Midlife is a time of significant hormonal change, and for many women it can also bring unexpected shifts in mood, anxiety, or low emotional resilience. Perhaps a relapse of PMS-like symptoms, sinking motivation or low mood. The research suggests that if you have a history of depression, these changes may be more intense during perimenopause, as fluctuating oestrogen levels, brain chemistry, and stress hormones interact in complex ways. Understanding the link between perimenopause and depression can help explain what’s happening in your body and highlight why a holistic, integrative approach is so important for supporting mental health during this transition.
Is a history of depression a risk factor for you in perimenopause?
I truly believe that perimenopause is a life phase for women that presents an incredible opportunity for growth and self-realisation. But I also know, from personal and professional experience, that in this period of our lives we are made vulnerable by major biological, psychological and social changes going on in the background. Things like changing interpersonal relationships, the stress of work and cost of living, going through loss and grief, cultural and societal stressors and aging. Alongside these we have these shifts in our neurochemistry and metabolic hormones, and I’m sure many of you are already aware of the erratic changes in oestrogen and the decline in progesterone. Depression is the topic of this article, and while we know that it affects around 3.8% of the global population (Liu et al., 2025), it’s less well known how many women suffer from depression in midlife and why. Let’s look at mood change, and specifically perimenopausal depression.
What the research says
A paper published recently caught my eye because it revealed helpful information and statistics about depression in perimenopause. This paper was published in the Journal of Affective Disorders and based on the longitudinal Swiss Perimenopause Study of 2020 (Willi et al., 2020). The study revealed that if a woman has had a history of depression, she may be more prone to significantly more negative health effects in perimenopause compared to women who haven’t experienced depression in the past.
Above: Willi, J., Süss, H., Grub, J., & Ehlert, U. (2020). Prior depression affects the experience of the perimenopause – findings from the Swiss Perimenopause Study. Journal of Affective Disorders, 277, 603–611.
Looking at another paper on depression in perimenopause, Worsley et al. (2012) state: “Perimenopausal depression is increasingly recognised as a new subtype of depression with specific clinical characteristics. Current treatments for perimenopausal depression have high failure rates, multiple adverse effects and potentially damaging long term consequences.”
This highlights that we can’t assume depression in general will have the same expression, intensity or co-existing symptoms as perimenopausal depression. The paper goes on to say:
“Whilst it is well known that depression is more common amongst women than men, there is now mounting evidence that the perimenopause is a time of increased risk for the onset of depressive symptoms and depressive disorders in women“.
– Worsley, R., Davis, S. R., Gavrilidis, E., Gibbs, Z., Lee, S., Burger, H., & Kulkarni, J. (2012).
If you’re wondering what the general risk of depression is perimenopause is, we’ve known for over a decade that there is a high prevalence (around 41%) of depressive symptoms in perimenopausal community globally (Timur & Sahin, 2010). Statistics may vary between studies depending on their location and the age range of participants, so here are a selection of the findings.
The Penn Ovarian Aging Study found that women were over four times more likely to have a high depression scale scores in perimenopause compared to premenopause (Freeman et al., 2006). This study also identified that depression diagnosis was 2.5 times more likely in perimenopause than in premenopause. Note however, the participants in this study were no older than 47, and many of us won’t reach menopause until our early fifties, at least in the West that seems to be the norm. This means an important cohort of women age-wise were missing from this study.
A 2024 systematic review and meta-analysis based on over 16,000 women and twenty years of studies scrutinised the figures for depressive symptoms in perimenopause. They concluded that perimenopausal women are 1.4 times as likely to experience depressive symptoms compared to premenopausal women (Badawy et al., 2024). Another systematic review in 2024 found a third of women in perimenopause experience depression (Jia et al., 2024).
Another study a couple of years earlier found that during the final year of perimenopause the risk of experiencing depression was fourteen times higher than it would be for a premenopausal woman (Schmidt et al., 2004). While the risk statistics vary from study to study (understandably, with varying demographics, ethnicities and locations), it seems that the risk of depression rises 2-3 fold in perimenopause compared to premenopause. (Premenopause is prior to the onset of menopausal symptoms, usually up to your late thirties)
Not sure if what you’re experiencing is depression? Use the MENO-D scale test to get a better idea of the severity of your symptoms and whether or not therapeutic care is advised.
What causes depression in perimenopause?
The reasons why any individual experiences depression can be many and varied, but one well known mechanism is a change in production and circulating levels of the neurochemical serotonin. This is your mood chemical and it helps us feel secure, happy and relaxed. This is why medications used in the management of depression include SSRIs (selective serotonin reuptake inhibitors) which free up more serotonin to roam through your body and make you feel better. However, SSRIs are known to have a high degree of remission in patients, they’re not a guaranteed cure for perimenopausal depression (Worsley et al., 2012).
