How Perimenopause Increases Anxiety and Depression

If you’ve found yourself more anxious, teary, irritable, or overwhelmed than ever before—and you’re in your late 30s or 40s—you’re not alone, and you’re not just “bad at coping.” For many women, these emotional changes are one of the first signs of perimenopause, even before their periods become irregular.

And yet, this side of the perimenopause journey is still rarely talked about.

Let’s change that.

Hormones, Mood, and the Windows of Vulnerability

Mental health experts have identified three key “windows of vulnerability” for women: puberty, postpartum, and perimenopause. These are times when dramatic shifts in estrogen and progesterone—two powerful hormones that influence brain chemistry—can trigger symptoms of anxiety, depression, and mood instability.

If you’ve ever experienced PMS, PMDD, or postpartum depression, you may be more sensitive to these hormonal changes—and more likely to experience mood symptoms during perimenopause.

This isn’t a weakness. It’s biology.

What Perimenopausal Mood Changes Look Like

Not all mood symptoms during perimenopause show up as full-blown depression or panic attacks. Many women don’t realize what they feel is connected to hormones.

You might notice:

• Feeling more irritable than usual

• Crying unexpectedly or “not feeling like yourself.”

• Trouble concentrating or making decisions

• Waking up with a sense of dread

• Racing thoughts or panic-like symptoms

• Low motivation or persistent fatigue

• Feeling emotionally raw, reactive, or numb

About 38% of women in late perimenopause report symptoms of depression—and even women with no history of mental health challenges are 2 to 4 times more likely to experience a depressive episode during this transition.

It’s Not All In Your Head—It’s In Your Hormones

Shifting hormone levels often drive these mood changes. Estrogen, which boosts serotonin and calms the nervous system, begins to fluctuate wildly and eventually drops. Progesterone, a calming hormone that supports sleep and stress resilience, also declines.

And it’s not just internal chemistry at play.

Night sweats can wreck your sleep. Hot flashes can mimic panic attacks. Fatigue, low libido, weight gain, and brain fog—all common perimenopause symptoms—can also feel like mental health issues. When your body is struggling, your mood often follows.

Risk Factors That Increase Vulnerability

Some women are more susceptible than others. You may be at greater risk of experiencing perimenopausal anxiety or depression if you:

• Had postpartum depression or PMDD

• Have a personal or family history of anxiety or depression

• Are experiencing frequent hot flashes or night sweats

• Are going through significant life stress (career shifts, caregiving, divorce, etc.)

• Had a difficult or traumatic childhood or adverse life experiences

Holistic Tools That Help You Reclaim Calm

You don’t have to wait for a diagnosis—or start with medication—to begin supporting your mental health. These evidence-based lifestyle tools can help regulate your mood naturally:

Morning sunlight

Supports circadian rhythm, balances cortisol, and helps regulate your sleep-wake cycle. Try to get 10–20 minutes within an hour of waking.

Blood sugar balance

Mood crashes often follow blood sugar crashes. Start your day with protein and fiber-rich meals, and avoid skipping meals.

Movement

Exercise increases endorphins and lowers stress hormones. Strength training and walking are beneficial in perimenopause.

Nervous system support

Breathwork, meditation, and even short nature breaks can help bring you out of fight-or-flight mode.

Better sleep hygiene

Go to bed at the same time each night, avoid screens before bed, and keep your bedroom cool and dark. Even minor improvements in sleep can boost mood.

Talk it out

CBT, therapy, or just connecting with someone who gets it can help you process your emotions and create a toolkit for support.

Consider your options

While antidepressants and HRT aren’t the focus here, they’re valid tools in the toolkit. If your symptoms persist, talk to your provider about whether these treatments might be right for you.

When to Seek Help

While mood swings and anxiety are common in perimenopause, they shouldn’t derail your daily life. If your symptoms:

• Last more than two weeks

• Make it hard to function at work or home

• Cause thoughts of hopelessness, self-harm, or suicidal ideation

...please reach out for professional help. Contact your OB-GYN, a reproductive psychiatrist, or a therapist who understands hormone-related mental health. And if you’re in crisis, call 911 or the Suicide & Crisis Lifeline at 1-800-273-8255.

There is help. And you can feel better.

Final Thoughts: You’re Not Broken

Perimenopause is a transition—not a failure. At times, you may feel raw, overwhelmed, or even like a stranger in your own mind (and body). But you are not alone, and you are not powerless. Understanding what’s happening in your body is the first step in getting back to yourself.

You don’t have to suffer in silence. And you don’t have to figure it out alone.