Worry that arrives without an obvious cause, tearfulness that catches you off guard, a low mood that sits with you through the day. Mood changes like these are a common part of perimenopause, often showing up as anxiety, irritability, or low mood alongside physical symptoms like hot flushes and irregular periods. Sometimes the mood changes come first, before any physical signs, which can make them harder to place.1
How perimenopause affects mental health
The emotional side of perimenopause can start years before your periods stop. It tends to build gradually, which is part of why it can be hard to link to this stage at first.2
What you might notice: anxiety, low mood, and irritability
Anxiety is common during perimenopause. It can show up in different ways: a background hum of worry, feeling reluctant to do things you used to manage easily, or, for some, panic attacks. If you are having panic attacks that are severe or frequent, call your GP or NHS 111.4
Low mood, sadness, and feeling more tearful are common during this stage too. These shifts are different from clinical depression, which is more constant and more severe, and needs separate assessment by a healthcare professional. If your low mood feels persistent, or you think it might be more than the shifts that come with perimenopause, speak to your GP.5
Irritability and mood swings are part of the picture too. Broken sleep is common in perimenopause, and when you are not sleeping well, irritability and anxiety often feel sharper. Looking at your sleep can be a useful part of managing how your mood feels overall.6
What helps with mood changes in perimenopause
A range of things can help, from everyday changes you can make yourself to treatments you can discuss with a GP. These work well together, and you may find you use more than one at the same time.
Lifestyle adjustments
Regular movement, as much rest as you can get, and time for calming activities like yoga or tai chi can all help with mood symptoms. These tend to work best alongside other support, and they sit well next to professional care if you need it.7
Talking to other people going through something similar, whether friends, family, or colleagues, can help too. Knowing your experience is shared can ease the sense of going through it alone.8
Cognitive Behavioural Therapy
Cognitive Behavioural Therapy (CBT) is a talking therapy that can help with the low mood and anxiety that come with perimenopause. It is one option your GP can talk through with you. Access to CBT through the NHS varies depending on where you live in the UK, and waiting times differ across England, Scotland, Wales, and Northern Ireland. Your GP can tell you what is available to you.9
Hormone Replacement Therapy
Hormone Replacement Therapy (HRT) can be an effective treatment for low mood that comes with perimenopause. It is a prescription-only medicine in the UK, so it needs medical supervision to start. If you want to know whether HRT might suit you, your GP is the place to start.10
When to seek support
If mood symptoms are having a real impact on your day-to-day life, it is worth speaking to your GP. They can talk through your options, which might include lifestyle changes, CBT, or HRT, depending on your situation.11
If your low mood is persistent, or you think you might be experiencing depression, speak to a healthcare professional rather than waiting it out. If you are in immediate distress, call NHS 111 or contact the Samaritans on 116 123.12