Mood Changes and Depression | The Rosewoman Library

Not Yourself

You’ve handled difficult things your whole life. But lately, you’re tearful over small things. Irritable with people you love. Flat in a way you can’t shake. Rageful when you’re usually patient. Hopeless when you’re usually optimistic.

You don’t feel like yourself. And that’s perhaps the most distressing part—the sense that the person you’ve been has somehow shifted.

This experience is incredibly common during perimenopause. And it’s not a character flaw or a sign of weakness. It’s hormones.

The Hormonal Mood Connection

Estrogen and progesterone profoundly affect brain chemistry:

Serotonin: Estrogen helps regulate serotonin, the neurotransmitter most associated with mood stability. Fluctuating estrogen means fluctuating serotonin.

Dopamine: Estrogen affects dopamine, which influences motivation, pleasure, and reward. Declining estrogen can mean less capacity for enjoyment.

Norepinephrine: Hormonal shifts affect norepinephrine, influencing energy and alertness.

GABA: Progesterone metabolites affect GABA, the brain’s calming neurotransmitter. Erratic progesterone means less stable calming.

During perimenopause, when hormones swing wildly, mood follows. This isn’t imagination—it’s neurobiology.

What It Looks Like

Mood symptoms during perimenopause vary:

Depression: Persistent low mood, loss of interest in things you usually enjoy, hopelessness, fatigue, difficulty concentrating

Irritability: Lower threshold for frustration, snapping at people, rage that seems disproportionate

Anxiety: Worry, dread, nervousness, panic (see the entry on Anxiety and Menopause)

Mood swings: Rapid shifts between emotional states, feeling stable one moment and tearful the next

Tearfulness: Crying easily, sometimes without clear reason

Flatness: Not depressed exactly, but muted—less joy, less enthusiasm, less emotional range

Rage: Intense anger that feels unfamiliar and hard to control

Is It Perimenopause or Clinical Depression?

This can be genuinely difficult to distinguish, and for some women, it’s both.

Consider:

Timing: Did mood changes coincide with other perimenopause symptoms or with changes in your cycle?
Pattern: Do symptoms fluctuate with your cycle (if you still have one)?
History: Have you had depression before, or is this new?
Context: Is there life context that explains depression (loss, stress, transitions)?

Many women experience depression for the first time during perimenopause. Others have recurrence of previous depression. Some have mood symptoms that are purely hormonal and resolve with the transition.

Getting clarity may require professional assessment. But knowing that perimenopause can cause mood symptoms is important—it means treatment approach may differ from standard depression treatment.

What Helps

Hormone Therapy

For mood symptoms caused by hormonal fluctuation, HRT can be remarkably effective. By stabilizing the hormonal environment, it often stabilizes mood.

This is particularly true when mood changes arrived with perimenopause and are clearly connected to the hormonal transition.

Antidepressants

SSRIs and SNRIs can help with perimenopausal mood symptoms—they work on the same neurotransmitter systems affected by hormonal changes.

Some antidepressants (like venlafaxine and paroxetine) also help with hot flashes, providing dual benefit.

For significant depression, antidepressants may be necessary regardless of whether hormones are also involved.

The Fundamentals

The basics have outsized impact during perimenopause:

Sleep: Poor sleep worsens mood dramatically. If you’re not sleeping, address that first.

Exercise: Regular physical activity is as effective as medication for mild to moderate depression. It directly affects the neurotransmitters involved.

Alcohol reduction: Alcohol worsens depression and interferes with sleep. Consider reducing or eliminating it.

Connection: Social isolation worsens depression. Maintain connection even when you don’t feel like it.

Therapy

Talk therapy—particularly cognitive behavioral therapy (CBT)—is effective for depression and can help with the adjustment challenges of midlife.

A therapist can help you:

Distinguish hormonal mood changes from situational depression
Develop coping strategies
Process the identity shifts of midlife
Address any life circumstances contributing to mood

Light Exposure

Morning bright light exposure (sunlight or a light box) helps regulate circadian rhythms and can improve mood, particularly if there’s a seasonal component.

Stress Reduction

Chronic stress worsens depression and anxiety. Whatever reduces your stress load—boundaries, delegation, saying no, meditation, time in nature—supports mood.

What Doesn’t Help

Powering through: Ignoring mood symptoms doesn’t make them go away. They often worsen without intervention.

Self-blame: This isn’t weakness. It’s biology. Blaming yourself adds shame to already difficult feelings.

Isolation: Withdrawing feels natural when you’re depressed, but it makes things worse.

Alcohol and substances: Temporary relief leads to worsening symptoms.

The Other Side

Here’s what’s reassuring: for most women, mood symptoms improve after the menopause transition.

Once hormones stabilize in their new pattern (post-menopause), the wild fluctuations end. The brain adapts to its new hormonal environment. Mood often stabilizes.

This doesn’t mean white-knuckling through years of suffering. Get treatment. Get support. But also know that this intensity is often a feature of the transition, not a permanent destination.

Go Deeper

These are the original writings this entry draws from: