Perimenopause depression and low mood: the signs, why it happens and where to get help

You wake up already tired of the day. Things you used to enjoy feel flat. You cry more easily, snap more quickly, and wonder where the old you has gone. Maybe you've started to ask yourself whether this is perimenopause depression, or "just" a bad patch.

You're not imagining it, and you're not weak. The NHS says mood swings, low mood and depression can all be symptoms of perimenopause and menopause. Women's Health Concern, the patient arm of the British Menopause Society, says menopause does increase a woman's risk of depression.

The good news is that help is available. This page explains the difference between low mood and depression, why menopause can affect your mental health, and what you can do.

Is it low mood or depression?

Most people feel low sometimes. The NHS says low mood often gets better within a few days or weeks. Small changes, like sorting out a worry or getting more sleep, can help.

Depression is different. The NHS says a low mood that lasts 2 weeks or more may be a sign of depression.

Women's Health Concern makes a similar point about menopause. Mood changes around menopause can be distressing and need to be taken seriously. But they are different from clinical depression, where your mood is low all the time. It also warns that if emotional symptoms are ignored, they can develop into more serious depression.

So you don't need to work out the label yourself. If your mood has been low for 2 weeks or more, that's reason enough to talk to your GP.

Symptoms of depression

The NHS lists many symptoms. You won't have them all.

How you feel:

• low mood or sadness that doesn't lift
• feeling hopeless or helpless
• low self-esteem, or feeling guilty
• feeling tearful
• feeling irritable and impatient with others
• no motivation or interest in things
• finding it hard to make decisions
• getting no enjoyment out of life
• feeling anxious or worried
• thoughts of suicide or harming yourself

What happens in your body:

• moving or speaking more slowly than usual
• changes in appetite or weight
• unexplained aches and pains
• little energy
• low sex drive
• disturbed sleep, such as waking very early

How you live:

• avoiding friends and doing fewer social things
• letting hobbies and interests go
• difficulties at home, at work or in family life

If you're having thoughts of suicide or self-harm, please use the help in the box at the top of this page. You don't have to wait until you feel worse.

Can perimenopause cause depression?

It can play a part. The NHS lists low mood and depression among the symptoms of perimenopause and menopause. Its page on the causes of depression says menopause can sometimes trigger depression, particularly in the first few years.

Women's Health Concern lists many emotional symptoms that can come with menopause. These include anxiety, low mood, crying spells, irritability, loss of confidence, loss of joy and poor motivation. It says they can be as hard to live with as any physical symptom, and shouldn't be dismissed.

Why can perimenopause affect your mood?

Changing hormones. Women's Health Concern explains that the hormonal changes of menopause don't only affect your body. They can also affect your emotional and mental wellbeing.

Poor sleep. Night sweats and broken nights wear you down. The NHS says mood symptoms may feel worse if you have sleep problems and feel very tired. Women's Health Concern says poor sleep can make emotional symptoms feel even worse if it's not dealt with.

Everything else going on. Midlife often brings work pressure, caring for children or parents, and less time for yourself. Women's Health Concern notes how hard it can be to find any time for you when work, friends and caring for others all come first.

Other things that can cause low mood

It isn't always the menopause, or not only the menopause. The NHS says there's often no single cause of depression. Things that can play a part include:

• stressful life events, such as bereavement, divorce, illness or money worries
• a long-term or serious illness
• an underactive thyroid
• a family history of depression
• feeling lonely or cut off from people
• drinking alcohol to cope

Your GP can help you work out what's going on.

What can help with low mood?

Things you can try yourself

The NHS suggests:

• Talk to someone you trust, such as a friend or family member. Peer support, from people who've been through something similar, can help too.
• Exercise regularly.
• Eat regular meals.
• Try mindfulness, gently bringing your attention back to the present moment.
• Set small goals that you can actually reach.
• Focus on the things you can change, rather than the things you can't.
• Go easy on alcohol, cigarettes and gambling. The NHS says relying on them can make your mental health worse.

Women's Health Concern adds two more. Make some time for yourself every day, even a short walk or a bath. And tell someone how you feel, because unless you do, they can't help.

NHS talking therapies

NHS talking therapies can help with low mood and depression. The NHS says you can refer yourself without seeing a GP, as long as you're registered with a GP. You usually need to be 18 or over, or 16 in some areas.

Depending on what you need and what's available locally, you may be offered:

• guided self-help, based on cognitive behavioural therapy (CBT)
• CBT with a therapist
• counselling

Women's Health Concern says CBT and other talking therapies can help with some of the emotional symptoms of menopause, even for women who have never tried therapy before. If you live elsewhere in the UK, ask your GP what talking therapy is available near you.

Treatments to talk to your GP about

Your GP can talk you through the options. These are things to discuss, not things to start on your own.

• HRT. The NHS says HRT is effective at relieving anxiety and low mood caused by menopause. Women's Health Concern says HRT can help with many emotional symptoms of menopause, and can also improve sleep.
• Antidepressants. The NHS says you may be offered antidepressants if you have low mood, depression or anxiety caused by perimenopause or menopause. Women's Health Concern says antidepressants can help. It adds that unless you've been diagnosed with depression, other treatments may be more helpful.
• Talking therapy, such as CBT (see above).

What suits you will depend on your symptoms, your health and what you'd prefer. If you already take any medicine, please don't stop or change it without talking to your GP first.

Getting the most from your appointment

It can be hard to explain how you feel, especially when you're low. A few things can help:

• Keep a short record of your mood, sleep, periods and other symptoms for a couple of weeks. Women's Health Concern says this helps your doctor find the right treatment.
• Write down the main things you want to say before you go.
• Say it plainly. "I've felt low most days for weeks and I'm not coping" is enough.
• Mention any thoughts of suicide or self-harm, so your GP can get you the right support.
• Take someone with you if that would make it easier.

When to see your GP

Book an appointment if:

• you've felt low most of the day, every day, for more than 2 weeks
• you're struggling to cope, or self-help isn't working
• your mood is affecting your work, relationships or daily life
• you think your low mood might be linked to perimenopause and want to know your options

If you're having thoughts of suicide or self-harm, don't wait for an appointment. Call Samaritans on 116 123, call NHS 111 and select the mental health option, or call 999 if your life is at risk.

You may also find these pages useful: menopause mood swings, perimenopause panic attacks and perimenopause fatigue.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms