The Links Between Menopause and Depression

Menopause is the time in a woman’s life when periods slow down and stop. There are many physical and hormonal changes during this time that can affect mood. Some common symptoms of menopause, such as hot flashes and insomnia, can also affect mood. Read on to learn about the links between menopause and depression, along with tips for prevention and treatment.

Does menopause cause depression?

It can. But many women go through menopause with no problems at all. After all, menopause is a normal life transition — not a medical condition.  

But there’s evidence that some women may be at greater risk of clinical depression in the years before, during, and after menopause. Experts don’t know exactly why this is. Mood changes and depression during menopause may be connected to many different things. Let’s take a closer look.

Hormonal changes

During menopause, the body starts to make less progesterone and estrogen. These are hormones that the ovaries make. They control your menstrual cycle and have many different jobs in your body, too. 

Anxiety, low mood, and irritability can occur as levels of these hormones start to go down during menopause. And some people may be especially sensitive to these hormone changes, putting them at higher risk for depression. 

Disturbed sleep and sleep deprivation

Many people have problems sleeping during menopause. This may be because hormonal changes can cause night sweats and insomnia. And not sleeping well can cause or worsen mental health problems like anxiety or depression. 

Major life changes

Stressful life events during menopause can put you at risk for major depression. Common problems include job loss, divorce, the death of a loved one, or caring for aging parents. Health conditions — like cancer, thyroid problems, and chronic pain — are also linked to depression. 

Prior depression

A person’s risk of depression during menopause more than doubles if they have had depression before. But not everyone going through menopause experiences depression — in fact, most women don’t. However, mood changes like anxiety, irritability, and low mood during menopause are very common.  

Signs and symptoms of major depression

Major depressive disorder (MDD) is a mental health condition that can make you feel sad and depressed. It can also affect your thinking and behavior. To be diagnosed with depression, you need to have at least one of these two symptoms:

• Feeling depressed, sad, hopeless, or empty most of the time

• Losing interest or enjoyment in almost all activities

People with MDD also have some, or all, of the following symptoms:

• Feeling irritable 

• Having problems sleeping at night

• Sleeping a lot during the day

• Feeling guilty or worthless

• Having appetite changes

• Feeling tired or having low energy

• Having trouble concentrating or thinking clearly

• Feeling like you’re moving very slowly

• Feeling physically restless

• Thinking about death or suicide

Depression may be diagnosed when these symptoms occur most days and persist for more than 2 weeks. 

If you or someone you know is having thoughts of suicide, you’re not alone and help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to 741-741 to reach the Crisis Text Line. 

Quiz: Am I depressed?

Can perimenopause cause depression?

Yes. For most people, menopause happens naturally in their 40s or 50s. 

But hormonal changes can start much earlier — as much as a decade before menopause. This time period before menopause is called perimenopause. 

During perimenopause, hormone levels begin to go down. You still get a period, but it might be lighter or more irregular. Many people also start to have menopause symptoms during this time, including mood swings. 

And just like during menopause, your risk of depression goes up during perimenopause. In fact, there’s even some evidence that your risk for MDD is at its highest toward the end of perimenopause.   

Treatment options for menopause-related depression

If you’re diagnosed with major depressive disorder during menopause, take heart: There are many good treatments that can help. These include:

• Antidepressant medications

• Hormone replacement therapy

• Lifestyle changes

• Cognitive behavioral therapy (CBT)

What is the best antidepressant for menopause-related depression?

The best medication for menopause-related depression depends on many factors. It’s a good idea to talk with your provider about your medication options. 

Medications that may be used to treat menopause-related depression include: 

• Selective serotonin reuptake inhibitors (SSRIs), such as escitalopram (Lexapro) or paroxetine (Paxil, Brisdelle)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor) or desvenlafaxine (Pristiq)

• Hormone replacement with estrogen (especially if you have other symptoms related to menopause)

Some of these medications can also help with other menopause symptoms, like hot flashes, sleep problems, and anxiety. 

Can vitamins or supplements help manage depression-related symptoms during menopause?

Some people prefer to avoid prescription medications for depressive symptoms and instead try vitamins or supplements. While there’s limited research on how effective vitamins and supplements are, some studies suggest possible benefits from black cohosh or St. John’s wort.

What else can you do to take care of your mental health during menopause?

As menopause approaches, there may be some steps you can take to help your mental health and balance your mood. Here are some things that can help with mood swings and depression:

• Regular exercise

• Mindfulness practice

• Healthy diet

• Quality sleep

• Avoiding tobacco and alcohol

But keep in mind: Though these strategies can be helpful, they aren’t always enough to overcome a diagnosis of major depressive disorder. For many people, lifestyle changes work especially well when combined with medication or therapy.  

When to get help

It’s never too early to talk with your healthcare provider about your menopause symptoms or mood concerns. As you get closer to menopause, it’s a good idea to start reviewing symptoms to look out for and treatment options for the future. If mood symptoms become frequent and begin to affect your day-to-day life, make sure to discuss this with your provider.

Why trust our experts?

Written by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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