top of page

Understanding and Managing Perimenopausal Depression: A Step-by-Step Approach


Perimenopause marks a profound transition that extends beyond mere physical transformations, encompassing significant hormonal shifts that deeply impact mental health. 

This journey towards menopause is a highly personal experience, characterised not only by the well-known physical symptoms but also by substantial emotional upheavals, particularly affecting mood stability

Depression is a global mental health issue that affects more women than men, and the hormonal fluctuations during perimenopause and into the early post-menopausal years can significantly heighten this vulnerability.

depression woman

Understanding and addressing the unique ways in which these hormonal changes can manifest in mood disorders is crucial. 

In today's post, we delve into the complex relationship between perimenopausal hormonal changes and mood disorders, exploring why these transitions can increase the risk of depression and anxiety. Our goal is to provide valuable insights and effective strategies to help manage these challenging emotional shifts during perimenopause.


The Biological Underpinnings of Mood Changes

Why do women experience more depression, and why are they more vulnerable during perimenopause and early menopause?

There are likely several compounding reasons, but changing oestrogen is a significant factor.


Oestrogen is fundamental to brain health and mood regulation. It ensures the optimal functioning of the brain while also profoundly influencing the production and regulation of critical neurotransmitters such as serotonin and dopamine.

These neurotransmitters are vital for maintaining mood stability, emotional well-being, and cognitive functions.

During perimenopause, a woman's oestrogen levels start to fluctuate and ultimately decline, a change that directly impacts neurotransmitter levels. This decrease in oestrogen can cause significant fluctuations in serotonin and dopamine levels, leading to variations in mood, emotional well-being, and mental clarity.

While the brain can easily adapt to these changes. This adaptation process however takes time and can temporarily disrupt brain function, leading to symptoms commonly associated with depression, general anxiety, and other issues that can pervade daily activities.


But it's not just about oestrogen.


Depression is often associated with (not caused by) inflammation in the body. As we age, it's natural for our bodies to experience more inflammation. Factors like poor sleep and high stress can also lead to excess cortisol production, a hormone that further increases inflammation.

Gut Health

There's a profound link between gut health and depression, primarily attributed to the fact that about 90% of serotonin is produced in our gut. Thus, issues with gut health can directly affect serotonin production, potentially leading to mood disturbances. 

Additionally, within the gut resides a specific group of bacteria known as the estrobolome. These bacteria are crucial for maintaining oestrogen balance by producing an enzyme called beta-glucuronidase. Proper levels of this enzyme help stabilise oestrogen levels, which supports mood stability.

When the gut microbiome becomes unbalanced, a condition referred to as dysbiosis, it can interfere with the production of this enzyme, altering our levels of oestrogen which can aggravate or trigger depression.

Research indicates that women experiencing depression often have elevated levels of this enzyme.

Therefore, maintaining a healthy gut is particularly vital during perimenopause. It affects digestion and physical health and is crucial for emotional well-being.


During perimenopause, women usually experience a decrease in progesterone levels. This decline can significantly impact mental health, as progesterone is closely linked to the production of GABA (gamma-aminobutyric acid). GABA is critical in regulating mood; it is a natural calming agent that helps manage stress and anxiety.

This disruption in the balance of neurotransmitters can contribute to the onset or worsening of depression during perimenopause. 



A diet deficient in tryptophan can significantly affect your mood. Tryptophan, an essential amino acid, plays a crucial role in the production of serotonin. 

Therefore, maintaining a tryptophan-rich diet- turkey, chicken, eggs, cheese, nuts, and seeds—is vital to mental health.

Vitamin D also plays a critical role in regulating mood and warding off depression. Vitamin D is crucial for brain health, influencing the function of neurotransmitters. Low levels of vitamin D have been associated with an increased risk of depression, as deficiencies can affect the brain's ability to process emotions and maintain neurotransmitter balance.

There are other vitamins and minerals that are also essential; magnesium, zinc, vitamin B6 and omega-3.


Strategies for Managing Depression in Perimenopause

While Hormone Replacement Therapy (HRT) has proven to be a safe and effective option for many women to manage mood fluctuations during perimenopause, and antidepressants can also be beneficial, there are numerous additional strategies to support mental health.

Here are several practical steps women can take to support their mental health during this transitional phase:

  1. Enhance Gut Health:

Since a significant amount of serotonin is produced in the gut, maintaining a healthy gut is essential. This can be achieved by consuming a balanced diet rich in fibre, probiotics, and prebiotics. Avoiding processed foods and managing stress are crucial to preventing dysbiosis, which can affect hormone and mood regulation.

2. Incorporate Anti-inflammatory Foods:

Inflammation can exacerbate depression. Incorporating anti-inflammatory foods such as omega-3 fatty acids (found in fish, flaxseeds, and walnuts), leafy greens, and berries can help reduce systemic inflammation.

3. Manage Stress:

Chronic stress leads to elevated cortisol levels, worsening inflammation and potentially leading to depression. Practices such as yoga, meditation, and mindfulness can effectively manage and reduce stress.

4. Regular Physical Activity:

Exercise boosts endorphins, which can improve mood. Regular physical activity, such as walking, cycling, or swimming, can have significant antidepressant effects. Getting outside in nature is always my preferred choice where possible.

5. Ensure Adequate Sleep:

Poor sleep can exacerbate mood swings and depression. Establishing a regular sleep routine, creating a comfortable sleep environment, and avoiding stimulants like caffeine close to bedtime can improve sleep quality.

6. Diet:

Optimise Vitamin D Levels: Exposure to sunlight helps the body produce vitamin D, which is crucial for brain health and mood regulation. Supplementing vitamin D, especially in regions with limited sunlight exposure, can help maintain adequate levels to support mood and cognitive functions.

Tryptophan-Rich Diet: Consuming foods high in tryptophan can support serotonin production. To help stabilise mood, include sources like turkey, chicken, eggs, cheese, nuts, and seeds in your diet.

Supplementation: Essential nutrients like magnesium, zinc, vitamin B6, and omega-3 support mental health. While a comprehensive multivitamin may cover some of these needs, magnesium and omega 3 often require separate supplementation.  

Always consult a healthcare provider to tailor a supplementation plan that fits your specific health needs and ensures compatibility with any other treatments you may be pursuing.

7. Cognitive Behavioural Therapy (CBT):

Engaging in therapy can provide strategies to cope with mood swings and emotional distress. CBT is particularly effective in addressing the negative thought patterns associated with depression.



Perimenopause is a multifaceted period that is deeply personal and varies significantly from one individual to another. 

Due to this variability, there is no universal solution to managing these changes, emphasising the need for personalised strategies.

Recognising the importance of the challenges that may arise during this time is crucial. If symptoms like depression begin to impact your daily life or become unmanageable, it's essential to consult with a healthcare professional. Professional guidance can help you manage this transition smoothly, maintaining your quality of life.

By adopting tailored lifestyle changes or medical interventions, you can address the complexities of perimenopause, helping to lessen its impact and pave the way for a healthier life both during and after this transition.


Remember, that I am here, should you want support, more information or accountability.

Start with small steps each day, and you'll notice the benefits over time. 


7 views0 comments


bottom of page