Mood Changes in Perimenopause Are Real — and They Deserve Attention

If your mood feels different in perimenopause, you are not imagining it.

In Mood and Menopause (2025), Pauline M. Maki, PhD, explains that perimenopause is a time when depressive symptoms and even major depression can become more common. This can affect quality of life, work, relationships, sleep, and overall health.

One reason this happens is that hormone levels during perimenopause can fluctuate more dramatically than they did before. These shifts may affect the brain, stress systems, and mood. Some women are especially sensitive to these hormone changes. Sleep disruption, hot flashes, and life stress can make things feel even worse.

The good news is that help exists. The article recommends screening tools like the PHQ-9 and says treatment should be personalized. Depending on your symptoms and history, options may include therapy such as cognitive behavioral therapy, antidepressants, stress-reducing approaches, exercise, and in some cases transdermal estradiol during perimenopause. The article also notes that treating hot flashes and sleep problems can help because those symptoms can worsen mood.

Most importantly, mood symptoms in midlife are not something you should have to just “push through.” If you have a history of depression, early menopause, major stress, or ongoing menopause symptoms, it is especially important to speak up and get support.