What happens with serotonin in perimenopause? Like many of the feel good chemicals such as dopamine, endorphins and noradrenalin, serotonin is thrown in chaos with the dramatic and erratic nature of perimenopausal oestrogen. Suddenly it’s withdrawn, suddenly it’s coursing through your bloodstream. In fact, if you’ve experienced premenstrual syndrome (PMS) or postnatal depression (PND), fluctuating oestrogen is the same fundamental underlying trigger in these conditions (Liu et al., 2025).
Oestrogen fluctuations are a key cause of impaired metabolism of neurochemicals which affects your mood.
This is called the ‘Oestrogen Withdrawal Theory’ which is associated with depressive symptoms in perimenopause. Depressive symptoms are not just about serotonin though. There are abberant functional connectivity changes in the perimenopausal brain which impacts the production of hormones like prolaction and sex hormones (Lu et al., 2019).
The reality is, we can’t link perimenopausal depression to one hormone, or one functional issue, it’s about many aspects of ovarian aging, changing brain metabolism, all those other life events that influence how we feel and our neurochemistry. A network of neurochemicals work together to affect your mood creating a web of chemical signalling which is influenced by oestrogen.
Furthermore, GABA is influenced by progesterone. And we know with both of these hormones, things get messy in midlife. Another chemical of note is the neuropeptide Kisspeptin, which plays a role in normal hormone production and thus perimenopausal mood change (Fidecicchi et al., 2024).
There’s another contributor to mood change in perimenopause that needs more research and exploration. Gordon et al. (2016) conducted weekly salivary hormones tests for 30 women in perimenopause and found that a link between increases in oestradiol (E2) and cortisol. Where these two hormones rose, they saw greater negative mood. The researchers postulated that the midlife onset of dysfunction in the hypothalamic-pituitary-axis (HPA) drove these hormonal changes, initiating the onset or relapse of depressive symptoms in perimenopause. One key contributor to HPA dysfunction is ongoing stress, something many midlife women are familiar with.
Back to the study now…
From: Willi, J., Süss, H., Grub, J., & Ehlert, U. (2020). Prior depression affects the experience of the perimenopause – findings from the Swiss Perimenopause Study. Journal of Affective Disorders, 277, 603–611.
Look at the graphic above, comparing the experience of symptoms in perimenopausal women with vs without a history of depression. The recurring trend is this, whether its (a) having depression symptoms or (b) feeling diminished or (c) having disturbed sleep, in the group with a history of depression they were consistently more likely to have adverse symptoms (dark grey panels). In the group with no prior depression they were more likely to have absence of those symptoms (light grey panels).
So what can we learn from this, and what else do we need to explore?
This paper outlines some of the consequences of a history of depression for us in perimenopause. Feeling more isolated, feelings of helplessness, neurotic behaviours, lower self-esteem have come up in this and prior studies as some of things women with a history of depression may experience in midlife (Willi et al., 2020).
What do we need to know? We don’t know how severe or frequent the prior depression episodes were for the participants in this study. That would be useful to know as a predictor of health and wellness in perimenopause. For example, does it make a difference to your perimenopause symptoms in the future if you’ve had one period of depression, or many? What about postnatal depression?
The study used a sample size of 136 women, which is low. Small sample numbers has been identified as a contributor to high depression prevalence findings in studies (Jia et al., 2024).
Overall, this is important research because it helps us identify a decisive predictor of a woman’s perimenopause health and the challenges she may face (more than most) with a history of depression. It’s important knowledge for the more than 264 million people worldwide who experience depression. It’s also relevant for all women in midlife because a later study in 2024 (Badawy et al., 2024) found that women had a 40% higher risk of depression in perimenopause compared to premenopausal women.
In other words, we need to be cognisant of the mental health challenges women face in midlife beyond hot flashes, night sweats and other vasomotor symptoms. Badawy et al (2024) used a larger population base but didn’t account for whether or not the participants had a history of depression.
So if you have a history of depression…
If you have prior experience of depression and you’re wondering how you can support yourself in perimenopause, here are some ideas to get you on the pathway to a happier, healthier you. Speaking from experience, nutritional deficiencies, stress, sleep issues and overwork are going to be roadblocks to healing. So addressing those first will help.
