Can perimenopause cause depression and anxiety?
Yes, and it’s common. The NHS lists mood swings, low mood, depression and anxiety as symptoms. But whether NICE suggests HRT for your mood turns on one question.
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Can perimenopause cause depression and anxiety?
Yes. The NHS says you may have mood swings, low mood or depression in perimenopause. That’s the stretch of years when your periods start to change, before they stop.
Hot flushes can cause anxiety too. And symptoms shift over time. Flushes may ease and be replaced by low mood and anxiety.
A 2024 review pooled 7 studies of 9,141 women. It found higher odds of depression or depressive symptoms in perimenopause than before it.
| Stage | Odds of depression or its symptoms | What the stage means |
|---|---|---|
| Before perimenopause | The starting point | Your periods haven’t started to change. |
| Perimenopause | About 1.4 times as high | Your periods are changing. |
| After menopause | No clear rise | No period for 12 months or more. |
Sources: Badawy 2024, J Affect Disord; NHS
The studies sorted the stages and measured depression in different ways. That may be why their results varied.
Low mood has other possible causes too. See blood tests for low mood and menopause or thyroid.
Track your mood next to your flushes and sleep for a few weeks. The NHS points to a symptom tracker you can use, and it gives your GP the pattern.
Why do hot flushes feel like panic attacks?
They share many signs. The NHS says a hot flush can make you sweat a lot, cause palpitations or anxiety, or make you feel dizzy. Palpitations means a fast, pounding or noticeable heartbeat.
| Sign | Hot flush | Panic attack |
|---|---|---|
| Suddenly hot or cold | Yes, in your face, neck and chest | Yes, hot flushes or chills |
| Sweating | Yes, it can be a lot | Yes |
| Racing or pounding heart | Yes (palpitations) | Yes, a racing heartbeat |
| Anxiety or fear | Yes | Yes, panic is the most severe form of anxiety |
| Dizziness | Yes | Yes |
| How long it lasts | Several minutes | Most last 5 to 20 minutes |
Sources: NHS: menopause symptoms; NHS: panic disorder
Think of two smoke alarms with the same siren. The sound alone can’t tell you which one went off.
So a flush that brings panic doesn’t mean you have panic disorder. That’s when sudden attacks of panic or fear come regularly, often for no clear reason.
Your GP will ask you to describe your symptoms, how often you get them and how long you’ve had them. A quick note after each episode makes that easier.
More on hot flushes and tests for palpitations.
Does HRT help depression or anxiety?
That one question is whether your low mood counts as depression. NICE’s advice on HRT, or hormone replacement therapy, depends on it.
Depression is more than feeling fed up for a few days. The NHS says you keep feeling sad for weeks or months.
| If you have | What’s suggested | Good to know |
|---|---|---|
| Low mood that began around the same time as other menopause symptoms, but isn’t depression | NICE: consider HRT. | HRT is mainly the hormone oestrogen, plus a second hormone, progestogen, to protect your womb if you still have one. |
| Low mood with hot flushes or night sweats, but isn’t depression | NICE: consider CBT, alongside other options, or instead if they’re unsafe for you or you’d rather not. | CBT is a talking therapy. The NHS says it can help low mood, anxiety and sleep. |
| Depression, diagnosed or suspected | NICE: your doctor follows the depression guideline as well as the menopause one. | Depression treatment can mix lifestyle changes, talking therapy and medicine. |
| Anxiety caused by perimenopause or menopause | NHS: CBT can help. If HRT doesn’t suit you, you may be offered antidepressants. | NICE’s menopause guideline has no advice just for anxiety. |
Sources: NICE NG23; NHS: treatment; NHS: things you can do; NHS: depression
Searching for the best HRT for anxiety? NICE’s menopause guideline has no advice on HRT just for anxiety. No source we checked ranks one type above another.
The type you’re offered depends on whether you still have periods or have had your womb removed.
One trial tested whether HRT could stop low mood starting. In the US, it followed 172 women aged 45 to 60, in or just past perimenopause, without depression.
For a year, they used oestrogen through the skin, or a dummy version. The oestrogen group also took progesterone pills for 12 days every 3 months.
On the dummy, 32.3% scored high for depression symptoms on a mood questionnaire at least once. On oestrogen, 17.3% did. The benefit showed only in women early in perimenopause.
So it tells us about prevention, not treating low mood you already have. Ask your GP whether HRT, CBT or both fit your symptoms.
Never stop or change a prescribed medicine without your prescriber.
What can I do myself for menopause mood swings?
Six NHS steps that can help mood and other menopause symptoms
- Get as much rest as you can, and keep to regular sleep routines.
- Exercise regularly.
- Do something relaxing, such as yoga, tai chi or meditation.
- Talk to other people going through the same thing, like family, friends or colleagues.
- Don’t smoke, and try not to drink more than the recommended alcohol limit.
- In England, you can refer yourself to an NHS talking therapies service for CBT. You don’t need to see a GP first.
Sources: NHS: things you can do; NHS: panic disorder
During a panic attack, the NHS suggests you breathe slowly and deeply. Remind yourself the attack will pass.
Thinking of a herbal remedy? The NHS says there’s very little evidence for how well they work or how safe they are. Some may cause serious side effects with other medicines, so talk to a doctor first.
Mood symptoms may feel worse if you sleep badly and feel very tired. See CBT for insomnia and menopause supplements.
When to speak to a GP
If you think you may be depressed, the NHS says it’s best not to delay. Speak to a GP if:
- You think you may be depressed, for example you’ve felt sad for weeks or months, not just a few days.
- You think you have perimenopause symptoms and want to know your options.
- You have symptoms like a fast heartbeat (palpitations).
- You get sudden attacks of panic or fear again and again. The NHS says to see a GP.
- You need urgent help for your mental health. Use 111 online, or call 111 and choose the mental health option, or ask for an urgent GP appointment.
Call 999 or go to A&E now if someone’s life is at risk, for example they’ve seriously injured themselves or taken an overdose. Do the same if you don’t feel you can keep yourself or someone else safe.
For free, private support from trained volunteers, call Samaritans on 116 123. See also perimenopause symptoms and blood tests for anxiety.