FEEL WELL • MOOD

Mood, anxiety & irritability:
it is not "just you".

LAST REVIEWED: 2026-10-24 • By the LatelyWell editorial team • How we write & review

Feeling anxious, tearful, irritable or flat for no obvious reason is common in perimenopause. Here is why mood can change, how to tell everyday ups and downs from something that needs care, and which treatments have good evidence.

How mood changes can show up

Mood symptoms in the menopause transition can be surprisingly varied. Women commonly describe:

• Feeling anxious or on edge, sometimes with a racing heart or a sense of dread.
• Irritability or a much shorter fuse than usual.
• Tearfulness or feeling overwhelmed by things that used to be manageable.
• Low mood, flatness or losing interest in things.
• Lower confidence or self-esteem.
• Mood swings that seem out of proportion to what is happening.

The NHS lists changes to mood, including low mood, anxiety, mood swings and low self-esteem, among the common symptoms of perimenopause and menopause. For some women, mood symptoms are the first sign that perimenopause has started, sometimes years before periods stop, which can make them hard to recognise.

Why perimenopause can affect mood

Hormonal fluctuation

Oestrogen interacts with brain chemicals involved in mood, including serotonin. In perimenopause, levels do not simply fall steadily; they can swing up and down. Research suggests the fluctuation itself, rather than low levels alone, may be particularly linked to mood symptoms. Women who have had premenstrual mood symptoms or postnatal depression in the past may be more sensitive to these changes.

A window of higher risk for depression

Several long-term studies, including the US Study of Women's Health Across the Nation (SWAN), found that the risk of depressive symptoms and of a depressive episode is higher during perimenopause than before it, including in women with no previous history of depression. The Menopause Society and the National Network of Depression Centers published guidelines in 2018 recognising perimenopause as a window of vulnerability for depression.

Knock-on effects of other symptoms

Night sweats and broken sleep, brain fog, joint aches and fatigue can all wear down your resilience. It is hard to feel calm and positive when you have not slept properly for weeks.

Midlife pressures

Midlife can bring a lot at once: work responsibilities, children leaving home or still at home, caring for older relatives, relationship changes and bereavement. These pressures are real and deserve attention in their own right; they are not "all hormones".

Low mood or depression?

Everyone has low days. Depression is different: it is persistent, affects most of the day on most days for at least two weeks, and makes it hard to function. Signs include:

• Feeling low, hopeless or numb most of the time.
• Losing interest or pleasure in things you used to enjoy.
• Changes in sleep or appetite.
• Feeling worthless or guilty.
• Difficulty concentrating or making decisions.
• Thoughts that life is not worth living, or of self-harm.

In the UK, NICE recommends that low mood associated with menopause is not automatically treated with antidepressants when there is no diagnosis of depression, and that HRT and CBT can be considered. If you do have depression, it should be assessed and treated as depression, whatever its trigger. Effective treatments include talking therapies and antidepressants.

What has good evidence

Cognitive behavioural therapy (CBT)

CBT is a structured talking therapy that helps you notice and change unhelpful patterns of thinking and behaviour. NICE recommends considering CBT for menopause-associated low mood and anxiety, and it also has evidence for reducing how much hot flashes and sleep problems bother you. In the UK, NHS Talking Therapies services accept self-referral in England. In Australia, a GP can make a Mental Health Treatment Plan for subsidised psychology sessions. In the US, ask your doctor or check your insurer's listings.

HRT

NICE says HRT can be considered to help menopause-related low mood. It is likely to be most helpful where mood symptoms are linked with hot flashes, night sweats and poor sleep, or with perimenopausal hormonal fluctuation. HRT is not a treatment for clinical depression on its own. Whether it is right for you depends on your health history, and the benefits and risks are worth discussing with a clinician.

Antidepressants

For diagnosed depression or anxiety disorders, antidepressants are an effective treatment. Some, at lower doses, are also used as non-hormone treatment for hot flashes. A doctor can help you weigh the options and side effects.

Lifestyle foundations

These do not replace treatment when it is needed, but they have a real effect on mood:

• Regular physical activity. Exercise has good evidence for improving mild to moderate depression and anxiety.
• Sleep. Improving sleep often improves mood. See our guide to sleep in menopause.
• Alcohol. Alcohol is a depressant and worsens sleep and anxiety for many people. Cutting down often helps.
• Connection. Talking to friends, family or other women going through the same thing can reduce isolation.
• Time for yourself. Even small, regular pockets of time for things you enjoy matter.

Mindfulness and relaxation techniques can also help some people manage stress and anxiety, although the evidence specifically for menopause symptoms is mixed.

Talking to the people around you

Irritability and low mood can strain relationships, particularly when no one, including you, has connected them to perimenopause. It can help to explain what is happening and what helps, for example space when you are overwhelmed, practical help with tasks, or simply someone noticing and asking. You might find it easier to share a trusted article than to explain everything from scratch.

Mood changes at work

Anxiety, low confidence and irritability can affect work, sometimes leading women to step back from roles they are good at. In the UK, ACAS guidance encourages employers to support staff with menopause symptoms, and many larger employers now have menopause policies. Small adjustments, such as flexible hours after a bad night or a quiet space, can make a difference. Talking to occupational health or your manager is a personal choice, but you are entitled to support.

Tracking mood

Tracking mood alongside other symptoms helps you and your clinician see patterns. Each day, note:

• Your mood (for example 1 to 5) and one word that describes it.
• Anxiety or irritability, and any triggers.
• Your sleep and night sweats.
• Where you are in your cycle, if you still have periods. A pattern linked to your cycle can be useful information.

Our free Menopause Symptom Tracker includes space for mood, and our appointment guide explains how to share your notes.

When to see a doctor

Book an appointment if:

• Mood changes have lasted for more than a couple of weeks or are affecting daily life, work or relationships.
• You feel anxious most of the time or are having panic attacks.
• You have lost interest in things you usually enjoy.
• You are drinking more to cope.
• You have a history of depression, postnatal depression or severe premenstrual mood symptoms and notice them returning.

Frequently asked questions

Can perimenopause cause anxiety even if I've never had it before?

Yes. Many women experience anxiety for the first time in perimenopause. It is common, but it is still worth discussing with a doctor, both to get support and to check for other causes such as thyroid problems.

Should I take antidepressants for menopause mood changes?

NICE advises that menopause-related low mood without a diagnosis of depression is not automatically treated with antidepressants, and that HRT and CBT can be considered. If you have depression, antidepressants and talking therapies are effective treatments.

Where to find reliable information

If you want to read further, these organisations publish free, evidence-based information for the public:

• UK: the NHS menopause pages, the NICE menopause guideline and the Women's Health Concern factsheets from the British Menopause Society.
• US: The Menopause Society, ACOG and the National Institute on Aging.
• Australia: Jean Hailes for Women's Health and the Australasian Menopause Society.

Guidance differs a little between countries, and treatment names and availability vary, so check what applies where you live and talk to a clinician about your own situation.

The bottom line

Mood changes in perimenopause are common, real and treatable. They often reflect a mix of hormonal fluctuation, poor sleep and the pressures of midlife, and perimenopause is a recognised time of higher risk for depression. CBT, HRT and, where needed, antidepressants all have a place, alongside sleep, exercise and connection. You do not need to wait until things become unbearable to ask for help.

Educational information only; not medical advice, diagnosis or treatment. Seek professional care for symptoms that are severe, persistent, worsening or concerning.