Understanding Depression in Perimenopause

Ya’ll, there’s been plenty of conversation lately about increased anxiety in perimenopause, but we’re not giving as much airtime to anxiety’s cruel cousin: depression. And we really need to.

Truly, the omission of depression from the conversation is not much of a surprise. Anxiety is much more socially acceptable as far as mental health concerns go. In fact, I could write a whole blog about that topic, but I’ll say here that folks typically think of anxiety as related to productivity. It’s work stress. I’m stressed about caring for ___. I lay awake thinking about ___. And in our culture, there’s a martyrdom that happens at this intersection.

Depression, meanwhile, has been framed as the opposite, and it’s more stigmatized. Even more, depression can be hard to recognize. It shows up for women in many different ways and hinders their wellbeing accordingly. That’s even more reason we need to normalize and tend to depression in perimenopause early, because it’s much more common than you’d think.

Why Depression Happens in Perimenopause

Let’s set the stage and start with our bodies. Perimenopause is a normal developmental stage in a woman’s life, lasting on average 5–7 years. Biologically, it is also a time of significant hormonal fluctuation. These hormones  don’t just regulate the reproductive system; they play a crucial role in brain chemistry. Estrogen and progesterone, for example, influence serotonin and dopamine, neurotransmitters that help regulate mood and motivation.

This can lead to mood swings, irritability, anxiety, and depression. And let’s not forget insomnia.

Psychologically, midlife (and the perimenopause years) often brings layered stressors: aging parents, shifting identity, career transitions, relationship changes, and a cultural narrative that can make women feel invisible or devalued. Depression in this phase is often not just biological. It is biopsychosocial. Our hormones may make us less resilient to stress, but the stress itself is also very real.

How Depression May Show Up

Depression during perimenopause doesn’t always present as persistent sadness. In fact, many women don’t feel “sad” at all, and that can be confusing.

Instead, it may look like:

·       Irritability or a shorter fuse than usual

·       A sense of emotional flatness or numbness

·       Loss of motivation or difficulty initiating tasks

·       Brain fog or trouble concentrating

·       Feelings of being overwhelmed

·       Social withdrawal or loss of interest in previously enjoyable activities

·       Changes in appetite or sleep patterns

For some women, the most distressing symptom is a loss of their sense of self. They feel disconnected from who they used to be physically, emotionally, and spiritually. And with that can come grief and anxiety.

When You Might Not Realize it’s Depression

Depression does not always look like the The Bell Jar kind-of-despair, though it certainly can. It exists on a spectrum, ranging from suicidal thoughts to a vague feeling of “blah” or not finding enjoyment where you once did.

It’s the latter that we have difficulty recognizing and even acknowledging, because of a lack of education and, again, social stigma.

We are often told these are “normal” parts of aging or hormonal change, so many women don’t recognize that they are experiencing depression.

You might attribute it to:

·       Stress

·       Burnout

·       Personality (“Maybe I’m just becoming more negative”)

·       Hormones (in a minimizing way, rather than a clinically meaningful one)

High-functioning women, in particular, may continue to meet responsibilities. You know the drill: working, caregiving, showing up, while internally struggling. This can make depression harder to detect, both for themselves and for others.

When Depression is Pre-Existing

For women with a history of depression, perimenopause can be a vulnerable time. Even if symptoms have been well managed for years, hormonal shifts can destabilize mood.

This doesn’t mean something is wrong with you, or that prior treatment has failed. It may simply mean that your treatment needs to be adjusted. This is true across mental health conditions and something we do not talk about enough.

This could include:

·       Re-evaluating medication type or dosage

·       Lifestyle interventions (nutrition, exercise)

·       Adjusting therapeutic approaches to include more somatic, nervous system-focused, or grief-oriented work

·       Prioritizing sleep support as a foundational intervention

It’s important to work with providers who understand the intersection of mental health and hormonal change, as standard approaches may not fully address what’s happening. The Menopause Society is an excellent source for specialized providers.

Getting the Perimenopause Care you Deserve

As I wrap up here, I want to reiterate that depression in perimenopause is real and treatable. Women do not need to wait until things have gotten bad enough or even bad at all, to reach out for support. We deserve care during such a profound time of transition. All of us.

I’ll add that I actively encourage medical providers to screen for emotional distress (not just depression) when working with patients, just as I believe psychotherapists should be screening for physiological concerns.

With the right web of care and interventions, whether that’s therapy, medical support, lifestyle shifts, or community, many women not only stabilize but emerge with a deeper sense of self-understanding and alignment. I’ve seen it happen.

Until Next Time wishing You Health & Ease,

Jessika

Jessika Fruchter, LMFT

Connect with me on IG : @that_feminist_therapist

Book a therapy consultation here. (for California residents only)

Jessika Fruchter, LMFT, (Lic. 9767) is based in Oakland California. She offers specialized mental health care for women navigating perimenopause and all things midlife. She offers individual and group therapy support to women throughout the state of California. She also writes frequently about issues of midlife, spirituality and mental health on her blog: Minding Midlife and Substack: We Were Made For This.