Depression in Perimenopause: The 'Window of Vulnerability' Studies

If you’ve never had depression and now feel flat, tearful or hopeless in your 40s, it isn’t just in your head, and it isn’t always just stress. Three studies that followed women for years found the same pattern.

What the studies found

Study	Who	Finding
Penn Ovarian Aging Study	Women with no history of depression, followed for 8 years1	High depression scores 4 times as likely during the transition; diagnosed depression 2.5 times as likely1
Harvard Study of Moods and Cycles	460 women aged 36 to 45 with no past major depression2	Those entering perimenopause were twice as likely to develop significant depressive symptoms2
SWAN, Pittsburgh	221 women aged 42 to 52, interviewed yearly3	Major depression 2 to 4 times as likely in perimenopause or early postmenopause3

In the Penn study, women were compared with themselves before the transition, and bigger swings in hormone levels went with depressed mood.¹ In the Harvard study, the risk was somewhat higher in women with hot flashes.²

It’s not only stress

The SWAN study accounted for upsetting life events, hot flashes, medicines and hormone levels, and the higher risk was still there.³ The Harvard study also adjusted for negative life events.²

Experts now describe the years from the early transition into early postmenopause as a “window of vulnerability” for both depressive symptoms and major depression.⁴

Who is most at risk

A past episode of depression is the strongest warning sign. In SWAN it predicted depression throughout the study.³ Guidelines say most women who have major depression in perimenopause have had an episode before.⁴

Depression can also hide among menopause symptoms: poor sleep and night sweats overlap with it.⁴

What treats it

1. Antidepressants and talking therapy are the front-line treatments.⁴
2. Estrogen isn’t approved for depression, but there’s evidence it has antidepressant effects in perimenopause, especially with hot flashes.⁴ Evidence on estrogen combined with a progestogen is thin.⁴
3. Sleep is worth treating too; see CBT for menopause insomnia.

If you have thoughts of suicide or self-harm, get help now: in the US, call or text 988.

For the broader picture, see low or irritable mood in menopause and what perimenopause is.

Try: “My periods have become irregular and for two months I’ve felt low and lost interest in things. I had depression after my second baby. Could this be perimenopausal depression, and what are my options?”

My Body Changed. Now What? covers this in Chapter 6, “Nights, Moods and Lost Words,” in a section called “The Window.” Its Visit Brief asks you to write down any past depression, severe premenstrual mood or low mood after a baby, in plain words, before the appointment. See the book.