Menopause and Depression: What Every Woman Should Know

When women go through menopause, they face big physical changes, and can also experience stress, anxiety, overwhelm, and tearfulness every day. Scientists have been telling us for decades – we have to pay extra attention to how women feel during this period of their lives. Yet, one of the most common and still overlooked issues is the connection between the menopause transition and depressive symptoms.

Research, however, is quite robust on this: depression during menopause is 2-4 times more common than in other stages of life, a study in the Psychological Medicine journal shows. However, this risk is primarily driven by the recurrence of past depression in women who are hormonally sensitive. A recent meta-analysis by UCL researchers also revealed that women are 40% more likely to experience depression in the perimenopause specifically than those who aren’t experiencing any menopausal symptoms. It is important to distinguish between depressive symptoms, which may ebb and flow, and clinical depression, which is more persistent and debilitating.

The way you feel, however, isn’t your personal failure. In fact, a survey from Newson Health found that up to 95% of women experience feelings of sadness, anxiety, and stress during both menopause and perimenopause, and it’s universal.

In this article, you’ll dive deeper into what depression during menopause is: the ways that it can be caused by hormone fluctuations, even though many healthcare providers still don’t fully recognize the phenomenon, how symptoms can be validated, and that they’re both real and measurable.

Help is available, and many different treatment options – from traditional hormone replacement therapy, antidepressants, and talking therapy, to modern techniques such as brain stimulation.

Let's embrace the conversation and navigate the journey together – by finding out the clinical and lifestyle recommendations that can help support the body and mind through menopause and perimenopause depression.

Why Menopause Triggers Depression: The Science Behind Changing Mood

Hormone Changes Affect Brain Chemistry

Menopause low mood comes down to oestrogen, a sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics.

As oestrogen falls, serotonin tends to fall with it. Oestrogen is 'neuro-protective'; it boosts serotonin and dopamine, which keep the brain's mood-regulation centre—the DLPFC—active Serotonin is often called the “happiness chemical”, as it’s what helps keep mood from tipping too far or staying low for too long.

This usually starts in perimenopause. At that point, hormones are fluctuating, so the effect on mood can feel inconsistent at first. As oestrogen levels drop more clearly, the mood effects often become stronger and more persistent, and in some cases cross into perimenopause depression.

Progesterone matters too. Changes in the balance between progesterone and oestrogen can make mood regulation less reliable, increasing anxiety, irritability, or emotional swings. For some women, this shift is as disruptive as the drop in oestrogen itself.

Hormones also change how the brain functions. One area involved is the left dorsolateral prefrontal cortex, or DLPFC. This region is involved in mood regulation, motivation, focus, and executive function, the mental processes that help you plan, make decisions, and stop negative thoughts from looping.

When activity in the DLPFC drops, regulating emotions takes more effort. Motivation slips, and negative thinking becomes harder to interrupt. These are classic features of depression, and they help explain why menopause can increase depression risk in a way that isn’t just psychological. This is also why treatments that target this brain region can work.

But note that not everyone is affected in the same way. Sensitivity to hormonal change varies, and genetics or individual brain chemistry plays a role, too. Women who’ve had hormone-related mood issues before – e.g. PMS or postnatal depression – are more likely to notice similar patterns here. Family history can matter too.

Sleep Problems Make It Worse: The Vicious Cycle

Sleep is often where menopause-related mood changes first show up. For some women, the problem is night sweats that wake them suddenly. When the body overheats, sleep cycles get interrupted, and getting back to deep sleep becomes difficult. Even if you’re in bed for long enough, the sleep itself becomes fragmented and unrefreshing.

For others, sleep problems happen even without night sweats. Hormonal changes affect sleep regulation directly. While falling asleep may still be easy, staying asleep is different. Early morning waking, often with a racing mind, is a particularly common pattern during perimenopause and menopause.

This matters because poor sleep has a strong effect on mental health and other health issues. According to a recent review in the American Journal of Lifestyle Medicine, sleep deprivation consistently harms health outcomes like mortality, cardiovascular disease, mental disorders (including anxiety and emotional dysregulation), and metabolic syndrome.

Research from the National Institute of Mental Health also shows that poor sleep can increase the risk of depression by up to 10 times.

This creates a vicious cycle: poor sleep leads to a low mood, which in turn makes it harder to fall asleep, perpetuating the problem. For many women, sleep problems are one of the first symptoms they notice, sometimes even before other signs of depression during menopause.

Life Stage Stress: When Everything Happens at Once

One of the biggest triggers of depression during menopause is life stage stress. It often involves caring for aging parents and simultaneously supporting children through adolescence – being a part of the so-called “sandwich generation.”

According National Institutes of Health, people of the “sandwich generation” report much more emotional difficulties compared to those not juggling between multiple caregiving roles.

What adds to the stress is discrimination in the workplace. Women often face discriminatory hiring practices or are overlooked for promotions, with assumptions made about their energy levels or adaptability.

As a woman in menopause, you may also experience a shift in identity. As children leave the nest, women often find themselves transitioning from the familiar role of caregiver to something new and uncertain. Changes in personal relationships, such as partners navigating their own aging, often add to the stress.

Multiple stressors compound hormonal changes

During menopause, declining sex hormones, estrogen and progesterone, change how the body responds to stress. When estrogen drops, cortisol, the body’s main stress hormone, can remain elevated for longer and react more strongly to everyday stressors, even if it’s positive events. These effects usually lessen once the body adjusts past menopause.

Is It Depression or Just Menopause? Understanding the Difference

Similar Symptoms That Cause Confusion

There’s a set of symptoms that can manifest both in depression and menopausal mood:

• Sleep problems (early morning waking);
• Anxiety or excessive worry (can be worse in perimenopause than in menopause, because hormone levels aren’t stabilized yet);
• Unpredictable mood swings;
• “Brain fog” and memory issues;
• Appetite changes (either increased or decreased);
• Self-doubt and indecisiveness (can manifest in imposter syndrome at work or lower interest in activities you usually enjoy).

Key Differences: How to Tell Them Apart

Menopausal mood typically begins in your 40s and is accompanied by hot flushes, irregular periods, and other physical menopause symptoms. While daily tasks may feel more challenging, you’re still managing your responsibilities, like making shopping lists or doing laundry. This is often referred to as “smiling depression,” where you appear joyful and functioning while struggling internally. With menopausal mood, you can recognize that something feels wrong and link it to hormonal changes.

Clinical depression is more severe. It involves persistent feelings of hopelessness and worthlessness for at least several weeks. It can make it impossible to cope with daily work and family responsibilities and push you to neglect basic personal care, like showering or brushing your hair. Unlike menopausal mood changes, which tend to fluctuate, clinical depression often feels like something that won’t ever improve.

It’s also possible to experience menopausal mood and clinical depression simultaneously. Menopause can trigger a depressive episode, and if there’s a history of depression, the risk of developing the condition rises by up to five times. In such cases, professional assessment is important.

When to Seek Help: Red Flags That Need Attention

Some signs it’s time to reach out for help include:

• Difficulty concentrating or making decisions;
• Feeling disconnected or withdrawing socially;
• Snapping at family members or withdrawing socially;
• Avoiding social activities you previously enjoyed;
• Colleagues or family commenting on changes in your behaviour;
• Thoughts about death or self-harm (Samaritans: 116 123).

If you’re having thoughts of death, dying, or feeling that others would be better off without you, or if you’re making plans or thinking about methods of self-harm, it’s important to seek help immediately. The Samaritans are available 24/7 for confidential support at 116 123. Their trained volunteers are there to listen and help you navigate through these difficult moments.

If you’ve had depression before, including postnatal, you may be at higher risk for depression during menopause. Don’t hesitate to seek help to prevent this early.

Treatment Options That Work: Your Path to Feeling Better

Hormone Replacement Therapy (HRT): The First Line of Defence

Guidelines from the National Institute for Health and Care Excellence (NICE) recommend HRT as the first-line treatment for menopause symptoms.

