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Low mood is common in perimenopause, and depression risk rises. Learn how to tell low mood from depression, which treatments help, and when to seek help.
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.
Low mood can include:
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.
| Menopause-related low mood | Depression | |
|---|---|---|
| Pattern | Often comes and goes, and may vary with cycle, sleep or hot flashes | Persistent: most of the day, nearly every day, for at least two weeks |
| Impact | Frustrating, but you can usually still function | Significantly affects work, relationships and daily life |
| Other features | Usually alongside other menopause symptoms | May include feelings of worthlessness, guilt, or thoughts of death or self-harm |
| Treatment | HRT, CBT, treating sleep and hot flashes, lifestyle | Standard depression treatment (talking therapies and/or antidepressants), plus menopause care |
It isn’t always clear-cut, and the two can overlap. A clinician can help you work out what’s going on.
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.
See perimenopause or something else.
A clinician will usually ask:
They may suggest blood tests, such as thyroid function, a blood count and vitamin levels.
NICE notes there’s no clear evidence that SSRIs or SNRIs help low mood in menopausal women who haven’t been diagnosed with depression.
If depression is suspected or diagnosed, NICE recommends following depression guidance alongside menopause guidance. Treatment may include:
HRT on its own isn’t a treatment for depression, but it may be part of the plan if menopause symptoms are contributing.
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.
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.
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.
See your first menopause appointment.
Anxiety · Irritability · Sleep problems · Fatigue · Brain fog · Low libido
Perimenopause is linked with a higher risk of developing depression. Not everyone is affected, and many people have milder 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.
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.
For many people, mood improves after the transition. But there’s no need to wait; help is available now.
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.
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.
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
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