Is It Perimenopause or Depression? Signs to Raise With Your Doctor

Some mornings you lie there and cannot find one reason to get up, even though nothing is wrong. The children are fine. Work is fine. And still everything feels grey and heavy, as if someone has turned the colour down on your life. Our mothers might have said मन भारी है, the heart feels heavy. You find yourself wondering: is this my hormones, or is this me?

In short: Perimenopause depression is real. The long-running SWAN study found the risk of depressive symptoms is 2 to 4 times higher during perimenopause. Low mood that comes alongside irregular periods, hot flushes or broken sleep may be linked to hormones, but it can also be depression, and both can happen together. If low mood lasts or stops you coping, see your doctor.

If you are having thoughts of harming yourself, please stop reading and contact your local emergency services or a crisis helpline now. You do not have to wait for an appointment, and you do not have to carry this alone.

Can perimenopause cause depression?

Perimenopause can make depression more likely. During these years your hormones, especially oestrogen and progesterone, rise and fall unevenly, and many women notice their mood shifting with them. Add night sweats that break your sleep for months on end, and almost anyone would feel worn down.

The SWAN study found that the risk of depressive symptoms is 2 to 4 times higher during perimenopause. So if you are feeling low, you are far from the only one, and it is not a weakness or a failure of gratitude.

It is okay to feel this. It is also okay to ask for help with it.

What is the difference between low mood and depression?

Low mood tends to come and go. It is painful, but you can still enjoy some things, and it often lifts a little with rest, a good night's sleep or a kind conversation.

Depression is more persistent. It can feel like a weight that does not move, whatever you do. These are signs worth raising with your doctor:

• low mood on most days that is not lifting
• losing interest or joy in things you used to love
• feeling hopeless, worthless, numb or very guilty
• pulling away from people you care about
• struggling to get through work or everyday tasks
• big changes in your sleep or appetite
• thoughts that others would be better off without you, or thoughts of harming yourself, which need help now

You don't need to tick every box. If several of these feel familiar, that is enough reason to talk to someone.

Clues that perimenopause may be part of the picture

Perimenopause and depression are not either-or. Not "hormones or me". Often both, and both deserve care. These clues suggest hormones may be playing a part:

• mood changes that started around the same time as irregular periods
• hot flushes or night sweats that wake you at night
• new anxiety, or rage that you don't recognise in yourself
• brain fog or word-finding trouble
• mood that feels worse at certain points in your cycle

If you want to see how these fit together, read 12 early perimenopause signs at 40 and what is happening with menopause mood swings.

What should you tell your doctor?

You don't need a perfect speech. You need a few honest notes. Before the appointment, write down:

• how long you have been feeling low, and how often
• how it is affecting your work, sleep, eating and relationships
• any changes in your periods, hot flushes or night sweats
• whether you have had depression or anxiety before, including after having a baby
• what you would most like help with

Then try one simple sentence: "I've been feeling low most days for a while, and my periods have changed too. I'd like to understand whether perimenopause might be part of this."

Your doctor may talk through different options. The UK's NICE menopause guidance includes CBT as one option for low mood linked to menopause. Hormone therapy is another conversation some women have with their doctor, and there are other treatments for depression too. What suits you is a decision to make together. If you feel brushed off, it is okay to go back, or to ask to see someone else. Here is how to talk to your doctor about perimenopause, and why tracking your symptoms helps.

Try this now: a 5-minute moment for heavy days

A 2023 Stanford study (Balban and colleagues, in Cell Reports Medicine) found that 5 minutes a day of cyclic sighing for a month improved mood and lowered breathing rate. It is not a treatment for depression. But on a heavy day, it is something small and kind you can do with your own breath, right where you are: in bed before the alarm, or sitting in the parked car before you go in.

1. Sit or lie down wherever you are, and rest one hand on your heart.
2. Breathe in through your nose, then take a second short sip of air on top.
3. Let it all out in one long, slow sigh through your mouth.
4. Repeat at an easy pace for about 5 minutes. If tears come, let them.
5. When you finish, name the feeling in one word, and if you can, send one message to someone you trust: "Having a heavy day."

You can't do this wrong. Getting through the five minutes counts. Even getting through one minute counts.

Meditation

It Is Okay to Feel This

4 min

When worry makes your heart race, this short practice can help you settle.

Meditation

Your Heart Is Safe

3 min

See in library→

When is it urgent?

If you have thoughts of harming yourself, or feel you cannot keep yourself safe, contact your local emergency services or a crisis helpline now. Tell someone close to you what is happening. This is exactly what those services are for.

See your doctor soon if low mood is lasting, getting worse, or making daily life hard. For everything else that can change in these years, see the full list of menopause symptoms.

You are not alone in this

What if this heaviness is not a flaw in you, but a signal that you need more care than you have been getting? Tonight, you could tell Sakhi how you feel. She is free, she speaks English and Hindi, and she will suggest a short practice, a sleep story or calming music for this moment. She is not a doctor and not a crisis service, so please keep reaching out to real people too. But she is there when the house is quiet and you need a gentle voice.

5 minutes. No mat. No mantra. Just you.