When we talk about menopause, most people immediately think of hot flashes or night sweats. But for many women, the first signs of perimenopause aren’t physical at all—they're emotional. Mood swings, unexpected irritability, anxiety, or even depressive episodes can show up years before a woman’s period stops altogether.
If you've never had mental health challenges before but suddenly find yourself battling anxiety or feeling low for no clear reason, you're not imagining it—and you're definitely not alone.
Mood Changes: A Common Early Symptom of Perimenopause
The Anxiety and Depression Association of America notes that up to 70% of women experience mood swings during menopause, and around 45–60% suffer from depression.[i]
Similarly, the Study of Women’s Health Across the Nation (SWAN) found that women in early perimenopause were nearly twice as likely to report depressive symptoms compared to premenopausal women.[ii]
Why Hormonal Shifts Impact Mental Health
Perimenopause is a period of significant fluctuation in estrogen and progesterone, hormones that have a strong influence on brain chemistry—especially neurotransmitters like serotonin and dopamine, which are key to mood regulation.
These hormonal ups and downs can lead to increased emotional sensitivity, anxiety, or depressive episodes. Yet, many healthcare providers overlook the hormonal link, treating mood symptoms in isolation rather than considering them as part of the broader menopausal transition.
The Problem with Missed Diagnosis
As a result, many women are routinely prescribed antidepressants or anti-anxiety medications when they may benefit more by addressing the root cause with hormone replacement therapy (HRT).
Approximately 17.7% of women aged 40–59 reported using antidepressant medications between 2015 and 2018. Usage increases with age, with 24.3% of women aged 60 and over reporting use.)[iii]
The use of HRT among women aged 50–59 has declined significantly over the past two decades. In 2007, approximately 6% of women aged 50–54 and 7.3% of women aged 55–59 used HRT. By 2023, these numbers had decreased to 3.6% and 3.8%, respectively.[iv]
The data indicates that midlife women are more likely to be prescribed antidepressants than HRT for menopausal symptoms. This trend reflects lingering concerns from the early 2000s about the safety of HRT, despite subsequent research clarifying its benefits and risks. It’s also important to note that most physicians, even OB GYNs, receive little to no training in menopause, so it’s not hard to see why they often miss the overlap of mental health and menopause. It's important for women experiencing menopausal symptoms to consult with healthcare providers knowledgeable about menopause to explore all treatment options, including HRT, which may address the root hormonal causes of their symptoms more effectively than antidepressants alone. This doesn’t mean antidepressants are “wrong”—for some women, especially those with a pre-existing history of depression or anxiety, a combination of HRT and psychotropic medications may be the most effective approach. But the hormonal piece must be acknowledged.
What Can You Do If You’re Struggling?
If you're experiencing emotional distress during perimenopause or menopause, please know:
You are not broken. You are not weak. And you are absolutely not alone.
Here’s how you can start getting the help you deserve:
Track Your Symptoms
Write down your mood changes, sleep patterns, energy levels, and menstrual cycle. This log can help you identify hormonal patterns and prepare for conversations with your provider.
Find a Menopause-Trained Clinician
Unfortunately, most doctors receive little to no formal training in menopause care, and as a result, many still rely on outdated information—particularly from the 2002 Women’s Health Initiative (WHI) study, which inaccurately linked hormone replacement therapy to major health risks. Although that study has since been widely debunked and clarified, its legacy continues to influence how providers counsel women today, often leading to unnecessary fear and under-treatment. Use the North American Menopause Society (NAMS) provider search to find a certified menopause practitioner near you. There are also excellent telehealth options for menopause care now including: Alloy, Midi Health, MyMenopauseRx, Evernow, and Winona. Do not let your doctor’s lack of experience stop you from getting the care you need.
Ask About Hormone Replacement Therapy (HRT)
Don’t hesitate to ask whether HRT could be right for you. While not for everyone, the latest guidelines from NAMS support its use for MOST healthy women in menopause—especially when mood symptoms are present.[v] HRT is a very safe, very effective treatment and most women are candidates.
Consider a Holistic Approach
A combination of HRT, psychotherapy, psychiatric medication (if needed), nutrition, sleep support, and menopause coaching can provide a personalized path forward.
You Deserve to Feel Like Yourself Again
Mental health challenges during the menopause transition are common—but they are also treatable. You don’t have to “tough it out” or accept feeling off as your new normal.
With the right information, care, and support, you can feel better—and thrive in midlife and beyond.
Book a free consultation call today at www.themenopauseot.com
Follow along on Instagram @themenoot and TikTok @TheMenopauseOT for more support and encouragement.
[i] Anxiety and Depression Association of America. (n.d.). Menopause and mental health. Retrieved May 30, 2025, from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/menopause-and-mental-health
[ii] Freeman, E. W., Sammel, M. D., Lin, H., & Nelson, D. B. (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry, 63(4), 375–382.
[iii] Centers for Disease Control and Prevention (CDC). (2020). Antidepressant use among adults: United States, 2015–2018 (NCHS Data Brief No. 377).
[iv] Nelson, A. L. (2023, March 10). Hormone therapy for menopause remains at historic lows despite effectiveness. MDedge ObGyn.
[v] The North American Menopause Society. (2022). The 2022 hormone therapy position statement of The North American Menopause Society. Menopause, 29(7), 767–794.