Low Mood and Menopause: When It's Hormones, When It's Depression, and What Helps

Low mood is common during perimenopause, and the risk of depression rises during this time. Fluctuating hormones, disrupted sleep, hot flashes and midlife pressures can all contribute. Mild low mood linked to menopause may improve with HRT or CBT. Depression needs its own assessment and treatment. If you have thoughts of harming yourself, seek help straight away.

What does menopausal low mood feel like?

Low mood can include:

• Feeling sad, flat, tearful or empty
• Losing interest or pleasure in things you usually enjoy
• Low confidence or self-esteem
• Feeling hopeless or overwhelmed
• Irritability or a short fuse. See irritability.
• Low energy and motivation. See fatigue.
• Changes in sleep or appetite

Menopausal low mood often comes and goes, and may be worse at certain points in your cycle, or alongside poor sleep and hot flashes. NICE describes low mood as mild depressive symptoms that affect quality of life, are usually intermittent, and are often linked with hormonal fluctuations in perimenopause.

Low mood or depression: what’s the difference?

It isn’t always clear-cut, and the two can overlap. A clinician can help you work out what’s going on.

Why does menopause affect mood?

• Hormone fluctuations. Estrogen and progesterone affect brain chemicals involved in mood. Research suggests the erratic fluctuations of perimenopause, more than low levels alone, make some people more vulnerable to depression.
• Poor sleep, often from night sweats. See sleep problems.
• Hot flashes, which can be exhausting and embarrassing. See hot flashes.
• Life circumstances. Midlife often brings pressures such as caring responsibilities, work demands, relationship changes, bereavement or health worries.
• Early or surgical menopause, which can bring grief about fertility and a sudden change in identity. See early menopause.

How common is it?

Mood changes are among the most common menopause symptoms. A large study published in 2024 found that perimenopause was associated with an increased risk of developing major depression. Many people find their mood improves after the transition, but that isn’t a reason to wait for help.

What else can cause low mood?

• Thyroid problems, particularly an underactive thyroid
• Iron deficiency or anemia, often from heavy periods
• Vitamin B12 or vitamin D deficiency
• Some medicines
• Alcohol
• Chronic pain or illness
• Life events, such as loss, stress or loneliness

See perimenopause or something else.

What will a clinician assess?

A clinician will usually ask:

• How long you’ve felt low, and how it affects your life
• About sleep, appetite, energy, concentration and interest in things
• About other menopause symptoms and your periods
• About previous depression or anxiety
• Whether you’ve had thoughts of self-harm or suicide. It’s important to answer honestly; this question is about keeping you safe.

They may suggest blood tests, such as thyroid function, a blood count and vitamin levels.

What treatments help?

For menopause-related low mood

• Hormone therapy. NICE recommends considering HRT to relieve depressive symptoms that don’t meet the criteria for depression and that start around the same time as other menopause symptoms.
• CBT. NICE recommends considering CBT for depressive symptoms that occur alongside hot flashes and night sweats, either with other treatments or instead of them.
• Treating sleep problems and hot flashes, which often improves mood.

NICE notes there’s no clear evidence that SSRIs or SNRIs help low mood in menopausal women who haven’t been diagnosed with depression.

For depression

If depression is suspected or diagnosed, NICE recommends following depression guidance alongside menopause guidance. Treatment may include:

• Talking therapies, such as CBT
• Antidepressants, where appropriate
• Treating menopause symptoms at the same time

HRT on its own isn’t a treatment for depression, but it may be part of the plan if menopause symptoms are contributing.

Practical steps that may help

• Move your body. Regular activity, especially outdoors, lifts mood and improves sleep.
• Protect your sleep. Try a regular routine, a cool bedroom and less evening alcohol.
• Stay connected. Talk to friends, family, a partner or a support group.
• Limit alcohol, which can worsen mood and sleep.
• Eat regularly and include a variety of whole foods.
• Do something you enjoy each day, even briefly.
• Track your mood alongside your cycle and symptoms. Our private Symptom Explorer can help.
• Be kind to yourself. Low mood isn’t a personal failing.

Why mood matters for your heart

The American Heart Association notes that depression during the menopause transition is strongly linked with higher cardiovascular risk. That’s another reason not to ignore persistent low mood. See heart health after menopause.

When should you get help?

Book an appointment if low mood lasts more than two weeks, affects your daily life, or keeps coming back.

Get help immediately if you:

• Have thoughts of harming yourself or ending your life
• Feel unable to keep yourself safe

Contact emergency services or a crisis line in your country straight away, or go to your nearest emergency department. If you’re not in immediate danger but are struggling, contact your doctor today.

Low mood after early or surgical menopause

Menopause that comes early, before 45, or suddenly after surgery or cancer treatment can bring particular emotional challenges. These include grief about fertility, feeling out of step with friends, and adjusting to an unexpected change in health. NICE recommends offering psychological support to people aged 40 to 44 who are distressed by early menopause. The 2024 international guideline on premature ovarian insufficiency recommends support groups and mental health care. See early menopause.

For partners, family and friends

• Notice changes, such as withdrawal, tearfulness, irritability or loss of interest, and gently ask how they’re doing.
• Listen more than you advise.
• Don’t blame it all on hormones. Low mood can have several causes, and it’s real either way.
• Help practically, by sharing tasks and protecting their sleep.
• Encourage professional support, and know the warning signs that need urgent help.

Questions to ask at your appointment

1. Is my low mood likely to be linked to perimenopause or menopause, or could it be depression?
2. Should I have blood tests, such as thyroid function or iron?
3. Would HRT help my mood?
4. Can I access CBT, including menopause-specific CBT?
5. If I have depression, what treatment do you recommend alongside menopause care?

See your first menopause appointment.

Related symptoms

Anxiety · Irritability · Sleep problems · Fatigue · Brain fog · Low libido

Frequently asked questions

Can perimenopause cause depression?

Perimenopause is linked with a higher risk of developing depression. Not everyone is affected, and many people have milder low mood.

Does HRT help with low mood?

NICE recommends considering HRT for depressive symptoms that start around the same time as other menopause symptoms. It isn’t a treatment for depression on its own.

Will antidepressants help menopausal low mood?

NICE notes there’s no clear evidence that SSRIs or SNRIs help low mood in menopausal women without a diagnosis of depression. If you have depression, antidepressants may be part of treatment.

Does low mood get better after menopause?

For many people, mood improves after the transition. But there’s no need to wait; help is available now.

Can HRT and antidepressants be used together?

They can be used together when appropriate. NICE recommends that if depression is suspected or diagnosed, menopause care and depression treatment are planned together. Your clinician will check for interactions and suitability.

Is it normal to feel a sense of loss at menopause?

Yes. Some people feel grief about fertility, youth or identity, especially if menopause came early or suddenly. These feelings are valid, and talking about them, with loved ones, a support group or a therapist, can help.

References

1. NHS: Menopause: symptoms
2. NICE guideline NG23: Menopause, identification and management (2024 update)
3. NICE NG23 recommendations (definition of low mood; SSRIs and SNRIs)
4. First onsets of mania, schizophrenia spectrum disorders and major depressive disorder in perimenopause (2024)
5. Menopause-associated depression: impact of oxidative stress and neuroinflammation (review)
6. American Heart Association: The connection between menopause and cardiovascular disease risks
7. ESHRE/ASRM/IMS: Evidence-based guideline on premature ovarian insufficiency, 2024 (psychological impact)
8. Mayo Clinic Press: Menopause symptoms? It could be a copycat

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.