HRT works by replacing the hormones that decline during menopause. Estrogen, progesterone, and testosterone all play a role: estrogen helps regulate neurotransmitters linked to mood and sleep, progesterone supports calming brain pathways, and testosterone, often overlooked in women, is necessary for energy and motivation.

Some HRT uses bioidentical hormones, which are chemically the same as those the body produces, while others use synthetic versions. HRT can be delivered in different forms: patches, gels, sprays, and pills.

Unlike antidepressants, HRT addresses the root hormonal cause of menopause and perimenopause mood symptoms. However, HRT is most effective when 'vasomotor symptoms' like hot flushes are also present; in the absence of these, other options like tDCS or CBT are often more effective.

However, HRT is not a one-size-fits-all solution, and finding the right dose and combination of hormones is key to achieving the best results. Also, give the treatment time. While many women may see improvements within weeks, for others it can take a few months to find the right hormone combination, with benefits rising over time.

While a tailored approach to HRT is necessary to see positive results, some women may seek out private menopause specialists, who can offer more personalized treatment plans.

Antidepressants: When You Need Extra Support

Antidepressants can be a helpful alternative to HRT, especially for women who can’t use the therapy if suffering from cancer, stroke risk, or blood clots. Others may have a personal preference for antidepressants, and sometimes a combination of both treatments might be the best approach.

When choosing antidepressants to address menopausal mood, keep in mind that they typically take 2-8 weeks to start working. During the first few weeks, side effects might pop up, but they might as well settle down as your body adjusts. It’s important to stay patient and keep checking in with a professional to make sure that the treatment is going smoothly.

Different antidepressants work in different ways, so finding the right one for you might take some trial and error. If you're using both HRT and antidepressants, don’t worry – this isn’t “doubling up.” In fact, research suggests a combination of both can often work better than just one alone.

Once your HRT is fully optimized, you might find you need less of the antidepressant, and your doctor can help guide that process. But remember, never stop taking antidepressants without your doctor’s support, as stopping suddenly can cause withdrawal symptoms or make depression worse. It’s always important to gradually reduce your dose under medical supervision.

Brain Stimulation: The Innovative New Option

Transcranial Direct Current Stimulation (tDCS) is an innovative treatment that uses a low (2 mA) electrical current to stimulate specific areas of the brain, such as the dorsolateral prefrontal cortex (DLPFC), which is involved in mood regulation. Think of it as “jump-starting” brain activity in areas that become underactive during depression. The treatment is painless, non-invasive, and precise, targeting specific brain regions rather than affecting the whole body.

tDCS has been used in clinics for decades and is now available for at-home use. In the largest-ever tDCS trial for depression published in Nature Medicine, 58% of users were depression-free within 10 weeks, compared to lower remission rates with antidepressants. For menopausal women, tDCS offers a way to treat the clinical depression directly without the side effects of medication or the risks associated with hormones. Each session lasts 30 minutes, done 5 times a week initially, with the schedule reducing to 3 times per week after the initial phase. The treatment fits easily into daily life, too, as users can watch TV, read, or relax during sessions.

Side effects are minimal, with most users experiencing slight tingling or a mild headache, which typically fades with continued use. tDCS has no sexual side effects and doesn’t cause weight gain, which are common issues with antidepressants.

As of now, tDCS is being used in NHS clinics with positive feedback from healthcare providers. Dr. Mark McConnochie, NHS Consultant Psychiatrist, also said:

“Flow has been an amazing tool to safely and effectively help patients with depression recover faster. The feedback has been overwhelmingly positive.”

Talking Therapy: Changing Your Thought Patterns

Cognitive Behavioural Therapy (CBT) helps to identify and challenge negative thought patterns, which effectively eases the symptoms of both depression and anxiety and provides practical tools for managing future episodes of low mood.

While you can access CBT through your GP, the wait times in the NHS are often very long – in such cases, private therapy can provide help faster. If flexibility of treatment is important in your individual case, try online CBT programmes and apps.

