Perimenopause Can Affect Women’s Mental Health — Here’s How to Protect Yours

Transitions in life are rarely easy. For women — in this case, anyone assigned female at birth — that includes perimenopause.

Perimenopause refers to the passage into menopause. That’s the end of a woman’s reproductive years. During this time, the ovaries slowly produce less estrogen and other reproductive hormones. Eventually, estrogen levels drop so low that periods stop. Ovaries stop releasing eggs. Once a woman has gone 12 months in a row without a period, she’s in menopause.

Perimenopause is a natural phase of life. But it can be jarring. It begins as early as someone’s 30s or as late as their 50s. It can last 1–8 years. Changing hormone levels can lead to a range of physical effects. And every body adjusts differently. Irregular periods are the biggest marker. Other symptoms include vaginal dryness, hot flashes, lower sex drive, and cognitive issues, like brain fog.

Some women may enter perimenopause early if they:

• Have a hysterectomy (surgery to remove the uterus)
• Have a family history of early menopause
• Smoke tobacco products

Some medical treatments, like chemotherapy, can cause temporary perimenopause. But it typically resolves after treatment wraps up. And your doctor can help guide you along the way.

Not knowing what to expect can take a toll on a person’s mental wellness. But there are ways to cope.

“Even before you notice symptoms, you can start looking for support, including cognitive behavioral therapy (CBT) and hormone replacement therapy (HRT),” says Kelli McElhinny, LCSW, Clinical Content Producer at AbleTo. “The more aware you are, the better you can equip yourself.”

In this piece, we’ll answer 4 common questions about perimenopause. We’ll touch on how it affects well-being. Then we’ll review risk factors and tips for easing the transition.

What mental health challenges come up during perimenopause? And why?

Many women report emotional health changes during perimenopause. Irritability and mood swings are common.¹ Studies show that women are at particular risk for depression.² The same may be true for anxiety, though it’s less studied.³

“There’s a complex mix of factors that can knock you down in different ways,” says McElhinny. “And they often feed into each other. This makes mental health concerns thorny to address.”

For instance, everyone’s estrogen levels waver. These ups and downs can mess with the levels of other hormones. One of those is serotonin, which affects mood.⁴

Beyond that, each person faces a different mix of symptoms and external factors. Physical symptoms, like hot flashes or night sweats, can disrupt sleep. Poor sleep can take a toll on mental health. And if someone is dealing with brain fog or other cognitive issues, their self-esteem might take a hit. Someone might also be caring for family members.

“All these things are stressful in their own right,” says McElhinny. “Add them together, and it makes sense if someone’s resources feel drained.”

Trans people may have an even more complex path through perimenopause. As one study notes, it’s tricky to make broad statements about what they’ll face.⁵ Not everyone has access to gender-affirming care like hormone therapy. And people who can find care may use different levels of hormones. Plus, most research done on perimenopause relies on cisgender women.

What factors increase the risk of having mental health challenges during perimenopause?

There are both biological and social reasons someone might be at higher risk of mental health challenges during perimenopause.

A history of mood disorders, like depression or anxiety, may increase risk.⁶ “Your brain might naturally lean on some unhelpful thought patterns,” says McElhinny. “But if you’re aware of that, you can brush up on your coping tools. Or try new ones.”

Research shows that external factors can also increase risk. A few examples are high stress levels, low income, and lack of support. Each of these things may mean a person has fewer resources to put toward their health and self care.³

Cultural norms can also play a role.¹ Someone may have been raised to see a woman’s status as linked to their fertility. They may think their value as a person decreases during perimenopause. And stigma can make someone less likely to seek support for perimenopause or mental health concerns.

How might other life changes impact someone’s mental health during perimenopause?

During perimenopause, a woman may also be dealing with changes in her work or personal life. She might be hitting her career peak. Or she could be getting ready to retire. Many women are also caregivers. Some might have kids who still need a lot of support. Others may be sending theirs off to college. Some may be looking after aging parents.

These life changes can affect someone’s bond with their spouse or partner. Job changes might mean one or both people are home more or less often. And shifting family dynamics can pull focus from romantic partnerships.

You’re not doing anything wrong. “The juggling act can be really stressful,” says McElhinny. “And the hormonal and cognitive changes of perimenopause make it tougher to manage everything.”

What can someone do to protect their mental health during perimenopause?

Here’s some good news: “You can start building coping skills before you notice symptoms,” says McElhinny. “There’s no bad time to work on new methods of boosting self-esteem. Or balancing negative thoughts.” For example, journaling is a great way to process emotional hurdles.

Healthy lifestyle habits can also have a positive impact. Changing hormone levels can slow metabolism and cause weight gain. Double down on eating nutrient-rich foods like fruit, vegetables, and lean protein.⁴

Exercise also has major benefits. Doctors may recommend low-impact weight-bearing activities to help preserve bone density.⁷ Walking and strength training are two good options.

Getting more and better sleep can improve mental health.⁸ The American Academy of Sleep Medicine recommends 7 to 8 hours for adults. To hit that amount, take stock of your routine and stick to smart habits. Turn off devices at least an hour before bed.

Lastly, you may want to ask your doctor about medical treatments. Research shows that estrogen replacement therapy can help ease feelings of depression in perimenopause. (Broader HRT may also be an option.)⁹ Your doctor may prescribe some types of antidepressants used for major depressive disorder during other stages of life.¹⁰

You can get to the other side

Perimenopause brings on a lot of changes. Many of which can come on without warning. But they don’t last forever. The mental health challenges that arise during perimenopause typically ease as hormone levels steady.¹¹

And support is available. Especially because more women are opening up about what they’re dealing with. “Doctors know more, so they can guide patients through the changes,” says McElhinny. “As women learn more, they can better support themselves. And each other.”