxiety, which in turn can make the hot flash worse. This cycle can be exhausting and isolating.
Just like depression, anxiety in midlife responds best to a comprehensive plan:
Medical options, including antidepressants or anti-anxiety medications when appropriate.
Therapy — such as cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) — to help reframe thought patterns, develop coping skills, and reduce symptom intensity.
Lifestyle strategies to calm the nervous system.
Targeted supplementation to support neurotransmitters and reduce stress reactivity.
Treatment That Works
If you are struggling, the first step is knowing you have options — and that getting help early matters.
Antidepressants are an effective, evidence-based option for perimenopausal depression and anxiety.
Therapy can provide tools and strategies to manage symptoms, improve resilience, and address underlying thought patterns.
Hormone therapy is not a first-line mood treatment but may be considered if you have both mood symptoms and significant menopausal symptoms, especially during perimenopause.
Lifestyle and supplementation can be powerful tools for mood stability:
Nutrition strategies to balance blood sugar and support brain health.
Targeted nutrients like omega-3 fatty acids
Movement plans that improve energy and reduce anxiety.
Mind–body practices for stress resilience.
A Whole-Person Approach
One of my patients came to me after two years of struggling with irritability, low motivation, and poor sleep. Her doctor had prescribed an antidepressant, which helped somewhat — but not enough. By adding targeted nutrition, an exercise routine she actually enjoyed, supplementation for sleep, guided stress-reduction techniques, and a referral to a therapist specializing in midlife women’s health, her mood and energy improved dramatically within months.
The Bottom Line
If you’re in perimenopause and feeling low, anxious, or unlike yourself, you don’t have to choose between medication, therapy, and lifestyle — the most effective results often come from combining them.
I’m Dr. Madeleine Clark, ND and Menopause Society Certified Practitioner. I help women move through PMS, PMDD, and perimenopause with clarity, evidence-based care, and more energy for what matters.
Book your appointment today to start your personalized mood and perimenopause plan.