1-page self-check · 5 min read
Is It Hormones, Depression, or Both?
How to tell when your mood has a hormonal driver, and why the answer is often both.
By Julie Murphy, FNP-BC, PMHNP-BC, MSCP
Mood changes are one of the most common and least discussed parts of perimenopause. Research following women through the transition has found that the risk of depressive symptoms rises during perimenopause, even in women who have never been depressed before.
Estrogen helps regulate how much serotonin your brain makes and how sensitive it is to it. When estrogen starts to swing, mood can shift for a chemical reason, not a personal one.
Clues your mood may be hormonal
- It started or worsened in your 40s, as your cycles became shorter, longer, or irregular
- It is worse in the week or two before your period
- It arrived alongside hot flashes, night sweats, or new sleep problems
- You feel anxious or low for the first time in your life
- An antidepressant that used to work seems to be working less well
Clues depression needs its own treatment
- Low mood most of the day, nearly every day, for two weeks or more, regardless of your cycle
- Losing interest in things you used to enjoy
- Feelings of hopelessness, worthlessness, or heavy guilt
- A personal history of depression or postpartum depression
- Any thoughts of death or of not wanting to be here
Often, it is both
These lists are not either-or. Many women have a real hormonal driver and a mood that needs direct treatment. That is why an evaluation that looks at both matters.
Treatment options can include hormone therapy, which research suggests can improve mood symptoms during perimenopause; antidepressants, which treat depression effectively and can also reduce hot flashes; therapy such as CBT; and restoring sleep. The right mix depends on you.
Quick reflection
This is a reflection tool, not a diagnosis. If you checked items in both lists above, an evaluation that looks at hormones and mental health together is worth it.
Questions to ask your clinician
- Could perimenopause be contributing to my mood?
- Should we consider hormone therapy, an antidepressant, or both?
- If I am already on an antidepressant, could hormonal changes explain why it seems weaker?
- Can we track my mood against my cycle for a few months?
In the free Healing in NM app
Track mood against your cycle
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