Perimenopause and Mental Health: An Overlooked Link

Perimenopause is a natural biological transition, yet its psychological toll remains widely underrecognized. While symptoms like hot flashes and irregular periods are well known, a growing body of research suggests that mental health challenges during perimenopause, particularly anxiety, depression, and cognitive difficulties, deserve far greater clinical attention. In this article, we examine how hormonal changes in perimenopause can impact mental health and why this link remains overlooked in both clinical care and public discourse.

Hormonal Shifts and Mental Health Symptoms

Perimenopause typically begins in a woman’s 40s and can last between 2 and 8 years before menopause, which is marked by 12 consecutive months without menstruation. During this time, estrogen and progesterone levels fluctuate significantly, and this hormonal instability has been linked to mood changes and cognitive symptoms.

Estrogen plays a key role in regulating neurotransmitters such as serotonin and dopamine. When levels fluctuate or decline, women may experience:

• Anxiety

• Depressive symptoms

• Irritability

• Sleep disturbances

• Difficulty concentrating

  
  

Notably, these symptoms can appear even in women with no prior history of mental illness. For those with a background of mood disorders, such as premenstrual dysphoric disorder (PMDD) or postpartum depression, the perimenopausal phase may trigger recurrence or worsening of symptoms.

Clinical Evidence: What the Research Shows

The psychological impact of perimenopause is increasingly supported by research. A 2023 study that integrated both qualitative and quantitative findings reported that women commonly identified:

1. Increased anxiety and depression

2. Negative shifts in emotional regulation

3. Lower self-worth

   
   

Other large-scale studies, including the Study of Women’s Health Across the Nation (SWAN), have found that perimenopausal and early postmenopausal women are significantly more likely to report depressive symptoms compared to premenopausal women.

Importantly, the mental health changes observed during this phase are not just reactions to life stressors, they are biologically mediated effects that coincide with hormonal instability.

A Gap in Clinical Practice

Despite growing evidence, many women are not properly assessed or supported for mental health concerns during perimenopause. Several factors contribute to this gap:

• Limited training among general practitioners and primary care providers on menopause-related mental health

• Fragmented healthcare systems that separate reproductive and mental health services

• Stigma and normalization of symptoms as “just part of aging”

  
  

As a result, symptoms are frequently misattributed, underdiagnosed, or dismissed altogether.

A 2023 clinical review noted the urgent need for training across primary and mental health care, highlighting that unmanaged symptoms can negatively affect relationships, employment, and overall well-being.

Approaches to Support and Treatment

Although perimenopause is a natural life stage, its symptoms, especially those affecting mental health are treatable. Interventions should be personalized, and may include:

• Cognitive Behavioral Therapy (CBT): Effective for both mood symptoms and sleep disturbances

• Antidepressants: Particularly SSRIs and SNRIs, which can also alleviate hot flashes

• Hormone Therapy (HT): Can stabilize mood in some women; requires individualized risk-benefit evaluation

• Lifestyle strategies: Regular physical activity, stress reduction techniques, and sleep hygiene can improve resilience and overall well-being

  
  

Integrating these approaches into routine care can improve both mental health outcomes and quality of life during perimenopause.

Looking Forward: Reframing Perimenopause

As awareness grows around the mental health dimensions of perimenopause, there is an opportunity to reframe how this life stage is approached in clinical care. Recognizing the hormonal underpinnings of mood symptoms is essential to timely, compassionate, and effective treatment.

For both patients and clinicians, open dialogue is a crucial first step. Validating women’s experiences and providing access to interdisciplinary care, combining gynecological, psychiatric, and primary care can help close the current gap in support.

Conclusion

Perimenopause is more than a hormonal shift, it is a critical period that can profoundly affect mental health. While much attention has been paid to the physical symptoms of menopause, the emotional and cognitive impacts remain underaddressed in both clinical settings and public health discourse.

By bridging the gap between reproductive health and mental health care, we can better support women through this complex life stage. As research and awareness continue to grow, the opportunity is clear: it’s time to recognize perimenopausal mental health as a central component of women’s well-being not a peripheral concern.

References

• O’Reilly, K., McDermid, F., McInnes, S. & Peters, K. (2024) “I was just a shell”: Mental health concerns for women in perimenopause and menopause. International Journal of Mental Health Nursing, 33, 693–702. Available at: https://doi.org/10.1111/inm.13271

• Riecher-Rössler, A. (2020). Menopause and Mental Health. In: Chandra, P., Herrman, H., Fisher, J., Riecher-Rössler, A. (eds) Mental Health and Illness of Women. Mental Health and Illness Worldwide. Springer, Singapore. https://doi.org/10.1007/978-981-10-2369-9_9

• The Menopause Charity. (2023). Menopause and mental health. Available at: https://themenopausecharity.org/information-and-support/symptoms/menopause-and-mental-health/

• UPMC. (2024). Perimenopause. Available at: https://www.upmc.com/services/womens-health/conditions/perimenopause

  
  
  
  

  Assessed and Endorsed by the MedReport Medical Review Board