You’ll want to eat more foods rich in B vitamins, magnesium, zinc, selenium, iron, calcium and omega 3 fatty acids (Zielińska et al., 2023). Your best bet is a Mediterranean diet and wholefoods (ditch the processed food). You also want to check the amount of high glycaemic index food in your diet, because a diet rich in low glycaemic index foods is actually protective against depression. It’s also the type of diet that will serve you really well in perimenopause for energy, body composition and metabolic health. A 2018 systematic review including a sample of over 75,000 people found a low glycaemic index diet reduces the risk of depression (Rahimlou et al., 2018). For more information on the best diet for perimenopause in general, read my article here.
Your ideal foods to eat on a regular basis could include:
- Meat, poultry, fish and dairy (high in B12, B6 and B3)
- Whole grains (high in B1, B2, B3 and B9)
- Leafy green vegetables (high in B2, B6 and B9)
- Fish, fish oils and flax seed oil (high in omega 3)
- Almonds and other nuts, chicken liver, cocoa, eggs, parsley, passionfruit, pork, kelp, sesame seeds, sunflower seeds and soy (high in magnesium)
- Barley, fish, eggs, cheese, cashews, oats, oat bran, red meat, tahini, chickweed, kelp and root vegetables (high in selenium)
- Liver, eggs, parsley, soy, tofu, tempeh, spinach and tomato (good for the blood and sources of iron)
- B12 (Cyanocobalamin) is particularly important, you’ll find this in beef, lamb, chicken liver, turkey, fish, eggs, dairy, sardines, cheese, and as an added nutrient to some foods.
- To help your body manufacture serotonin, eat more banana, beef, fish, cheese, cottage cheese, peanuts, soy, lentils and pumpkin seeds. These are high in tryptophan, a precursor to serotonin production.
Naturopathy
I work with herbal medicine and nutritional supplementation to support women with low mood, low libido and/or depression symptoms in perimenopause. There are wonderful herbs that lift your mood (traditionally known as ‘thymoleptics’ and ‘euphorics’). Herbs like St John’s Wort which helps relieve vasomotor symptoms of menopause as well.
However we’re not just putting a bandaid over the symptoms, we’ll go to the root cause and work on that specifically. So often I’ll be working on adrenal, thyroid and neurochemical status to really deliver long lasting results. Herbs like Ashwagandha, Rhodiola, Licorice and other adaptogens work well here and create better stress tolerance and strength in the body.
Menopause Hormone Therapy
Sometimes medication may be required, and for some women menopause hormone therapy can work. There are promising results in the studies (Herson & Kulkarni, 2022). For those you can ask your general practitioner for guidance.
Acupuncture
If you don’t mind a needle or two, acupuncture has been found to reduce the severity of depression in perimenopause and menopause. A 2019 systematic review of 18 randomised controlled trials found significant benefits from the combination of herbs and acupuncture for depression symptoms compared to antidepressant medications (Di et al., 2019).
Meditation, yoga, qi gong are other practices I would recommend. Explore the many different ways you can build a self-care routine with some time for resting, bathing, reflection, and just doing the things that bring you joy. My interview with Deborah Devaal and Dr Anna Young-Ferris might be helpful to give some tools and techniques for self care. I also have a free mini course on Insight Timer (link below) that you can listen to, and that includes a morning and night meditation for perimenopause.
Also important to note is that sleep deprivation and disturbance is common in perimenopause, and it affects the way you feel including your mood. Having a good sleep hygiene ritual will help. Check out my articles on sleep for some tips and advice there.
In summary…
Having a history of depression could significantly impact your health and wellbeing in perimenopause. It could lead to stronger depressive symptoms or relapse of historical depression, and may exacerbate typical menopausal symptoms.
More research needs to be done to be conclusive, and the proposed risk statistics are variable. However, with so many studies suggesting the link, it’s important to look out for your mental health as you move into midlife. There are several underlying processes and dysfunctions that lead to mood change in perimenopause including neurochemical changes, fluctuating oestrogen (oestradiol specifically) and change in the HPA axis.
Understanding these can help you get a better idea of what might be happening for you, and are worthwhile exploring with a naturopath, integrative doctor or holistic practitioner. If you’d like to explore naturopathy and herbalism to relieve depression in midlife, then book an appointment with me using the link below, or reach out to me by email. I would be happy to chat with you about what’s involved and what herbal support might look like for you. I hope this article was helpful for you.
Most of all, take care of yourself as best you can,
Hey there! Welcome to my world of totally natural and powerful healing medicines. Medicines from nature. Medicine from Source. I’m a naturopath and herbalist with extensive clinical experience working with a range of health conditions including hormonal, metabolic, mental health, sleep and more.
I’ve brought together years of clinical and teaching experience, academic skill and curiosity to bring you this blog. I hope you enjoy it! If you do, leave a comment, I’d love to hear from you!
