Perimenopause and menopause: depression, mood swings, anxiety, sleep and what helps

The term for the years around menopause is used slightly differently from source to source. Korea’s official health portal uses it for the time from when periods start to become irregular until the last period, and says menopause itself is confirmed when there has been no period for 12 months after the last one, with no specific test to diagnose it (Korea Disease Control and Prevention Agency, 2026a). By the international staging system, the early menopausal transition begins when cycle lengths keep differing by 7 days or more, and the late transition when 60 days or more pass without a period. The late transition lasts about 1 to 3 years on average, and symptoms, most notably vasomotor symptoms such as hot flushes, are likely during this stage; “perimenopause” runs from the early transition until 12 months after the last period (Harlow et al., 2012). Hormonal contraception can make it harder to tell which stage you are in (NHS, 2026a).

In Korean data, menopause usually comes between 50 and 52, and the menopausal transition starts at about 46 on average and lasts 2 to 8 years (about 5 years on average); menopause before 45 is diagnosed as early menopause, and before 40 as premature ovarian insufficiency (Korea Disease Control and Prevention Agency, 2026a). In Japan, the menopausal period means the roughly 10 years from about 5 years before to 5 years after menopause; with an average age at menopause of 50.5, that is usually around 45 to 55 (Ministry of Health, Labour and Welfare, n.d.a). In France the average is 51 (Assurance Maladie, 2026a), and worldwide most women reach menopause between 45 and 55 (WHO, 2024).

During this time, vasomotor symptoms such as hot flushes and night sweats affect about 60-70% of women in the menopausal transition, and when they get worse at night they can lead to insomnia (Korea Disease Control and Prevention Agency, 2026a). Mood can swing or sink, anxiety can rise, and memory and concentration can slip, all of which can feel worse with poor sleep and tiredness. Symptoms usually last 7 to 9 years, sometimes longer, and can change over that time (NHS, 2026a). But experiences vary widely: some women have few symptoms, while for others they are severe enough to affect daily life and quality of life (WHO, 2024).

In the World Health Organization’s International Classification of Diseases (ICD-11), menopause and the menopausal transition sit not among mental disorders but in a gynaecological category (GA30), which includes symptoms such as flushing, sleeplessness, headache and lack of concentration (WHO, 2026). There is no separate mental-disorder diagnosis of “menopausal depression”. The diagnostic criteria for mental disorders are the same regardless of menopause, and not every woman going through menopause feels more psychological distress (FIGO, 2026). It is advised to see a health professional if low mood lasts most of the day, nearly every day, for at least 2 weeks (NIMH, 2023). An older edition of the US diagnostic manual had a depression diagnosis specific to menopause, but it was removed in a later edition for lack of supporting evidence (Bromberger et al., 2011). Depression may start for the first time in this period, or an earlier depression may come back (FIGO, 2026).

Korea’s national mental health portal also uses the term “menopausal depression”, but explains that it does not differ much from ordinary major depression (National Center for Mental Health, 2021). mind.io does not offer a menopause test, and this guide is not a diagnosis. It sets out, from research and official sources, how common changes in mood, anxiety, sleep and concentration are, why they happen, other causes that can look similar, what helps and what has weak support, the so-called male menopause, and where to get help. Other common reasons moods swing, such as the time before a period, sleep and stress, are covered in mood swings.

A meta-analysis that reviewed 17 prospective studies (16,061 women) and pooled 7 of them (9,141 women) found that women in the menopausal transition had higher odds of depressive symptoms or depression than premenopausal women (odds ratio 1.40), with no clear difference after menopause. It pooled questionnaire scores and interview diagnoses together, and could not take past depression into account (Badawy et al., 2024).

Some studies used diagnostic interviews. In a US study that interviewed 221 women, premenopausal at the start, every year for 10 years, a major depressive episode was diagnosed at 5.8% of 535 premenopausal visits, 9.1% of 782 visits in the menopausal transition and 9.8% of 381 postmenopausal visits, with the highest risk in the first 2 years after the last period (Bromberger et al., 2011). Among 460 women aged 36 to 45 who had never had depression, those who entered the menopausal transition were twice as likely as those who stayed premenopausal to develop significant depressive symptoms (Cohen et al., 2006). Even so, most midlife women did not have high depressive symptoms (Bromberger et al., 2007).

