Is It Anxiety, Depression… or Perimenopause?
Many women in their 40s and early 50s experience sudden changes in mood, energy, and thinking and wonder:
“Is this anxiety, depression, or something hormonal?” Common perimenopause mental health symptoms include:
Anxiety or emotional sensitivity
Brain fog or word-finding difficulty
Low motivation and fatigue
Tearfulness or irritability
Poor sleep
Feeling “not like yourself”
These experiences are real, common, and often linked to perimenopause.
What Is Perimenopause?
Perimenopause is the transition leading up to menopause, often beginning in the early-to-mid 40s. During this time, estrogen and progesterone fluctuate unpredictably, rather than steadily declining.
These hormonal shifts directly affect the brain—particularly areas involved in mood regulation, attention, and memory.
How Perimenopause Affects Anxiety and Mood
Estrogen plays a critical role in regulating neurotransmitters such as:
Serotonin (mood and emotional balance)
Dopamine (motivation and focus)
Norepinephrine (energy and alertness)
When estrogen levels fluctuate, many women experience:
New-onset or worsening anxiety
Increased emotional reactivity
Lower stress tolerance
Depressive symptoms without a clear cause
This is why perimenopause anxiety often appears in women with no prior anxiety history.
Menopause Brain Fog: What’s Really Happening?
“Brain fog” is one of the most distressing cognitive symptoms of perimenopause. It may include:
Trouble concentrating
Forgetting words or names
Difficulty multitasking
Slower thinking speed
Importantly, menopause brain fog is not dementia. It reflects temporary hormone-related changes in brain function.
What Research Shows
A 2023 review published in Menopause found that hormonal fluctuations during the
menopausal transition are associated with changes in attention, working memory, and verbal fluency, particularly during perimenopause rather than post-menopause.
Why Perimenopause Is Often Missed in Mental Health Care
Perimenopause symptoms often overlap with:
Anxiety disorders
Depression
ADHD
As a result, many women are:
Prescribed antidepressants without discussing hormones
Told symptoms are “just stress”
Left feeling unheard or dismissed
While medication can help some women, hormonal context matters. The most effective care often looks at the whole picture, not just symptoms.
The Emotional Side of Perimenopause
Midlife is often a time of:
Identity shifts
Physical changes
Grief and loss
Aging-related reflection
Many women mourn the version of themselves who felt:
Stronger
Sharper
More resilient
This grief is valid—and frequently unacknowledged.
You Are Not Broken — You Are in Transition
Experiencing anxiety, depression, or brain fog during perimenopause does not mean something is wrong. It means the brain and body are adjusting.
With the right support, many women experience:
Improved emotional stability
Better cognitive clarity
Renewed confidence
A stronger sense of self
When to Seek Mental Health Support
Consider reaching out if:
Symptoms persist for months
Work or relationships are affected
Emotional exhaustion is constant
Current medications no longer feel helpful
Perimenopause-informed mental health care can be life-changing.
Scholarly Reference
Maki, P. M., Kornstein, S. G., Joffe, H., et al. (2023). Guidelines for the evaluation and treatment of perimenopausal depression. Menopause, 30(2), 117–134.