Depression & Anxiety During Perimenopause: What’s Going On, and How to Help

You’re not just moody. You’re not making it up.

Many women experience sudden shifts in mood, anxiety, or depression in their late 30s or 40s — often before they even realize they’re in perimenopause. The emotional symptoms can feel overwhelming and confusing, especially if you’ve never struggled with mental health before.

But here’s the truth: Your hormones affect your brain, not just your cycle. And the good news? There are ways to feel like yourself again.

What’s Happening in Your Brain During Perimenopause?

During perimenopause — the transitional stage before menopause — your levels of estrogen and progesterone fluctuate unpredictably. These hormones don’t just regulate your periods; they also affect key brain chemicals. Serotonin helps regulate mood and emotional stability, so when it’s disrupted, you may feel more irritable, anxious, or down. GABA is your brain’s natural calming signal, and lower levels can make you feel restless or on edge. Dopamine plays a role in motivation, focus, and feeling rewarded, so fluctuations can lead to brain fog, low drive, or a sense of being emotionally flat.

Even if your life looks the same on the outside, your internal chemistry is shifting — and that matters.

According to the North American Menopause Society (NAMS), women in perimenopause are 2 to 4 times more likely to experience depressive symptoms compared to premenopausal women. Anxiety also tends to rise during this transition, especially if you’ve had past episodes.

It’s not weakness — it’s biology.

And it's time we talked about it.

What Can You Do?

Here are ways to support your mental health during perimenopause:

1. Prioritize Rest and Routine

Sleep disruptions are both a symptom and a driver of mood changes. Poor sleep can worsen anxiety, depression, and brain fog — and perimenopause often makes quality sleep harder to come by.

Try this sleep-supporting routine:

• Go to bed and wake up at the same time every day, even on weekends.

• Cut off caffeine after 12 p.m. — it can linger in your system for hours.

• Use blackout curtains or an eye mask to reduce light exposure.

• Power down screens at least 1 hour before bed to avoid melatonin suppression from blue light.

• Try a wind-down ritual: stretching, journaling, or a calming breath exercise.

2. Feed Your Brain

Nutrition plays a huge role in hormone balance and mental clarity. What you eat fuels not just your body, but your brain chemistry.

Key nutrients for mood stability and cognitive function:

• Omega-3s (anti-inflammatory, support serotonin production): salmon, walnuts, flaxseed, chia seeds

• Protein (needed for neurotransmitter synthesis): eggs, legumes, tofu, lean meats

• Fiber + slow-digesting carbs (keep blood sugar stable): oats, sweet potatoes, lentils, quinoa

• Magnesium & B-vitamins (support stress regulation): leafy greens, almonds, whole grains

3. Get Support

Mental health struggles in perimenopause aren’t something you have to “tough out.” There are real, effective treatments available.

Options to consider:

• Therapy: Cognitive Behavioral Therapy (CBT) is especially effective for mood swings and anxiety. It helps reframe negative thought loops and build mental resilience.

• Medication: Antidepressants or anti-anxiety meds can provide symptom relief, especially when mood disruption is intense or persistent.

• Hormone Replacement Therapy (HRT): For many women, estrogen-based HRT can significantly reduce depressive symptoms linked to hormone fluctuation.

4. Move Your Body

Exercise doesn’t just strengthen your muscles — it literally changes your brain. Physical activity increases the production of feel-good neurotransmitters like serotonin, dopamine, and endorphins.

Aim for at least 20 minutes a day of:

• Walking or hiking (gentle movement + exposure to natural light = mood win)

• Yoga or Pilates (reduces cortisol, improves flexibility and sleep)

• Strength training (supports bones, hormones, and self-confidence)

Even 5–10 minutes is better than nothing; the key is consistency.

5. Track Your Symptoms

Perimenopause can feel like a moving target. Tracking can help you make sense of what’s going on — and gives your provider valuable insight into your patterns.

What to log daily:

• Mood changes (anxiety, irritability, low mood, etc.)

• Sleep quality and duration

• Energy levels

• Period changes or cycle irregularities

• Notable stressors or lifestyle shifts

Use a journal, notes app, or hormone health tracker. Patterns may emerge that help you decide when to seek support, adjust routines, or consider treatment options.

Perimenopause isn’t just about periods — it’s about your whole body, including your emotional well-being. If you’re feeling anxious, down, or not like yourself, it’s not “just stress.” It could be your hormones — and you deserve support.

At Lyv Health, we believe mental health is health. And you don’t have to navigate this alone.

Find support at lyvhealth.co