Hormones, Mood, and Midlife: Mental Health During Perimenopause and Menopause

The transition through perimenopause and menopause is often associated with physical changes—hot flashes, weight gain, night sweats—but for many women, the emotional and mental health effects can be just as significant. What’s less talked about is how these hormonal shifts can influence mood, memory, anxiety, and even the risk for depression.

Understanding what’s happening biologically during this stage of life can help women better recognize and address the emotional symptoms that sometimes emerge.

The Brain-Hormone Connection

Estrogen and progesterone, two major female sex hormones, play an important role not just in reproduction, but also in brain function. Estrogen, in particular, affects several key neurotransmitters involved in emotional regulation, most notably serotonin.

As estrogen levels decline during perimenopause (which can begin as early as the late 30s or early 40s), serotonin activity can also drop. This can result in changes to mood, sleep patterns, and even pain sensitivity. Similarly, reductions in progesterone may contribute to increased anxiety or irritability.

Research has shown that during perimenopause, women are at significantly higher risk for developing new or worsening symptoms of depression. In fact, one longitudinal study found that women in perimenopause were two to four times more likely to report depressive symptoms than their premenopausal counterparts, even when controlling for prior mental health history (Freeman et al., 2014).

Emotional Symptoms During Midlife

The emotional symptoms that can appear during this transition aren’t always immediately recognized. Many women report feeling unlike themselves. Common changes include:

• Mood swings or emotional reactivity

• Increased irritability or anxiety

• A sense of flatness or emotional numbness

• Sleep disturbances that worsen emotional resilience

• Low motivation or focus (sometimes described as “brain fog”)

• Feelings of sadness, hopelessness, or emptiness

These changes may be gradual or sudden. For some, symptoms are intermittent and manageable. For others, they can significantly affect daily life, relationships, and work performance.

Why It’s More Than “Just Hormones”

It’s easy to dismiss these emotional changes as “just part of aging,” but that view is not only outdated, it’s unhelpful. The reality is that hormonal shifts during midlife interact with brain chemistry, stress levels, and often pre-existing life demands (such as caregiving, career transitions, or health issues), making this period a perfect storm for emotional dysregulation.

Mood symptoms during this time aren’t a sign of weakness or failure. They are neurobiological responses to real physiological changes. Recognizing this can help reduce the stigma that often prevents women from seeking help or even talking about how they feel.

Approaches to Managing Midlife Mood Shifts

There is no one-size-fits-all solution, but support often begins with validation and awareness. Effective approaches may include:

• Education about the connection between hormones and mental health

• Therapy, particularly cognitive-behavioral therapy (CBT), to build emotional resilience and process midlife stressors

• Lifestyle modifications like sleep regulation, physical activity, and nutrition to support brain and hormone health

• Medical options, including hormonal therapy and psychiatric medication, when symptoms are moderate to severe

• Mind-body practices such as mindfulness, journaling, or breathwork to support emotional grounding

Some women also explore complementary or integrative therapies, and emerging options such as GLP-1 medications or ketamine infusions may be appropriate in cases of treatment-resistant depression—but these should be evaluated on an individual basis with a qualified provider.

The emotional effects of perimenopause and menopause are real, common, and treatable. As more research highlights the complex relationship between hormones and mood, the conversation around midlife mental health is starting to shift—from one of silent suffering to one of validation, support, and informed care.

We’d love to hear from you

Have you noticed any emotional changes during perimenopause or menopause that caught you off guard? What helped you feel more grounded during this time? Feel free to share your thoughts or experiences in the comments — your story might resonate with someone else walking a similar path.