Symptoms measured by questionnaire are far more common. A meta-analysis of 102 studies found depressive symptoms at any one time in 32% of women in the menopausal transition and 30% after menopause, and insomnia symptoms in 27% and 42% respectively. Anxiety symptoms affected roughly one in three as well, but the estimates were very uncertain. Overall, rates were higher in studies using screening questionnaires and in early menopause (Balasubramanian et al., 2026). These are not rates of diagnosed depression.

In Korea, a one-off survey of 45,177 women aged 40 to 65 attending health check-ups found that severe depressive symptoms on a questionnaire were more common from the early transition onwards and most common after menopause (An et al., 2022). By contrast, a study that followed 1,178 women from the same hospital’s check-ups for about 11 years found no clear average rise in depressive symptoms as they moved through the stages, and most (75.5%) stayed low throughout. Symptoms worsened in 5.8% (68 women), which was linked with poor sleep and moderate-to-severe hot flushes (Jang et al., 2025). Results differ with the study design.

In a 2022 online survey by Japan’s Ministry of Health, Labour and Welfare (5,000 people aged 20 to 64), 3.6% of women in their 40s and 9.1% in their 50s said a doctor had diagnosed menopausal disorder, but 28.3% and 38.3% thought they might have it (Ministry of Health, Labour and Welfare, 2022). Anxiety can rise too. In a 10-year study of 2,956 US women, high levels of irritability, tension, fear for no reason and a pounding heart were reported at 15.6% of premenopausal visits and 20.7% of visits in the early transition, rising after the transition began in women who had not been anxious before (Bromberger et al., 2013). Of 12,603 US women aged 40 to 55, 38% reported difficulty sleeping, and 45.4% in the late menopausal transition (Kravitz et al., 2003).

Expert guidelines describe the menopausal transition and early postmenopause as a “window of vulnerability” for both depressive symptoms and major depressive episodes (Maki et al., 2018). One reason is hormonal fluctuation. In a study that followed women with no history of depression for 8 years, high depressive-symptom scores (odds ratio 4.29) and a diagnosis of depressive disorder (odds ratio 2.50) were both more likely during the menopausal transition than before it, and larger swings of hormones around a woman’s own average went with high symptom scores (Freeman et al., 2006). Single blood hormone levels, on the other hand, were not linked with major depressive episodes (Bromberger et al., 2011). Korea’s official health portal likewise describes three factors acting together: falling oestrogen affecting the brain chemicals that regulate mood, physical changes such as hot flushes, and the changes in life circumstances that come at this time (Korea Disease Control and Prevention Agency, 2026a).

The same change can affect people differently. In a small experiment comparing 26 women who had had perimenopausal depression that improved with hormone therapy and 30 women who had never been depressed, depressive symptoms came back when hormones were stopped without the women knowing only in the first group. This is read as a sign that some people react unusually strongly to normal hormone changes (Schmidt et al., 2015). In a study that followed 52 women aged 45 to 60 who were not depressed for 14 months, greater oestrogen variability was followed by more depressive symptoms, but only in women who had been going through many very stressful events at the start (Gordon et al., 2016).

Night-time hot flushes and broken sleep are part of the picture. In an experiment in which 29 young women were given a medicine that lowered their ovarian hormones to mimic menopause, depressive symptoms appeared together with sleep disturbance, measured both objectively and by the women’s own reports, and with the number of night-time hot flushes, but not daytime ones (Joffe et al., 2016). A review of 16 longitudinal studies (10,008 participants) found associations in both directions between hot flushes and night sweats and depressive symptoms, but that hot flushes alone may not explain depression in the menopausal transition (Natari et al., 2018). Anxiety is similar: women with frequent hot flushes had nearly three times the odds of high anxiety symptoms compared with women with less frequent ones (Bromberger et al., 2013). The Korean Society of Menopause considers that oestrogen’s mood benefit comes more from better sleep than from direct relief of hot flushes, and says managing insomnia is a key part of dealing with menopause-associated depression (Korean Society of Menopause, 2025).

A history of depression calls for extra attention. In a study that interviewed US midlife women every year for 13 years, 59% of the 151 women with past depression and 28% of the 274 without had at least one episode of major depressive disorder over that time (Bromberger et al., 2015). The evidence generally suggests that most midlife women who have a major depressive episode in perimenopause have had depression before (Maki et al., 2018). In a 14-year study of 203 US women, those with no history of depression had a low risk from about 2 years after the last period, while women with a history stayed much more likely to have high depressive symptoms even after menopause (Freeman et al., 2014). A study of hospital records of 270,613 Danish women who had given birth before 40 found that both women who had had postpartum depression and women who had had depression at other times were at much higher risk of a depression diagnosis in the 9 years from age 47 than women with no record of depression (Venborg et al., 2023). Women who had premenstrual syndrome were more likely over 5 years to report hot flushes, low mood and poor sleep (Freeman et al., 2004).

Midlife itself adds weight. At this age, women often care for ageing parents while their children are becoming adults, and job changes or conflict with a partner can pile on (Bromberger & Epperson, 2018). Korea’s national mental health portal also describes the years around menopause as a time when children leaving home, long-running family conflict, limits to social achievement and worries about old age overlap, and women redefine the roles they have played (National Center for Mental Health, 2021). In the interview study above, a history of depression or at least one very upsetting event nearly tripled the odds of a major depressive episode (Bromberger et al., 2011). So low mood around menopause is neither “all hormones” nor “weakness”. It comes from hormone changes combined with sleep, physical symptoms and life stress, and which weighs most differs from person to person.

Menopausal symptoms and depression occur together and overlap, so they are not easy to tell apart. Expert guidelines say midlife depression commonly shows classic depressive symptoms combined with menopausal symptoms such as hot flushes and sleep problems, plus psychosocial challenges, and that diagnosis involves identifying the menopausal stage, assessing co-occurring psychiatric and menopausal symptoms, considering the psychosocial factors common in midlife and other possible conditions, and using validated screening tools (Maki et al., 2018). Sleep problems and mood swings are common in the menopausal transition, but much stronger irritability, anxiety or sadness, or a loss of enjoyment, may be signs of depression (NIMH, 2023). How depression shows up is covered in depression symptoms.

Physical causes need checking too. An underactive thyroid can bring tiredness along with low motivation, poor concentration and memory loss (Korea Disease Control and Prevention Agency, 2026b), and an overactive thyroid can cause heat intolerance, more sweating, a pounding heart, anxiety and poor sleep, so both are easy to confuse with menopausal symptoms. Thyroid disease can be checked with a blood test (Korea Disease Control and Prevention Agency, 2026c). Heavy periods are a very common cause of iron deficiency anaemia, which leaves people tired and short of energy (NHS, 2024). Even when depression seems linked to perimenopause, it has been argued that a woman’s physical health should be checked to rule out other causes such as thyroid and autoimmune disorders (Kulkarni, 2018).

Women with bipolar disorder may have more frequent depression at this time. In a study of 47 women aged 45 to 55 with bipolar disorder, 68% had at least one depressive episode during the menopausal transition, and depressive episodes became more frequent than in their reproductive years, while episodes of elevated mood did not (Marsh et al., 2008). A recent review found converging evidence that perimenopause is a period of higher risk for bipolar disorder starting for the first time (Radosavljevic et al., 2026). If you have ever had a period of unusually elevated mood and greatly increased activity, be sure to mention it to your doctor. More is in bipolar disorder.

In your 40s, premenstrual symptoms can overlap with those of the menopause transition; premenstrual symptoms repeat with the cycle, while menopausal symptoms come regardless of periods (Japan Society of Obstetrics and Gynecology, 2025). Premenstrual syndrome became less common with age and with changes in menstrual bleeding (Freeman et al., 2004), but symptoms can get worse in the years before menopause (Pinkerton, 2026). How to keep a record that helps tell them apart is covered in premenstrual syndrome (PMS) and PMDD.

