Written by: Manya Brown, LAC-T
October is World Menopause Awareness Month, and October 18 is World Menopause Day, a global effort to improve awareness of menopause and the support options available. Most of the conversation focuses on hot flashes, sleep disruption, and physical changes. What gets discussed far less is how much the menopausal transition can affect mental health.
If you have found yourself feeling more anxious, irritable, sad, or just not like yourself during this transition, you are not imagining it. The hormonal shifts of perimenopause and menopause affect the brain in ways that can genuinely change mood, cognition, and emotional regulation.
What Is Happening in the Brain
Estrogen is not just a reproductive hormone. It acts on the brain as a neuroactive steroid, helping regulate mood, cognition, and overall neural stability through receptors throughout the brain. When estrogen levels swing dramatically during perimenopause, a lot can shift downstream: neurotransmitter systems become less stable, the stress response activates more easily, and processes like neuroplasticity and inflammation can be affected.
So when someone says the mood changes are "all in your head," that is technically true, but not in the dismissive way they mean it. They are in your head because your brain is responding to a real hormonal shift. That is a neurological event, not a personal failing.
Conditions That Can Get Worse During Menopause
For people with a history of certain mental health conditions, this transition can intensify symptoms or bring them back.
Major Depressive Disorder. The biggest risk factor for depression during perimenopause is a history of depression. About 59% of women with a history of depression experience another major depressive episode during perimenopause and early postmenopause, compared with 28% of women without that history. If you have been treated for depression before, this is a good season to be proactive about monitoring and support.
Bipolar Disorder. Research consistently shows an increased risk for depressive episodes during the menopausal transition in women with bipolar disorder. It also appears to be a potential trigger for bipolar onset in some cases. A history of premenstrual symptoms and postpartum depression are both linked to higher risk of depressive episodes during perimenopause in this group.
OCD. Reproductive events, including menopause, can influence how severe obsessive-compulsive symptoms are. One study found that 9 of 101 women with OCD reported symptom worsening during menopause. OCD is not rare in postmenopausal women, and it often co-occurs with depression or other anxiety disorders.
ADHD. There is growing recognition that menopausal symptoms can look a lot like adult ADHD, particularly when it comes to executive function, attention, and memory. Some researchers have suggested a possible role for ADHD medications in treating executive function difficulties during menopause. Women may be a particularly vulnerable group when it comes to cognitive and emotional changes with age.
Conditions That Can Show Up for the First Time
Even without a prior history, the menopausal transition can bring mental health symptoms that were not there before.
Anxiety. A 2023 study found that about 15% to 50% of perimenopausal and postmenopausal women experience symptoms like anxiety, depression, forgetfulness, and insomnia. A large web-based survey found that 52% of menopausal women reported anxiety symptoms. Anxiety during this time can look like panic attacks, persistent worry, restlessness, irritability, or physical symptoms like a racing heart and muscle tension.
Depression. The risk for elevated depressive symptoms and major depressive disorder increases during the shift from premenopause to perimenopause, even in women with no history of depression. Perimenopausal depression often includes anhedonia, anger, feelings of rejection, anxiety, and irritability alongside the more familiar depressive symptoms.
Sleep disruption. Sleep problems are common during this transition and are tied to both mood and anxiety difficulties. Night sweats and hot flashes disturb sleep, and poor sleep in turn makes mood worse. It can become a cycle that is hard to break without support.
What This Means for You
The research is clear that the menopausal transition involves real vulnerability to mental health symptoms. It is also clear that most women do not experience a major depressive episode during this time. The increased risk seems to concentrate in specific groups: those with a history of depression, those with severe or sleep-disrupting vasomotor symptoms, those with a long transition, and those navigating significant life stress.
If you are in a harder season than usual, that is information worth acting on. It is not a character flaw or a sign of weakness. It is a physiological transition with psychological consequences, and it responds to treatment.
What Treatment Looks Like
Treatment for depression during perimenopause includes the standard evidence-based options: antidepressants, cognitive behavioral therapy, and other psychotherapies. If you have been treated for depression before, the medication that worked previously is often the first choice for recurrence.
Hormone therapy also has a role. Transdermal estradiol has shown efficacy in treating major depressive disorder in perimenopause, even for women without vasomotor symptoms, and is considered a second-line treatment. It may also boost antidepressant response. That said, estradiol is not effective for treating depression in postmenopause.
The most important step is the same one that applies to any mental health concern: talk to someone who understands the intersection of hormones and mood. A therapist can help you separate what is hormonal from what is psychological, develop coping strategies for the symptoms you can control, and connect you with medical support when appropriate.
Final Thoughts
Menopause is not just a physical transition. It is a neurological and emotional one. If you are struggling more than you expected during this time, you are not failing. You are experiencing something real that deserves real support.
At Bloom & Breathe Therapy, we provide evidence-based therapy for OCD, anxiety, and related concerns. Our therapists use approaches such as ERP, I-CBT, and other evidence-based interventions tailored to each client's goals and symptoms.
We offer in-person therapy in Lander, Wyoming and Mesa, Arizona, as well as secure telehealth services throughout Wyoming, Arizona, Missouri, and Idaho.
References
Congress.gov. (2025). S. Res. 480, 119th Congress. https://www.congress.gov/119/bills/sres480/BILLS-119sres480is.pdf
Cleveland Clinic. (2025, March 27). Menopause anxiety and mental health. https://health.clevelandclinic.org/is-menopause-causing-your-mood-swings-depression-or-anxiety
Kandasamy, G., et al. (2024). A study on anxiety and depression symptoms among menopausal women. Front Public Health, 12, 1467731. https://pubmed.ncbi.nlm.nih.gov/39737455/
Mass General Brigham. (2026, July 19). Menopause and mental health. https://www.massgeneralbrigham.org/en/health-wellness/menopause-and-mental-health
Uguz, F., et al. (2010). Obsessive-compulsive disorder in postmenopausal women. Aust N Z J Psychiatry, 44(2), 183-187. https://pubmed.ncbi.nlm.nih.gov/20113307/
Vulink, N. C., et al. (2006). Female hormones affect symptom severity in obsessive-compulsive disorder. Int Clin Psychopharmacol, 21(3), 171-175. https://pubmed.ncbi.nlm.nih.gov/16528139/
Wang, C., et al. (2026). Research advances on estrogen deficiency leading to depression. Transl Neurosci, 17(1), 20250399. https://pubmed.ncbi.nlm.nih.gov/42136886/