Some women describe it as a shorter fuse. Others describe a flatness, a loss of interest in things that used to matter, or a worry that will not settle. Many describe something harder to name: the sense that the same life now takes more effort to carry.
These experiences are common during the menopause transition, and they are real. This article explains what is known about mood during perimenopause, why the timing is not a coincidence, and when a change in mood needs care of its own.
What women describe
The federal Office on Women's Health notes that during perimenopause and menopause you may feel more irritable or anxious, or experience symptoms of depression. Researchers at the National Institute of Mental Health describe the experiences they study in similar terms: irritability, anxiety, sadness, and loss of enjoyment around the time of the transition.
Motivation often belongs on that list. Loss of enjoyment can look like a lack of drive, and it is easy to mistake for a character flaw when it may be a symptom.
Why the timing is not a coincidence
Two things happen at once during perimenopause.
The first is biological. Hormone levels rise and fall unpredictably, and federal health guidance links mood changes during this time to those hormone shifts. Hot flashes and night sweats can also disrupt sleep, and poor sleep can worsen or contribute to depressive symptoms.
The second is circumstantial. Midlife often brings caregiving for children and aging parents, changes at work, changes in relationships, and illness in the family. Guidelines on perimenopausal depression from The Menopause Society and the National Network of Depression Centers note that life stressors, low social support, and physical health problems are strongly related to depression during perimenopause.
This is what the phrase "mental load" points to. It is not a clinical term, and it is not a diagnosis. It describes the weight of organizing, anticipating, and holding everything together, often for several people at once. When that weight arrives in the same years as hormonal change and interrupted sleep, the combination can be heavier than any one part.
A window of vulnerability
The same guidelines describe perimenopause as a window of vulnerability for depression. The risk of depressive symptoms is elevated during this time even in women with no prior history of depression.
One study, the Harvard Study of Moods and Cycles, followed 460 women aged 36 to 45 who had never had major depression. Those who entered perimenopause during the study were about twice as likely to develop significant depressive symptoms as those who had not yet entered it. Women who have had depression before may also have another episode during this period.
None of this means that low mood in midlife is inevitable, or that it is only hormonal. It means that a change in mood during these years deserves to be taken seriously rather than explained away.
What helps
Mood symptoms deserve their own care. For a depressive episode during perimenopause, antidepressants, cognitive behavioral therapy, and other forms of psychotherapy remain front-line treatments. The guidelines also suggest that clinicians consider treating disrupted sleep and night sweats as part of care, since they can feed into mood.
One point is often misunderstood. Estrogen therapy is not approved to treat depression. The guidelines found evidence that it has antidepressant effects in women during perimenopause, particularly those who also have hot flashes and night sweats, but that it is ineffective as a treatment for depression after menopause. Either way, antidepressants and psychotherapy remain the front-line treatments.
The right first step is a conversation with your primary care provider or a mental health clinician. Tell them what has changed, when it started, and how it relates to your cycle, your sleep, and what else is happening in your life.
When to get help right away
If you have thoughts of harming yourself, call or text 988 to reach the 988 Suicide and Crisis Lifeline. If you are in immediate danger, call 911.
A change in mood during the transition is not a personal failing, and it is not something you are expected to push through alone.
The Energē Editorial answers one question like this each month, with sources printed in full. Join the Editorial. Energē Health evaluates hormonal, metabolic, thyroid, and digestive concerns for women located in Virginia. It does not provide mental health treatment, and works alongside the care you already have. Request an Energē Introduction.
This article is general education. It is not medical advice and does not replace care from your own clinician.
Sources
Office on Women's Health, U.S. Department of Health and Human Services. Menopause symptoms and relief. Updated October 19, 2026.
National Institute of Mental Health. Perimenopausal Depression.
National Institute of Child Health and Human Development. Menopause fact sheet.
Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause. 2018;25(10):1069–1085. Co-published in Journal of Women's Health. Summarized by the University of Illinois Chicago.
Cohen LS, Soares CN, Vitonis AF, Otto MW, Harlow BL. Risk for new onset of depression during the menopausal transition: the Harvard Study of Moods and Cycles. Archives of General Psychiatry. 2006;63:385–390. Summarized by the MGH Center for Women's Mental Health.
