What perimenopause is
Perimenopause is the transition before menopause, when the ovaries make less estrogen and progesterone and periods become irregular. Menopause itself is confirmed once you have gone 12 months without a period.
The timing varies. The National Institute on Aging (NIA) says most women begin the transition between 45 and 55 and that it may last several years, with an average age of menopause of 52 in the United States. Cleveland Clinic notes that perimenopause usually starts in the mid-40s, lasts about four years on average and can last up to eight. ACOG adds that estrogen levels can start to fluctuate in the 30s and 40s.
That means mood changes can arrive years before periods stop, and many people do not connect the two at first.
The mood changes people describe
NIA lists moodiness and irritability, forgetfulness and difficulty concentrating among the possible symptoms of the transition. Cleveland Clinic includes irritability, depression and mood swings. The NHS describes low mood, anxiety, and problems with memory and concentration that people often call brain fog. In practice it can look like:
- A shorter fuse with your partner, children or coworkers than you recognize in yourself
- Waves of anxiety or dread, sometimes with a racing heart, that seem to come from nowhere
- Feeling flat, tearful or unlike yourself for stretches of time
- Losing words, forgetting why you walked into a room, or struggling to focus at work
- Lying awake at 3 a.m. with a mind that will not slow down
The NHS notes that symptoms can change over the years. Hot flushes and night sweats may ease and be replaced by low mood and anxiety, so a new emotional symptom does not mean something else has gone wrong.
Why mood can shift: more than hormones
Changing hormone levels are part of the picture, but NIA notes that scientists do not fully know why mood changes happen around menopause. Several things tend to pile up at once.
Broken sleep
ACOG explains that night sweats can wake you and leave you tired the next day, and that insomnia or waking long before your usual time is common. The NHS points out that poor sleep can make you irritable, stressed and anxious, and can make memory and mood symptoms feel worse. For more on that loop, see Sleep, Insomnia and Mood: How They Feed Each Other.
Midlife load
NIA mentions stress and family responsibilities, such as supporting growing children or caring for aging parents, as possible contributors. These years often hold a peak in work demands, teenagers or adult children, aging parents and changes in a long relationship, all at the same time.
Meaning and identity
For some people the end of fertility brings relief. For others it brings grief, especially after infertility or pregnancy loss, or a new awareness of aging. Changes in desire and comfort with sex can add strain; Perimenopause, Menopause, and Changes in Intimacy covers that side.
Moodiness or depression?
Cleveland Clinic notes that depression is common during perimenopause and that many people report feeling more anxious, even though research on perimenopausal anxiety specifically is limited. Ordinary irritability that comes and goes is different from depression. NIMH describes major depression as depressed mood or loss of interest most of the time for at least two weeks, along with other symptoms that affect daily life.
It is worth getting checked if you notice:
- Low mood, emptiness or loss of interest lasting more than two weeks
- Anxiety or panic that is changing what you do, such as avoiding meetings or driving
- Hopelessness, or thoughts that others would be better off without you
- A history of depression or postpartum depression and a sense that it is returning
- Drinking more to sleep or to take the edge off
A past episode of depression, especially after a pregnancy, is worth mentioning even if it was years ago. Knowing your history helps your doctor and therapist read what is happening now.
What to bring to your doctor
Many people see a gynecologist or primary care doctor first, which makes sense because the medical options are theirs to discuss. ACOG notes that hormone therapy can relieve symptoms of perimenopause and menopause, and that some nonhormonal medicines are also used for hot flashes and sleep. Whether any of these fits you is a decision for you and your prescriber.
A few weeks of notes can make the appointment more useful:
- Your cycle dates, and whether mood dips line up with them
- How often night sweats or hot flashes wake you
- What the mood changes look like, and how long they last
- Any past depression, anxiety or postpartum depression
- All medicines and supplements you take
Say directly if you want your mood addressed as well as your physical symptoms: "I want to know if this is perimenopause, depression, or both."
Where therapy fits
Hormonal treatment and psychological care can work side by side. Cleveland Clinic notes that providers may recommend medication or behavioral therapy when perimenopause is affecting emotional well-being. Therapy can help you sort out what is hormonal, what is sleep, and what is the weight of this stage of life, and it can be a place to think about identity, relationships and what you want from the years ahead.
Dr. Lehmann, a licensed clinical psychologist in Franklin, works with adults on depression and anxiety, in person or by telehealth for clients located in Michigan. She does not prescribe; she can work alongside your gynecologist or primary care doctor.