Anxiety and mood changes in menopause: causes and what actually helps

Name: Anxiety and mood changes in menopause: causes and what actually helps
Creator: MenoWoman

Anxiety, irritability and low mood are common in perimenopause, and the risk of depression rises in these years. Effective help exists, including talking therapies, antidepressants and, for some women, hormone therapy.

Researched by the MenoWoman team. Edited by Marcela Sat. Updated 7 November 2026. We may earn from links.

See a doctor if low mood, hopelessness or loss of interest lasts most days for two weeks or more. Also seek help if anxiety or panic is disrupting daily life. If you have thoughts of harming yourself or ending your life, contact a doctor or your local emergency or crisis service straight away.

What it is and how common it is

Mood symptoms in menopause include anxiety, irritability, anger, mood swings, crying spells, low motivation, loss of confidence and panic attacks. They can be as disabling as physical symptoms.¹

These symptoms are very common. In a global survey led by Mayo Clinic, about three in four women over 35 reported anxiety, and a similar share reported low mood.² The survey used volunteers from a health app, so it may not reflect all women.

The risk of depression rises too. A 2024 review of seven studies and over 9,000 women found about a 40% higher risk of depression in perimenopause than before it. Risk was not raised after menopause.³

Risk is highest in the years just before the final period, often in the mid-to-late 40s.⁴

Emotional symptoms deserve attention, because untreated ones can develop into depression.¹ The good news is that most women with perimenopausal depression improve with treatment.⁴

Why it happens in menopause

Estrogen receptors are found throughout the brain, including areas that control mood. The large hormone swings of perimenopause seem to trigger mood symptoms in some women, though the exact mechanism is unclear.⁵

Some women appear more sensitive to these shifts. Risk is higher after earlier depression, or after mood symptoms linked to birth control, pregnancy or the postpartum period.^4,5 Surgical removal of the ovaries and early menopause also raise the risk.⁶

Other symptoms play a part. Hot flashes can trigger anxiety, and anxious thoughts can trigger hot flashes.⁵ Poor sleep can worsen both mood and thinking.¹

Midlife events add strain. Caring for children or aging parents, work and relationship changes, and illness can all affect mood.⁶

Many women develop depression in midlife with no earlier history, so a clean record does not rule it out.⁷

What else can cause it

Menopause symptoms can hide or mimic depression. Poor sleep, low libido, fatigue and trouble concentrating occur in both, which makes depression harder to spot.⁷

Things a doctor may consider include:

Depression or an anxiety disorder. These need proper diagnosis and treatment, whether or not menopause is involved.⁷
Thyroid problems. An overactive thyroid can cause nervousness, irritability and a racing heart. An underactive one can cause low mood. A blood test can check.⁸
Alcohol. Some women drink more to cope, but alcohol can worsen sleep and hot flashes.⁹

Tell your doctor about any new medicines or health changes, since these can also affect mood.

Everyday measures

Lifestyle steps do not replace treatment for depression, but they can help many women feel steadier.⁶

Stay active and make time for things you enjoy, such as a daily walk or a class.¹
Protect your sleep, and raise sleep problems with your doctor. Treating them can ease other symptoms.¹
Cut down on alcohol. This may do more for your mood than drinking to relax.⁹
Try relaxation, mindfulness or yoga.¹
Talk to people you trust. Family, friends, colleagues or online groups can all offer support.¹

Talking therapy and antidepressants are the first-line treatments for depression in perimenopause.⁷ Hormone therapy can lift mood in some women, but guidelines differ on its role.⁶ There is no evidence to recommend complementary therapies for perimenopausal depression.⁶

What helps: options rated

Option	Evidence	What the research shows
CBT and other talking therapies	Strong evidence	First-line for depression in perimenopause in expert guidelines. NICE also says CBT can reduce depressive symptoms linked to menopause.^7,10
Antidepressants	Strong evidence	A first-line option for depression in perimenopause; desvenlafaxine has the strongest trial evidence in this group. They are prescription medicines.⁷
Hormone therapy (HRT)	Some evidence	Studies show estrogen has antidepressant effects in perimenopause, but some guidelines do not recommend it as a first treatment for depression. It may suit women who also have hot flashes or night sweats.^6,7
Regular physical activity	Some evidence	Recommended by the Australasian Menopause Society as part of managing mood. Rated on guideline support, as trials focused on menopausal mood are limited.⁶
Mindfulness, yoga and relaxation	Weak evidence	Suggested by Women's Health Concern for relaxation and coping. Menopause-specific trial evidence is limited.¹
Cutting down on alcohol	Weak evidence	Alcohol can disturb sleep and trigger hot flashes, so cutting down is sensible. It has not been tested as a mood treatment in menopause.⁹
Herbal and complementary remedies	Weak evidence	The Australasian Menopause Society says there is no evidence to recommend them for perimenopausal depression.⁶

Ratings explained: how we rate. Always talk to a doctor or pharmacist before starting a medicine or supplement.