Menopause and Mental Health: Understanding Mood Swings, Anxiety, and Depression in Midlife

When we talk about menopause, we tend to focus on the physical symptoms: hot flashes, night sweats, weight gain, and sleepless nights. But for many women, the most debilitating changes are invisible—the emotional and mental health challenges that creep in as hormones begin to fluctuate wildly in perimenopause and beyond. 

This is the side of hormone imbalance that doesn’t get enough airtime. And yet, it’s often the most frightening, especially if you don’t understand what’s happening. 

It’s Not Just in Your Head 

Women in midlife are at increased risk for depression, anxiety, and other mood disorders—often for the first time in their lives. 

A 2024 study from University College London found that women are 40% more likely to experience depression during perimenopause than those not experiencing menopausal symptoms.¹ 

The Study of Women’s Health Across the Nation (SWAN) reports that up to 60% of women have depressive symptoms during the menopause transition.² 

And nearly half report increased irritability, mood swings, or anxiety.³ 

Why? Hormones. 

Estrogen has a major impact on brain chemistry. It influences serotonin, dopamine, and norepinephrine—neurotransmitters that regulate mood and emotional stability. When estrogen levels fluctuate or drop, these brain chemicals follow suit, leading to mood changes, anxiety, and even depression. 

Progesterone, which acts as a calming hormone, also declines, often earlier and more abruptly than estrogen. When it disappears, many women feel wired, anxious, or unable to sleep—and those symptoms only magnify emotional distress. 

Throw in midlife stressors—career pressure, caregiving, relationship changes—and it’s no surprise that so many women feel mentally overwhelmed. 

The Rage No One Warned You About 

Let’s talk about the emotional landmine of menopause rage. 

Snapping at loved ones. Zero patience. Feeling like your emotions are bubbling right under the surface. 

This isn’t just “being moody.” Hormonal changes, especially falling progesterone and low estrogen, affect how your brain regulates emotions. The result? Emotional dysregulation that can feel like you’re no longer in control. 

And you’re not alone. 

Brain Fog, Memory Lapses, and Mental Fatigue 

“Menopause brain” is real—and incredibly frustrating. 

Studies show that over 60% of women report cognitive issues during the menopause transition.⁴ This includes forgetfulness, word-finding issues, difficulty concentrating, and mental fatigue. 

Sleep disruption (hello, night sweats) worsens these issues. And since sleep quality is directly tied to mental health, it becomes a vicious cycle: poor sleep → worse mood → more stress → even worse sleep. 

When It Feels Like Depression—But Isn’t 

Here’s the twist: a lot of what gets diagnosed as depression or anxiety in perimenopausal women isn’t a psychiatric disorder at all—it’s hormonal. 

Unfortunately, many women are prescribed SSRIs without ever having their hormone levels tested.  And while antidepressants can help some women while further root cause exploration is happening, they don’t correct the underlying hormone imbalances causing the symptoms. 

That’s why it’s essential to work with a provider who understands midlife women’s health and won’t dismiss your symptoms as “just getting older.” 

What You Can Do 

If you’ve felt like you’re losing yourself lately, you are not broken—and you are definitely not alone. Here are some action steps to take: 

Track Your Symptoms 

Start logging your mood, sleep, cycle (if applicable), energy, and any emotional shifts. Patterns matter and can reveal hormonal trends. 

Get Your Hormones Tested 

A DUTCH test or comprehensive blood panel can uncover issues with estrogen, progesterone, testosterone, cortisol, and more. 

Consider Hormonal or Non-Hormonal Support 

• Bioidentical hormone therapy can be a game-changer. 
• Adaptogens, lifestyle changes, targeted supplements, and CBT can help. 
• SSRIs may be helpful short-term, but they’re not the only tool. 

Build Mental Health Hygiene Into Your Life 

• Prioritize 7–9 hours of sleep 
• Get daily movement (even 15 minutes helps) 
• Practice mindfulness or breathwork 
• Stay connected—emotional isolation worsens symptoms 

Work With a Menopause-Literate Provider 

A provider who gets it can make all the difference. You don’t have to white-knuckle your way through this alone. 

Final Thoughts 

Mental health symptoms during menopause are common—but not normal. They’re signals from your body that something is off. And the great news? You can do something about it. 

You are not crazy. You are not weak. And this is not the end of your vibrancy—it’s the beginning of a new chapter. Let’s rewrite the story of midlife, together.

References 

1. University College London. (2024, May 1). Women are 40% more likely to experience depression during the perimenopause. Retrieved from https://www.ucl.ac.uk/news/2024/may/women-are-40-more-likely-experience-depression-during-perimenopause 
2. Freeman, E. W., Sammel, M. D., Lin, H., & Nelson, D. B. (2006). Associations of hormones and menopausal status with depressed mood in women with no history of depression. Archives of General Psychiatry, 63(4), 375–382. https://doi.org/10.1001/archpsyc.63.4.375 
3. Maki, P. M., Kornstein, S. G., Joffe, H., Bromberger, J. T., Freeman, E. W., Athappilly, G., et al. (2019). Guidelines for the evaluation and treatment of perimenopausal depression. Journal of Women’s Health, 28(2), 117–134. https://doi.org/10.1089/jwh.2018.27099 
4. Epperson, C. N., Sammel, M. D., & Freeman, E. W. (2013). Menopause effects on verbal memory: Findings from a longitudinal community cohort. Journal of Clinical Endocrinology & Metabolism, 98(9), 3829–3838. https://doi.org/10.1210/jc.2013-1808