Many women describe trouble concentrating, finding words, multitasking and remembering things in the short term around menopause, often calling it “brain fog”. These difficulties are strongly influenced by hot flushes, sleep problems, mood changes and stress; they are usually subtle, daily functioning is preserved, and they often stabilise or improve over time. Symptoms that are progressive, persistent or limit daily life should still be checked for other causes (Khadilkar et al., 2026). In a 4-year study of 2,362 US women, learning performance that dipped during the menopausal transition returned to its earlier level after menopause (Greendale et al., 2009). The Japan Society for Menopause and Women’s Health also notes that dementia is rarely found in women going through menopause, but that memory loss which worsens quickly and looks clearly abnormal to others should be seen by a specialist (Japan Society for Menopause and Women’s Health, n.d.). Other reasons for forgetting things are covered in forgetfulness.

Start with the guidelines. The UK guideline says to consider hormone replacement therapy (HRT) for depressive symptoms that do not meet the criteria for a diagnosis of depression and began around the same time as other menopausal symptoms, and to consider cognitive behavioural therapy (CBT) when such symptoms come with vasomotor symptoms; for suspected or diagnosed depression, the depression guideline applies as well (NICE, 2026). Expert guidelines see proven treatments for depression, that is antidepressants and psychotherapy, as the front-line treatment for perimenopausal depression, and say that although oestrogen therapy is not approved to treat depression, there is evidence of an antidepressant effect in perimenopausal women, particularly when vasomotor symptoms such as hot flushes are present (Maki et al., 2018). The Korean Society of Menopause’s 2025 guideline likewise does not recommend menopausal hormone therapy solely to treat depression: depression that recurs at menopause should be treated mainly with antidepressants or evidence-based psychotherapies such as CBT or interpersonal therapy, with hormone therapy as a possible add-on when symptoms such as hot flushes are also present (Korean Society of Menopause, 2025).

Here is the evidence on psychological treatment. In an analysis of 30 studies (3,501 women), CBT and mindfulness reduced depression and anxiety around menopause by a small to moderate amount (Spector et al., 2024). Another meta-analysis of 14 randomised trials (1,618 patients) found that cognitive and behavioural therapy reduced hot flushes, depression and anxiety by a small to moderate amount, with effects that lasted, though they faded somewhat over time (Ye et al., 2022). However, most of the menopause CBT studies reviewed by the UK guideline committee showed no difference from comparison groups on depressive symptoms; the committee kept CBT as an option because its effectiveness for depressive symptoms in general is established (NICE, 2026). In a UK randomised trial of 140 women, both group CBT and self-help CBT with a booklet made hot flushes and night sweats less of a problem, and mood had improved at 6 weeks (Ayers et al., 2012).

For sleep problems, CBT for insomnia (CBT-I) comes first. In a randomised trial of 106 women aged 40 to 65 with insomnia symptoms and two or more hot flushes a day, 33 of 47 (70%) of those given CBT-I by telephone were in the no-insomnia range at 8 weeks and 37 of 44 (84%) at 24 weeks, compared with 10 of 41 (24%) and 16 of 37 (43%) of those given menopause education only. The number of hot flushes a day did not differ between the groups (McCurry et al., 2016). A meta-analysis of 11 randomised trials (973 women) by a Korean research team also found that CBT-I improved sleep quality and reduced insomnia severity, whether delivered face to face or remotely (Moon et al., 2025). A 2026 meta-analysis concluded that for perimenopausal and postmenopausal women with chronic insomnia, non-drug treatments such as CBT-I seem to be the most robust first-line options, ahead of medicines (Bruyneel et al., 2026). Hormone therapy improved sleep quality in women with hot flushes (moderate-quality evidence), but made no difference in women without them (Cintron et al., 2017). What CBT-I involves is covered in insomnia: what helps.

The effect of hormone therapy on mood depends on timing. In a 12-week randomised trial of 50 women in the menopausal transition who had a depressive disorder, 17 (68%) of those given oestrogen went into remission, compared with 5 (20%) on placebo (Soares et al., 2001). By contrast, in 57 older postmenopausal women with mild to moderate depression, oestrogen was no better than placebo (Morrison et al., 2004). A 2026 meta-analysis of 12 randomised trials of hormone therapy for depressive symptoms in perimenopausal women found a small effect (SMD -0.23) with limited certainty of evidence (Li et al., 2026). The Korean Society of Menopause also notes that women whose depressive symptoms improve with hormone therapy may get worse when they stop it (Korean Society of Menopause, 2025).