References
- Badawy, Y., Spector, A., Li, Z., & Desai, R. (2024). The risk of depression in the menopausal stages: A systematic review and meta-analysis. In Journal of Affective Disorders (Vol. 357, pp. 126–133). Elsevier B.V. https://doi.org/10.1016/j.jad.2024.04.041
- Di, Y. M., Yang, L., Shergis, J. L., Zhang, A. L., Li, Y., Guo, X., Xue, C. C., & Lu, C. (2019). Clinical evidence of Chinese medicine therapies for depression in women during perimenopause and menopause. In Complementary Therapies in Medicine (Vol. 47). Churchill Livingstone. https://doi.org/10.1016/j.ctim.2019.03.019
- Fidecicchi, T., Giannini, A., Chedraui, P., Luisi, S., Battipaglia, C., Genazzani, A. R., Genazzani, A. D., & Simoncini, T. (2024). Neuroendocrine mechanisms of mood disorders during menopause transition: A narrative review and future perspectives. In Maturitas (Vol. 188). Elsevier Ireland Ltd. https://doi.org/10.1016/j.maturitas.2024.108087
- Freeman, E. W., Sammel, M. D., Lin, H., & Nelson, D. B. (2006). Associations of Hormones and Menopausal Status With Depressed Mood in Women With No History of Depression. In Arch Gen Psychiatry (Vol. 63).
- Gordon, Jennifer L, Eisenlohr-Moul, Tory A, Rubinow, David R, Schrubbe, Leah, & Girdler, Susan S. (2016). Naturally Occurring Changes in Estradiol Concentrations in the Menopause Transition Predict Morning Cortisol and Negative Mood in Perimenopausal Depression. Clinical Psychological Science, 4(5), 919–935. https://doi.org/10.1177/2167702616647924
- Herson, M., & Kulkarni, J. (2022). Hormonal Agents for the Treatment of Depression Associated with the Menopause. In Drugs and Aging (Vol. 39, Issue 8, pp. 607–618). Adis. https://doi.org/10.1007/s40266-022-00962-x
- Jia, Y., Zhou, Z., Xiang, F., Hu, W., & Cao, X. (2024). Global prevalence of depression in menopausal women: A systematic review and meta-analysis. In Journal of Affective Disorders (Vol. 358, pp. 474–482). Elsevier B.V. https://doi.org/10.1016/j.jad.2024.05.051
- Liu, Y., Fu, X., Guan, B., Cui, R., & Yang, W. (2025). The Role and Mechanism of Estrogen in Perimenopausal Depression. Current Neuropharmacology, 23. https://doi.org/10.2174/011570159×371863250327073835
- Lu, W., Guo, W., Cui, D., Dong, K., & Qiu, J. (2019). Effect of Sex Hormones on Brain Connectivity Related to Sexual Function in Perimenopausal Women: A Resting-State fMRI Functional Connectivity Study. 16(5), 711–720. https://doi.org/10.1016/j.jsxm.2019.03.004
- Rahimlou, M., Morshedzadeh, N., Karimi, S., & Jafarirad, S. (2018). Association between dietary glycemic index and glycemic load with depression: a systematic review. European Journal of Nutrition, 57(7), 2333–2340. https://doi.org/10.1007/s00394-018-1710-5
- Schmidt, P. J., Haq, N., & David Rubinow, M. R. (2004). A Longitudinal Evaluation of the Relationship Between Reproductive Status and Mood in Perimenopausal Women. In Am J Psychiatry (Vol. 161). http://ajp.psychiatryonline.org
- Timur, S., & Sahin, N. H. (2010). The prevalence of depression symptoms and influencing factors among perimenopausal and postmenopausal women. Menopause, 17(3). https://journals.lww.com/menopausejournal/fulltext/2010/17030/the_prevalence_of_depression_symptoms_and.18.aspx
- Willi, J., Süss, H., & Ehlert, U. (2020). The Swiss Perimenopause Study – study protocol of a longitudinal prospective study in perimenopausal women. Women’s Midlife Health, 6(1). https://doi.org/10.1186/s40695-020-00052-1
- Worsley, R., Davis, S. R., Gavrilidis, E., Gibbs, Z., Lee, S., Burger, H., & Kulkarni, J. (2012). Hormonal therapies for new onset and relapsed depression during perimenopause. In Maturitas (Vol. 73, Issue 2, pp. 127–133). Elsevier Ireland Ltd. https://doi.org/10.1016/j.maturitas.2012.06.011
- Zielińska, M., Łuszczki, E., & Dereń, K. (2023). Dietary Nutrient Deficiencies and Risk of Depression (Review Article 2018–2023). In Nutrients (Vol. 15, Issue 11). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/nu15112433
