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When you think of perimenopause—the years leading to menopause—you may think of the physical symptoms: hot flashes, night sweats, and the eventual end of periods. But many people also experience mood symptoms during this time.

As an ob-gyn and psychiatrist, I wish everyone understood how perimenopause can affect mental health. Here are the top facts you should know.

Causes and Types of Mood Changes

Mental health changes can have many causes.

The hormone changes that affect your periods during perimenopause can affect your emotions too. Also, physical menopausal symptoms can lead to stress and fatigue, intensifying emotions.

On top of that, your 40s and 50s are a time when life’s pressures can be greatest. Many people in this age group are managing demanding jobs, raising younger children or sending older children off to college, and caring for aging parents. All of this stress can add to mental health challenges.

Mood changes can feel like PMS.

About 4 in 10 women have mood symptoms during perimenopause that are similar to PMS, or premenstrual syndrome. You might feel irritable, have low energy, feel tearful and moody, or have a hard time concentrating.

Unlike PMS, these symptoms may come at times unrelated to your menstrual cycle. Symptoms may occur for years with no pattern. This type of mood change is known as perimenopausal mood instability.

Depression is common during perimenopause.

Most studies agree that the risk of depression increases during the menopause transition. Symptoms of depression include crying a lot, feeling hopeless or worthless, feeling numb, and losing interest in your normal activities.

You may have anxiety too.

There are few studies about anxiety and perimenopause, but some women report symptoms of anxiety during this time. Anxiety involves constant worrying that gets in the way of your day-to-day life. You may feel muscle tension, sweating, or nausea. Both depression and anxiety can make it hard to concentrate, sleep, and take care of yourself.

Finding Help

Treatment options are available.

Talk with your ob-gyn about how you are feeling. They can help determine if your symptoms are a sign of a mental health condition and refer you to a psychiatrist.

Before or after menopause, antidepressant medications can help with depressive and anxious symptoms. Medications that provide your body the hormone estrogen may help with depression during perimenopause, too.

Getting better sleep can make a big difference.

If you're getting too little or poor-quality sleep, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change. Not getting enough sleep has also been linked to depression, risk-taking behavior, and suicide.

Try to create the best environment possible for comfortable sleep:

  • Go to bed and wake up at the same time every day.

  • Avoid your computer, phone, TV, and other screens in the hour before bedtime.

  • Avoid heavy meals close to bedtime.

  • Skip coffee, soda, or tea in the afternoon—caffeine can affect you up to 8 hours after drinking it.

  • Keep your bedroom quiet, cool, and dark. Use a fan if that makes you more comfortable.

Other lifestyle changes can help too.

Other changes found to be helpful with mental health conditions include exercising, limiting caffeine or sugar, and quitting smoking. Anything that reduces stress can help too, such as meditation, yoga, playing music, journal writing, and massage therapy.

Keep your health care team in the loop.

During perimenopause, see your ob-gyn regularly and discuss how you are feeling. Ob-gyns, mental health professionals, and other members of your health care team can help you through this phase of life.

Published: April 2023

Last reviewed: April 2023

Copyright 2023 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

About the Author
Dr. Nazanin Silver headshot.
Dr. Nazanin E. Silver

Dr. Silver is an obstetrician–gynecologist and women’s behavioral health psychiatrist. She is a fellow of the American College of Obstetricians and Gynecologists (ACOG) and a former member of ACOG’s Women’s Preventive Services Initiative Multidisciplinary Steering Committee.