The risks of hormone therapy are neither “always dangerous” nor “always safe”. The US Women’s Health Initiative (WHI) trial was a primary prevention trial that gave one combined oestrogen and progestogen tablet, the most commonly used preparation in the US at the time, to 16,608 healthy postmenopausal women aged 50 to 79 with a uterus; in 2002 it was stopped early, after an average of 5.2 years, because invasive breast cancer crossed a pre-set boundary and risks overall were judged to exceed benefits. Per 10,000 women a year, there were 7 more heart disease events, 8 more strokes, 8 more pulmonary embolisms and 8 more invasive breast cancers, and 6 fewer colorectal cancers and 5 fewer hip fractures, and the investigators concluded that this treatment should not be started or continued to prevent heart disease (Rossouw et al., 2002). In a 2024 review, the WHI investigators concluded that hormone therapy is not supported for preventing chronic diseases such as cardiovascular disease, but that starting it before 60 is supported for women in early menopause who have bothersome symptoms and no contraindications (Manson et al., 2024).

Current guidelines put it this way. According to the UK guideline, combined HRT increases the risk of breast cancer, and the increase rises with duration of use and declines after stopping but persists for at least 10 years. It does not increase the risk of coronary heart disease, and the risk of dementia might increase if it is started at 65 or over. Combined HRT that includes oestrogen through the skin is unlikely to increase stroke risk, and HRT through the skin does not increase the risk of blood clots in the veins, while oral HRT does (NICE, 2026). The NHS explains that there are around 5 extra cases of breast cancer in every 1,000 women who take combined HRT for 5 years, that for women under 60 who have menopausal symptoms and are not at high risk of breast cancer or blood clots the benefits are likely to outweigh the risks, and that the older view focused on risks is now seen as out of date (NHS, 2023). A Cochrane review of long-term hormone therapy (24 studies, 45,660 participants) found that of every 1,000 women on combined therapy for about 5 years, breast cancer probably rose from about 19 to 24 (moderate-certainty evidence), stroke may have risen from 13 to 18 and blood clots in a vein from 10 to 20 (low-certainty evidence), and fractures probably fell from 111 to 87. These figures, however, come from one trial of oral hormone therapy in mostly older women, mainly over 60, and may not represent the treatments used today (Bofill Rodriguez et al., 2026).

Korea’s official health portal says that for healthy women aged 60 or under or within 10 years of menopause, menopausal hormone therapy can be considered after weighing benefits and risks, and that in women over 60 who have used combined therapy for a long time, the risks of breast cancer, stroke and blood clots rise (Korea Disease Control and Prevention Agency, 2026a). Unexplained vaginal bleeding, oestrogen-dependent cancers such as breast cancer, active blood-clotting disease, liver dysfunction and gallbladder disease are listed as contraindications (Korean Society of Menopause, 2025). Whether it suits you is a decision to make with your doctor.

Looking at antidepressants by class, a 2026 review of 31 studies (8,124 participants) of non-hormonal medicines for depressive and anxiety symptoms in the menopausal transition and after menopause found that SNRIs showed positive effects on depressive symptoms more often than other classes, while SSRIs had modest and variable effects (moderate-certainty evidence for depressive symptoms), and results for anxiety were inconsistent across all classes (Hedayati et al., 2026). The NHS says you may be offered antidepressants for low mood, depression or anxiety caused by menopause (NHS, 2026b), and the UK guideline says SSRIs and SNRIs should not routinely be offered as first-line treatment for hot flushes alone (NICE, 2026).

Supplements and herbal products have less evidence than people often expect. In a meta-analysis of 22 papers (2,310 women), black cohosh had a small effect on hot flushes but did not clearly reduce anxiety or depressive symptoms (Sadahiro et al., 2023). Rare but serious cases of liver damage have been reported in people taking products labelled as black cohosh, though it is uncertain whether black cohosh caused them, and some products have been found to contain the wrong herb or unlisted mixtures (NCCIH, 2024). St John’s wort taken with certain antidepressants can cause serious side effects, and it can weaken the effects of many medicines, including birth control pills (NCCIH, 2025). The NHS likewise says there is very little evidence on how well herbal remedies such as red clover and black cohosh work or how safe they are (NHS, 2026b). Korea’s official health portal also says the effect of black cohosh is not yet clear (Korea Disease Control and Prevention Agency, 2026a).

