Menopause and Depression: How to Recognize Depression vs. Mood Swings

Written by Rachel Reiff Ellis
Medically Reviewed by Traci C. Johnson, MD on April 30, 2025
6 min read

Hormonal changes during your menstrual cycle can be linked to an increased risk for depression. That includes the hormone fluctuations of perimenopause, menopause, and postmenopause. But it's hard to know the exact cause of that depression. That's because many women in these groups also face the stress of balancing work and home responsibilities, single parenthood, and caring for children and aging parents.

Here are some ways your hormones may affect your mood and likelihood of depression.

As you go through perimenopause (the months and years leading up to menopause), your hormone levels go through a lot of shifts. These hormonal shifts cause many physical symptoms such as hot flashes, insomnia, and night sweats. But your mood can be affected, too. 

During the perimenopause phase, your period becomes less regular. You might get it less often, more often, or very infrequently. It might be heavier or lighter. But no matter how it changes, there are hormonal changes happening alongside it. 

These hormones impact more than just your reproductive system. They can affect your brain, too. 

In a review of studies, researchers found that being in perimenopause increases your chance of depression. Dropping estrogen and progesterone levels impacts serotonin, the chemical that gives you feelings of well-being and happiness. Dips in estrogen and progesterone can cause feelings of anxiety, irritability, and sadness. 

“During most of your life, your hormones change in very predictable ways that your body is used to, but random fluctuations disrupt things,” says Julie Clark, MD, an obstetrician/gynecologist in Petaluma, California. 

“Depressive episodes are a little bit more common during these fluctuations. So just like women are more prone to depressive episodes just after pregnancy when their hormones are rapidly changing, the perimenopausal period can also be a time of mood changes.”

Can menopause cause depression?

Menopause is technically only one day — the one-year mark of having no periods. Before that, you’re in perimenopause, and after that, you’re postmenopausal. Most of the physical and mental changes that people talk about happening during “menopause” are happening during perimenopause. 

You’re more likely to get perimenopausal depression if you already had depression in your life. But for some people, perimenopausal depression is the first time in their lives they have symptoms of depression. 

You may have mild depression symptoms or more severe ones. Severe perimenopausal depression is less common, but you’re at a higher risk of having severe symptoms if you’ve had depression in the past. 

Your risk of having depressive symptoms also goes up with physical symptoms. So if you’re having vasomotor symptoms — hot flashes, night sweats, insomnia — you’re more likely to also have depression. 

The symptoms of perimenopausal depression are the same as clinical depression symptoms and can vary in how severe they are. 

You might have:

  • Anger and irritability
  • Anxiety
  • Forgetfulness
  • Low self-esteem
  • Lack of confidence
  • Low mood and feelings of sadness or depression
  • Poor concentration (“brain fog” or trouble finding the right word in conversation)

If your depression is severe, you may have:

  • Trouble sleeping or you may sleep too much
  • No motivation
  • Lack of energy 
  • Appetite changes such as eating too much or eating too little
  • Disturbing, hopeless thoughts or thoughts of suicide

“Depression is really defined as the inability to function,” says Clark. “So your mood is low, but you’re also typically going to find it hard to do everyday things, such as complete work tasks, do chores around your home, or even participate in hobbies you enjoy.”

How long does menopause depression last?

Once you reach menopause, there’s a chance your depression will lessen along with other symptoms. Your hormones balance out after your periods stop for good, and this can stabilize your mood. Perimenopause can start 8-10 years before menopause, so your symptoms may last for some time. 

This may not be the case if you have major depression. Doctors can’t always predict whether reaching menopause will bring an end to symptoms. Depression is something you may get more than once. There often isn’t a pattern to it. 

Menopause mood swings are a common side effect of perimenopause, and they also happen because of the changing hormones in your body. You may not be able to tell a difference between the “downs” you feel during these swings and depression.

Sometimes menopause is misdiagnosed as depression because of the similarity of symptoms, such as fatigue, sleep issues, weight change, poor concentration, and low sex drive. This may feel similar to some of the emotional changes you have during PMS. Sometimes the physical changes can make you feel depressed because they’re hard to deal with. 

Depression may feel different. It may last longer with no let up, and the symptoms may be more severe. Figuring out which you’re dealing with is important when figuring out how to treat it. 

Perimenopausal depression is treatable. For mild symptoms, hormone therapy (estrogen therapy) can be a help. You take it as a pill or a patch, and it can help calm vasomotor symptoms and mood swings. 

For depressive symptoms that are more severe, your doctor may prescribe an antidepressant to treat your symptoms. These medications (selective serotonin reuptake inhibitors, or SSRIs) treat serotonin issues in your brain. 

Most people also benefit from therapy alongside medication. Talk therapy and cognitive behavioral therapy are two approaches you can try. Studies show that therapy and medication together (combination therapy) is the most effective treatment for depression. 

Can HRT cause depression?

Researchers questioned if taking hormone replacement therapy (HRT) could cause depression, but studies have not been able to prove this theory. However, stopping HRT while you’re in perimenopause may have an increased risk of depression because of the sudden stop of hormonal support.

“Talk to your doctor,” says Clark. “You can see your primary care physician, an OB/GYN, a psychiatrist, or a reproductive endocrinologist for guidance.”

You can support your mental health during perimenopause and postmenopause with practices at home. Try these habits:

  • Get regular exercise.
  • Reduce or avoid alcohol. 
  • Make plans to get yourself out of the house.
  • Get some sunlight every day.
  • Keep track of how you’re feeling with a journal.
  • Limit your caffeine intake.
  • Eat a nutritious diet with plenty of fruits, vegetables, whole grains, and protein.

Once your periods have stopped for at least 12 months, you’re officially postmenopausal. You may see a reduction in perimenopausal symptoms, including depression. But for some people, postmenopause can come with its own mental health challenges. Or you may be dealing with depression that’s not related to your menstrual cycle. 

You can still have moodiness, anxiety, and depression in postmenopause. Stress in your life, sexual issues, or other life changes at this age can contribute to mental and emotional struggles. Your hormone levels during the postmenopausal period also affect your mood. 

A menopause specialist can help. Ask your doctor for a referral if they don’t have the special training you need to help you through this phase of your life.