Anxiety and depression become more common for some women during the menopause transition, and many don’t link the two. Guidelines from NICE and FIGO now give women a clear basis to ask for mood to be assessed, and Australia has funded a GP check that includes it.
You may be in your 40s and notice your periods changing at the same time as your sleep and your mood. Anxiety may arrive without an obvious cause, or low mood may settle in for weeks. It is easy to treat these as separate problems, and many women do.
In a US survey of 1,000 women, 33% didn’t know perimenopause can affect mental health. Some 74% had symptoms for six months or more before suspecting perimenopause. Before they made the connection, 49% believed they had standalone anxiety and 39% standalone depression.
Dynata ran the survey for LifeStance Health, a commercial US mental health provider, in June 2026. It isn’t peer reviewed. Its figures sit beside a growing body of research. That research shows a real but uneven rise in anxiety and depression during the transition.
In September 2026, a University of Oulu study reported on more than 2,600 Finnish women aged 46. Those already in the transition were 44% more likely to have clinically significant anxiety. About 23% had such symptoms, compared with 16% of women the same age who hadn’t started the transition. Depressive symptoms affected just over 30%, against just under 25% of their peers. Our report on the Finnish study covers its findings in more detail.
Questions worth taking to an appointment
In England, the National Institute for Health and Care Excellence revised its menopause guideline in November 2024. The update added recommendations on cognitive behavioural therapy (CBT), a structured talking therapy, for menopause-associated symptoms. It also clarified how clinicians should address the possible effects of menopause on mental health.
A woman in her 40s or 50s can therefore ask for mood, anxiety and sleep to be assessed alongside physical symptoms. She can ask whether CBT is available locally. England’s NHS guidance notes that hot flushes may be “replaced by other symptoms such as low mood and anxiety”. It encourages women to see a GP about their options.
The International Federation of Gynecology and Obstetrics (FIGO) published best practice recommendations on mental health at menopausal age in April 2026. FIGO recommends treatment tailored to the individual, with options including lifestyle changes, CBT and hormone therapy.
Women with a past history of depression can tell their clinician. The research below identifies them as the group most at risk of a new episode. Women whose low mood follows broken sleep and night sweats can ask whether treating those symptoms is likely to help. Anyone with thoughts of self-harm or severe low mood should seek urgent help from a doctor or local emergency service.
Which women face the highest risk
A 2024 meta-analysis led by University College London pooled seven studies covering 9,141 women. Perimenopausal women had roughly a 40% higher risk of depressive symptoms and diagnoses than premenopausal women. Postmenopausal women showed no significant increase.
The Lancet’s 2024 menopause series included a paper on mental health led by Lydia Brown, with Martha Hickey and Hadine Joffe as senior authors. It found “no compelling evidence for a universal increased risk” of depression or anxiety. It identified specific groups of women who were vulnerable to depressive symptoms.
Women with a very long transition were among them, as were women whose sleep was badly disrupted by night sweats. Women with a stressful life event shortly before assessment also had higher risk, according to a Harvard summary of the review. Major depressive disorder appeared mainly in women who had experienced it before.
UCL, Oulu and the Lancet authors all relied on observational data, so their findings show associations. They can’t separate the effect of hormones from sleep loss, life stress or other changes in midlife. Read together, they describe higher rates of anxiety or low mood in a minority of women, with some groups at clearly higher risk.
Treatments in current guidance
FIGO describes the antidepressants escitalopram and venlafaxine as effective for depressive symptoms and hot flushes in women with major depressive disorder. In North America, the main reference remains 2018 guidelines from the North American Menopause Society and the National Network on Depression Centers. They state that antidepressants and psychotherapy should remain front-line treatments for major depressive episodes during perimenopause. They also advise treating disrupted sleep and night sweats alongside mood.
The Lancet review found that menopausal hormone therapy can improve depressive symptoms in women who also have troublesome hot flushes and night sweats. However, its authors write that the evidence does not support hormone therapy to prevent depressive symptoms. Regulators in Europe and the US have not approved it as a treatment for depression.
A woman whose low mood is driven by sleepless nights may benefit from treatment for night sweats. A woman with a history of depression may need psychological care or antidepressants as well. Telling the two apart requires a clinician who asks about both.
Health systems that put mood on the checklist
The World Health Organization’s menopause fact sheet lists mood changes, depression and anxiety among common symptoms. WHO says menopause care should be an integral part of health care, including diagnosis, treatment and counselling. It also reports that menopause gets limited attention in the training of many health workers.
FIGO states that menopause-related anxiety and depression are often overlooked in low- and middle-income countries. It says early detection requires training primary care providers.
On 1 July 2025, Australia introduced a Medicare-funded menopause and perimenopause health assessment, a GP consultation of at least 20 minutes. It is available once every 12 months. Its history covers symptom severity, including mood changes and sleep, and its management discussion includes psychological support.
The Australian government committed A$26 million to the assessments. It also announced an expansion of endometriosis and pelvic pain clinics from 22 to 33, with specialist support extended to menopause. Women in Australia can ask their GP for the assessment by name.
This article is for information only and does not replace advice from a qualified health professional.
Header image: Galina Bogdanova on Unsplash