Evidence that exercise reduces hot flushes themselves is insufficient (Daley et al., 2014). Still, in an analysis comparing 23 exercise trials for depressive symptoms in perimenopausal and postmenopausal women, aerobic exercise ranked first (Wang et al., 2025). It does not replace treatment, but an active routine is worth adding.

Men do not go through a sudden hormonal change like the female menopause. Testosterone falls slowly, by about 1% a year from around 30 to 40, and this alone is unlikely to cause problems. The NHS says the label “male menopause” is misleading because it suggests a sudden drop in testosterone in middle age, and that a testosterone deficiency developing later in life (late-onset hypogonadism, LOH) is an uncommon and specific medical condition, not a normal part of ageing. Low sex drive and mood swings are often nothing to do with hormones and may come from stress, depression or anxiety (NHS, 2022). Korea’s official health portal likewise says male menopause develops gradually rather than suddenly as the female menopause does, that a diagnosis needs both clinically meaningful symptoms such as low sex drive, fatigue or low mood and a blood testosterone measurement, and that self-report questionnaires are for reference only, not diagnostic tools (Korea Disease Control and Prevention Agency, 2026d). In a study of 3,369 randomly selected men aged 40 to 79 in 8 European cities, late-onset hypogonadism by strict criteria was found in 2.1% (Wu et al., 2010).

There is no basis for saying that low testosterone causes depression. The European Association of Urology guideline says the relationship between hypogonadism and depression is still unclear, that testosterone therapy alone did not appear to be an effective treatment for most men with clinical depressive disorders, that severe depressive symptoms should be treated with conventional therapies, and that testosterone therapy should not be used in men with normal levels (European Association of Urology, n.d.). A meta-analysis of 27 randomised trials (1,890 men) found that testosterone treatment reduced depressive symptoms slightly (effect size 0.21), but called for more trials with depression as the main outcome (Walther et al., 2019). Korea’s official health portal says indiscriminate use can harm the heart and blood vessels or the prostate, so the decision should follow careful discussion with a specialist, and suggests seeing a urologist, an endocrinologist or a family doctor when symptoms recur and persist, including low mood or lack of motivation that lasts and affects relationships or work (Korea Disease Control and Prevention Agency, 2026d). In that case, also consider whether it may be depression.

A Japanese health ministry manual lists these as signs it is time to see a doctor: several menopausal symptoms together that are hard to bear, effects on daily life, and low mood that leaves you with no will to do anything (Ministry of Health, Labour and Welfare, n.d.b). The same goes for symptoms most of the day, nearly every day, for at least 2 weeks (NIMH, 2023). Early advice can help reduce the effects of menopause on your health, relationships and work (NHS, 2026a). The World Health Organization notes that many women do not know that their symptoms are related to menopause, or that counselling and treatment can help, and may feel embarrassed or ashamed to ask for support (WHO, 2024).

In Korea, menopausal symptoms such as hot flushes can be discussed with a gynaecologist, and marked low mood or anxiety with a psychiatrist. Korea’s national mental health portal suggests seeing a psychiatrist at a nearby clinic or visiting a local mental health welfare centre to find out whether treatment is needed (National Center for Mental Health, 2021). If you are considering hormone therapy, the doctor first checks your own and your family’s history of conditions such as blood clots, cardiovascular disease and breast cancer, any psychiatric illness, and habits such as smoking and drinking (Korea Disease Control and Prevention Agency, 2026a). If it is your first time, see seeing a psychiatrist for the first time. mind.io’s depression check-in (PHQ-9) is a screening tool that looks at your mood over the past 2 weeks; it is not a menopause test or a diagnosis. Because menopausal symptoms overlap with the picture of depression (Maki et al., 2018), sleep lost to hot flushes or night sweats can also raise the score on the sleep question.

In Japan, a government site advises women not to put up with symptoms that are hard to bear but to see a gynaecologist for treatment (Ministry of Health, Labour and Welfare, n.d.a). The Japan Society for Menopause and Women’s Health says that for mild to moderate low mood or loss of motivation, a gynaecology department or menopause clinic is a good first place to ask (Japan Society for Menopause and Women’s Health, n.d.). Because problems in other organs such as the thyroid can come with menopausal disorder, several departments may need to be involved (Ministry of Health, Labour and Welfare, n.d.b).

