Depression appears to be more common during perimenopause, which is the first stage of menopause. However, research has not proven a causal link between the two.

A 2018 review states that depression is common during the menopausal transition. The risk seems to decrease in the 2–4 years following someone’s last period.

Scientists are not sure why depression is more common during perimenopause, but a mixture of physiological and psychological factors may play a role.

Keep reading to learn more about the link between menopause and depression and the treatment options available.

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Depression is a mental health condition that affects a person’s feelings, thoughts, and behaviors. The symptoms can include:

  • a lack of interest in activities a person used to enjoy
  • feelings of sadness, apathy, or emptiness
  • fatigue or lack of energy
  • trouble remembering, concentrating, and making decisions
  • appetite changes, weight changes, or both
  • difficulty sleeping or oversleeping
  • slow movement or speech

There are several types of depression. The medical name for one of the most common is major depressive disorder (MDD). According to the 2018 review, people going through menopause appear to be more likely to develop MDD.

Not all of the studies that the authors looked at found an association. However, two well-designed studies indicated that the risk of developing a depressive disorder might be two to five times higher during perimenopause compared with the late premenopausal years.

Researchers are not certain why depression is more common during perimenopause, but several factors may contribute.

Physiological factors

During perimenopause, a person’s hormone levels change unpredictably. Estrogen and progesterone may rise and fall while they decline overall. These hormonal changes may affect brain chemistry, structure, and function.

Estrogen enhances the effect of certain neurotransmitters, such as serotonin and norepinephrine. These neurotransmitters help regulate mood. When estrogen levels decline, it may affect the balance of these chemicals.

Some people may be especially susceptible to hormone-related mood changes. A 2015 study reports that clinical depression during perimenopause may be more common in people with:

However, the authors of the study emphasize that the risk of depression is higher in all people going through perimenopause, regardless of their personal or family history.

Psychosocial factors

The psychological and social impact of menopause may also affect mental health. Although some people feel that menopause and aging can be positive, others may feel as though:

  • menopause or aging is a negative thing
  • it makes them less youthful or womanly
  • menopause symptoms are stressful or affect their ability to work
  • they lack social support

These feelings may affect someone’s mental health. However, they may not be inevitable.

While some cultures value youth highly, others value age and experience. A 2021 review notes that people from cultures that revere older age report fewer menopause symptoms, which may suggest that social norms can contribute to how the transition affects people.

Gender roles and expectations may also influence how people experience menopause. Despite an increasing number of women entering the workforce, in heterosexual relationships, women still do the most child care and household labor overall. Managing these responsibilities, as well as menopause symptoms, may cause stress.

Women are also more likely than men to have roles as caregivers, although this role can change around midlife. Children can leave home, and older relatives may begin to need care due to illness or disability. Either of these events may contribute to stress or depression.

Other health factors

In addition to menopause, other health-related factors may influence depression risk, including:

  • Chronic health conditions: Having a chronic health condition may be a risk factor for depression in midlife, and it may coincide with menopause.
  • Lifestyle: Studies have found an association between depression and certain behaviors, particularly smoking and a lack of physical activity. This means not necessarily that smoking or a lack of exercising causes depression but that depression is more common in people who have these habits.
  • Surgical menopause: If a person undergoes surgery to remove the ovaries, they enter menopause more quickly than they would otherwise. This, as well as the procedure itself, may cause stress.

Treatment for depression often involves a combination of antidepressants and psychotherapy.

Doctors may suggest selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) for menopause-related mood changes. These medications change neurotransmitter levels and may reduce the symptoms of depression. They may also make someone feel well enough to begin psychotherapy.

Psychotherapy may help with identifying the factors contributing to depression, such as life events or stress. A therapist can help someone understand and manage their emotions.

A 2018 study notes that the Food and Drug Administration (FDA) has not approved estrogen therapy to treat perimenopausal depression. However, this therapy may help reduce hot flashes, sleep disturbances, and other symptoms that can affect mood.

Learn more about hormone therapy for menopause.

There is little research on complementary therapies specifically for depression that occurs during perimenopause. However, steps that people can take to help with depression, menopause symptoms, or both include:

  • getting regular exercise
  • quitting smoking, if applicable
  • reducing caffeine and alcohol consumption, especially for those with sleep difficulties
  • practicing yoga or tai chi, which may reduce stress and help with sleep
  • undergoing hypnosis, which may reduce hot flash frequency

It is important to speak with a healthcare professional about symptoms that could indicate depression. Depression is not an expected part of menopause or aging, and effective treatments are available. Anyone experiencing it at this life stage should reach out to a doctor or therapist who understands menopause and its potential effects on mental health.

A person should contact a doctor or mental health professional immediately if they are considering self-harm or suicide.

Studies link perimenopause and depression, but the nature of the connection is not clear. Scientists believe that people may be more vulnerable to depression during this time as a result of hormonal fluctuations.

However, other factors may also play a role, including a person’s mental and physical health, and societal attitudes toward menopause and aging.

The risk of depression appears to return to normal 2–4 years after the last menstrual period. Several treatments are available to manage the symptoms and alleviate stress.