In addition to individual therapy, group CBT can be especially helpful for many women because it provides a supportive space to connect with others facing similar challenges. If you’re looking for more targeted support, you can also explore CBT with a menopause counsellor.

Lifestyle Changes: Simple Steps with Big Impact

It’s clinically proven that exercise can be as effective as antidepressants for mild depression. Physical activity increases endorphins and serotonin, the brain compounds that improve mood. Even 10-15 minutes of exercise daily can make a significant difference. Group exercise can boost the feeling of connection and emotional well-being.

The Mediterranean diet is another powerful tool for improving mood. Rich in omega-3 fatty acids, which are essential for brain health, the Mediterranean diet has anti-inflammatory effects that support menopause mental health. Key foods include oily fish, nuts, olive oil, and vegetables. Reducing sugar and processed foods can also help keep your mood stable.

Also, you should always prioritize quality sleep. Simple changes like keeping your bedroom cool, going to bed at the same time each night, and avoiding screens before sleep can improve its quality. Morning walks can help you with light exposure for a regulated sleep-wake cycle. In the evening, read or meditate to relax and fall asleep faster.

You should also limit alcohol, as it’s a depressant that disrupts sleep, and women in menopause tend to be more sensitive to its effects. Instead, try alcohol-free alternatives for relaxation, such as herbal teas or non-alcoholic beverages.

Regular meditation can support menopause mental health as well – even 5 minutes a day can make a long-term difference. For immediate anxiety relief, try breathing exercises. Mindfulness apps and online resources make it easier to start.

Getting Help: Your Practical Action Plan

Talking to Your GP: How to Prepare for Success

When preparing to talk to your GP about menopause, make sure to list all your symptoms, not just those related to mood. Include physical symptoms like hot flushes, sleep problems, and any changes in your periods. To help your GP understand the full scope, keep a symptom diary for 2-4 weeks before your appointment. Track how your symptoms affect your work, relationships, and daily life.

Timing is crucial, so it’s important to mention when your symptoms first started, especially if they began in your 40s. Even if your periods are still regular, perimenopause can begin at this stage. It’s also important to share if there’s a family history of early menopause or if you’ve experienced hormone-related mood issues in the past.

Don’t hesitate to ask your GP about a menopause mental health specialist. Many GP practices now have designated menopause leads who are specifically trained in this area, and their specialist knowledge can make a big difference. If a menopause clinic is available in your area, ask for a referral. If not, consider seeing a private menopause specialist.

Track Your Symptoms: Understanding Your Patterns

Tracking your menopause and depression symptoms is essential for understanding what’s happening with your body. Keep a mood diary using a simple 1-10 scale to rate your mood each day. Remember to keep a note if any specific event or stressor influences your symptoms. This will help you identify patterns and triggers that aren’t that obvious.

You may also notice cyclical or seasonal changes in your symptoms, so make sure to note those as well. Also, include positive moments or activities that ease your symptoms – they can become your future health toolkit.

Validated tools like the MADRS-S for depression or menopause symptom checkers provide an objective way to measure your symptoms. Specialized apps can help you track everything more easily and stay organized.

Be sure to share these notes with your healthcare provider – it will help create a treatment plan that suits you best.

You Can Feel Better: Hope for the Journey Ahead

If you worry about your menopause and depression symptoms, remember: today’s treatment is effective for most women, and you can feel better, even if it takes some time to find the right approach. Be sure: improvement is possible even with severe symptoms. Start by completing Flow’s depression assessment.

Don’t be discouraged if your first attempt at treatment doesn’t immediately work. It’s not about a quick fix but finding the approach that best supports your needs. Regular review of your treatment plan with a healthcare provider will ensure that you’re on the right track.

It’s not only the Menopause Awareness Day when we should talk about it. We need to continuously break the stigma surrounding menopause and depression. By sharing this article and your own experiences, you can help normalize the conversation and show other women that they are not alone. Openness about menopause-related challenges is the most important step to create a more supportive and long-needed environment for women.