Women in the perimenopause stage are 40% more likely to experience depression compared to those who aren’t undergoing menopausal changes, according to a new study led by researchers at University College London (UCL). This research, published in the Journal of Affective Disorders, draws on data from over 9,000 women across the globe and underscores an urgent need for awareness and support for women facing these mental health challenges.

As hormone levels shift during perimenopause, many women find themselves caught off guard by an unexpected wave of mental distress. But why is this critical life stage leaving so many women vulnerable to depression? The answers lie in a complex interplay of biology, psychology, and social factors.

Perimenopause: The Precursor to Change

Perimenopause typically begins three to five years before menopause officially hits. During this transitional period, levels of estrogen and progesterone fluctuate wildly, causing a host of symptoms. Hot flashes, irregular menstrual cycles, and sleep disturbances are common, but mood swings and depressive symptoms can be particularly debilitating. This stage can last anywhere from four to eight years, creating a prolonged window where mental health risks are significantly elevated.

The UCL-led study conducted a meta-analysis of seven international studies, encompassing data from women in Australia, the United States, China, the Netherlands, and Switzerland. By comparing depressive symptoms across different stages of menopause, the researchers discovered a stark reality: women in perimenopause are at a 40% higher risk of experiencing depressive symptoms compared to premenopausal women​.

So, what makes perimenopause such a high-risk period for depression? Researchers point to several overlapping factors. The primary culprit is hormonal fluctuation. Estrogen, which influences serotonin levels in the brain, plummets during perimenopause. This drop can directly impact mood, making women more susceptible to depressive symptoms.

Senior author Dr Roopal Desai (UCL Psychology & Language Sciences) said:  

“Our findings emphasize the importance of acknowledging that women in this life stage are more vulnerable to experiencing depression. It also underlines the need to provide support and screening for women to help address their mental health needs effectively.”

But biology is only part of the story. Social and psychological stressors, such as caring for aging parents, managing careers, and dealing with teenagers, often converge during this life stage. These pressures can amplify feelings of anxiety and depression, creating a perfect storm for mental health challenges.

How to alleviate the risk

Interestingly, the UCL team’s previous research highlighted that non-medical interventions, such as cognitive behavioral therapy (CBT) and mindfulness, can be effective in treating depressive symptoms associated with menopause. These therapies offer practical tools for managing mood swings, anxiety, and low mood, making them valuable options for women who prefer to avoid medication.

Corresponding author, Professor Aimee Spector (UCL Psychology & Language Sciences), says there’s a great need for support for women during this period.

“Women spend years of their lives dealing with menopausal symptoms that can have a huge impact on their wellbeing and quality of life.

“Our findings show just how significantly the mental health of perimenopausal women can suffer during this time. We need greater awareness and support to ensure they receive appropriate help and care both medically, in the workplace and at home.”

Other approaches may also yield rewards. One such approach is bioidentical hormone therapy (BHT), a treatment designed to balance hormone levels using hormones that are chemically identical to those produced by the body. Unlike synthetic hormone replacement therapy (HRT), bioidentical hormones are derived from natural sources, such as yams or soybeans, and are tailored to each individual’s hormonal needs.

Proponents argue that BHT can help alleviate both the physical and psychological symptoms of perimenopause, including mood swings and depression. However, while there are some encouraging results reported in some studies, more rigorous research is needed to confirm its safety and efficacy.

Stigma and Silence: The Need for Awareness

Despite the prevalence of depression during perimenopause, societal stigma still prevents many women from seeking help. Menopause-related symptoms are often dismissed or minimized, both by women themselves and by healthcare providers. This dismissal can lead to feelings of isolation, shame, and frustration.

Cultural attitudes also play a significant role. In some cultures, menopause is viewed as a sign of aging and decline, which can exacerbate feelings of anxiety and depression. Conversely, cultures that view menopause as a natural transition or a time of wisdom tend to report fewer depressive symptoms.

The study’s findings underscore a pressing need for better support systems for women entering perimenopause.

While the conversation around menopause and mental health is growing, there’s still much work to be done. For women navigating perimenopause, knowing that these struggles are shared—and scientifically validated—can be a powerful first step toward healing.

Depression during perimenopause is not just a personal challenge; it’s a public health issue. Recognizing it, talking about it, and addressing it with effective treatments are essential for improving the quality of life for millions of women worldwide.