Journal / Mood, Anxiety, Depression

How Hormonal Imbalance During Menopause Can Cause Depression

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

How Hormonal Imbalance During Menopause Can Cause Depression

Perimenopause and menopause can be very vulnerable times and the hormonal imbalance during menopause can cause depression. Not only are women experiencing physical changes, but their mental health and lifestyles are likely shifting.  Most women with perimenopausal anxiety or depression respond well to treatment, but recognizing the relationship between menopause and mood changes is the problem. 

It is not appropriate to decide that anxiety or depression is minor,  or worse, to presume that these disorders will improve with time. The process of menopause can take well over a decade to complete. There is no need for a woman to suffer unnecessarily with these menopausal mental health concerns that if left untreated, can significantly impact a woman’s quality of life and that of her family.4 Tragically, suicide in middle-aged women is becoming a more common occurrence that could be prevented through increased awareness of the root causes, and make medical solutions such as hormone replacement therapy (HRT) available.

Menopause Can Cause Depression

How Hormonal Imbalance During Menopause Cause Depression Inner article

Women often experience anxiety as a result of the hormonal changes brought on by perimenopause and menopause, specifically the drop in estrogen and progesterone. Menopause can lead to unpredictable mood swings, anxiety, and depression. Determining the cause and extent of mental changes is very important.  Many of the depressive disorders that lead to suicide are often overlooked or misunderstood during menopause.

The data speaks for itself. There is a significantly higher rate of mental illness and suicide in women aged 42–52 years of age. For most women, this is the period where they experience perimenopause.1 The seriousness of mental health issues during peri and menopause cannot be ignored. Menopausal women’s suicide rates have increased by 45% over the past 15 years.2 Anxiety and depression are some of the most reported issues in this female age group, but there is a gap between these symptoms and the recognition that they are related to menopause.

To add to the confusion, the psychological symptoms of perimenopause often occur up to five years before the more obvious physical symptoms. This delay in physical symptoms (an obvious hot flash or end of menses) can make the diagnosis of perimenopausal depression difficult. Therefore, the diagnosis of perimenopausal depression is often made retrospectively. It means women are suffering unnecessarily due to a missed diagnosis. 

Menopause and perimenopause impact both a woman’s mind and her body. The systemic impact of this dramatic decrease in estrogen and progesterone during peri and menopause is often overwhelming. Eighty percent of women in menopause experience hot flashes or ‘night sweats,’ setting women up for interrupted sleep and unpredictable days. Persistent sleep disturbances caused by hot flashes contribute to the development and worsening of depressive symptoms.2 Unfortunately, many women do not correlate their mental health disorders and sleep disorders with menopause.

It is critically important for women experiencing anxiety and depression in their late 30’s to mid-40s to recognize that they may be in perimenopause. Additionally, women who go through a worsening of a previously well-controlled depression may also be experiencing a perimenopausal relapse. The risk for depressive symptoms is elevated during perimenopause, even in women with no prior history of depression.2  

When a woman is in her late 30’s to late 40’s they often find themselves in a decade marked by significant life changes that can adversely impact their mental health. During this time, women may be helping aging/ailing parents, saying goodbye to children who are leaving home, facing increased career demands, and possibly dealing with other personal health concerns. Not only does this combination of physical and environmental changes cause stress and anxiety. But it also poses a risk of suicidality and affects a woman’s ability to function.3

Symptoms of perimenopausal depression

  • Hot flashes/night sweats

  • Low Energy

  • Paranoid thinking

  • Irritability or hostility

  • Decreased self-esteem

  • Isolation

  • Anxiety

  • Sleep disturbances

  • Weight gain

  • Decreased sexual interest

  • Problems with memory and concentration

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Management of perimenopausal depression

The good news is that there are effective treatments. If a woman’s medical history allows, anxiety and depression could be abated with hormone replacement therapy (HRT), antidepressant, or both.1  It is common for women with menopausal symptoms to experience depressive symptoms that do not meet the criteria for a diagnosis of depression, but these low-level depressive symptoms can be treated with HRT.2 

Additionally, let’s not underestimate the value of a good night’s sleep. Depression is correlated with sleep disturbances. By decreasing the number of hot flashes or night sweats, sleep will likely improve and in turn, depression will be reduced. Regular exercise, a healthy diet, and minimizing alcohol intake will also help.

Other treatments for perimenopausal depression include antidepressants and estrogen (often with progesterone) hormones. Hormone replacement therapy alone may be appropriate for treating depression in healthy women experiencing other perimenopausal symptoms. The specific HRT chosen must be tailored for each patient. Antidepressant treatment for perimenopausal depression usually begins with a selective serotonin reuptake inhibitor (SSRIs), or serotonin noradrenaline reuptake inhibitors (SSNRI) are often second-line drugs.


Perimenopause and menopause can cause depression because of hormonal imbalance, making women very vulnerable. Not only are they experiencing physical changes, but their mental health is likely shifting.2 Most women with perimenopausal depression respond to treatment. It is not appropriate to deem this type of depression as minor or presume that the depression will improve with time.

The process of menopause can take over a decade to complete. There is no need to suffer unnecessarily with these menopausal symptoms that if left untreated, can impact a woman’s quality of life and that of her family.4 Tragically, suicide in middle-aged women is becoming a more common occurrence that could be prevented through increased awareness of the root causes, and exposure to the available options for proper treatment.

For mood symptoms, estrogen and progesterone therapy are the most effective natural remedy treatment. Hormone replacement is a safe and physiologically natural way for a woman to regain her vitality, and HRT can restore proper hormone levels using substances that are bioidentical to those produced by your own body.

Winona offers our female patients a unique experience. Winona’s healthcare platform is a place to safely connect with a healthcare provider to receive care and to ask the sometimes difficult questions. Winona is not just a site to get a quick prescription. The decision to treat and whether to prescribe a product available through Winona is up to the patient and their Winona affiliated providers who are all licensed, board-certified, and never financially motivated to prescribe.

Winona is proud of our doctors, providers, and scientists who work tirelessly to treat all of the symptoms of menopause in the most effective and scientifically appropriate way. That treatment might be a prescription or it could be one of our over-the-counter treatments, but it will be the treatment that the patient and their doctor devise together. 

Whether experiencing severe or minor symptoms, natural remedies may help ease the side-effects of menopause. If women embrace their evolving bodies by providing the nutrients their body needs, they can move through this sometimes precarious phase with grace and wellness.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”




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