In France, the main people to see are your regular doctor (médecin traitant), a gynaecologist or a midwife (Assurance Maladie, 2026b). In the UK, the NHS suggests seeing a GP if you think you have menopausal symptoms and want to know your options (NHS, 2026a).

If you have thoughts of dying or of hurting yourself, do not wait. FIGO recommends that suicidal tendencies be taken seriously, with care led by a team that includes psychiatrists (FIGO, 2026). The Japan Society for Menopause and Women’s Health also says that strong symptoms, or words and behaviour that deny living itself, call for assessment for depression as a psychiatric illness (Japan Society for Menopause and Women’s Health, n.d.). Please reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services. There is also a guide on self-harm.

Q. Will menopause pass if I just put up with it? A. Symptoms often ease, but depression cannot be assumed to lift by waiting. In a 14-year study of 203 US women, depressive symptoms were more common in the years before the last period and fell afterwards, but women with a history of depression stayed at higher risk after menopause (Freeman et al., 2014). One review notes that the risk of depression appears to decline 2 to 4 years after the last period, particularly for women whose only episode came in perimenopause (Bromberger & Epperson, 2018), but it has also been argued that it is not appropriate to presume depression will improve once hormonal fluctuations settle (Kulkarni, 2018). A Japanese government site likewise advises not to put up with symptoms that are hard to bear but to see a doctor (Ministry of Health, Labour and Welfare, n.d.a).

Q. Is low mood around menopause all down to hormones? A. No. In a US study that followed 3,302 women every year, health and psychosocial factors also raised depressive-symptom scores and were sometimes more important than menopausal stage (Bromberger et al., 2007). Hormone variability went with more depressive symptoms only in women going through many very stressful events (Gordon et al., 2016), and a history of depression or a very upsetting event nearly tripled the odds of a major depressive episode (Bromberger et al., 2011).

Q. Is hormone therapy dangerous or safe? A. Neither can be said outright. For women under 60 who have menopausal symptoms and are not at high risk of breast cancer or blood clots, the benefits are likely to outweigh the risks, but HRT can slightly increase the risk of breast cancer, and that risk grows the longer you take it and the older you are (NHS, 2023). Starting before 60 is supported for women in early menopause with bothersome symptoms, but using it to prevent chronic disease is not (Manson et al., 2024). It is not recommended solely to treat depression either (Korean Society of Menopause, 2025). Weigh your own risks with your doctor.

Q. My forgetfulness has got worse. Is it the start of dementia? A. Usually not. Menopausal brain fog is usually subtle, daily functioning is preserved, and it often stabilises or improves over time. But if it keeps getting worse or limits daily life, have it checked for other causes (Khadilkar et al., 2026). The Korean Society of Menopause does not recommend hormone therapy solely to improve cognitive function or prevent cognitive decline (Korean Society of Menopause, 2025).

Q. Do men go through menopause too? A. Not a sudden change like the female menopause. Testosterone falls slowly with age, and an uncommon deficiency sometimes needs treatment, but mood changes are often due to stress, depression or anxiety (NHS, 2022). More is in the section on the so-called male menopause above.

Q. Can a menopause self-test tell me? A. A score sheet is not a diagnosis. Self-report scales are useful for gauging how many symptoms you have and how severe they are, and for finding people who need further assessment, but they do not diagnose depressive disorder (Bromberger & Epperson, 2018). FIGO recommends routine mental health screening with tools such as the PHQ-9 as part of standard midlife care (FIGO, 2026). mind.io does not offer a menopause test; the depression check-in (PHQ-9) is a screening tool that looks at your mood over the past 2 weeks.

Q. How long do menopausal symptoms last? A. It varies. Symptoms usually last 7 to 9 years, sometimes longer, and can change over that time; for example, hot flushes may ease and be replaced by low mood or anxiety (NHS, 2026a). The Korean Society of Menopause guideline says vasomotor symptoms such as hot flushes typically start 1 to 3 years before menopause, peak around the time of menopause and may continue for several years, occasionally up to 10 years after menopause (Korean Society of Menopause, 2025).

Q. My low mood around menopause is so bad that I have thought about wanting to die. A. Please do not carry this alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

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