Is This Anxiety, Depression or Perimenopause

December 10, 2025|Tania Mullan

MIDLIFE, EXPLAINED

Is This Anxiety, Depression or Perimenopause

When perimenopause looks like anxiety, depression or losing yourself. Take heart — a life that has become smaller can grow again.

SOMA Wellness Co. · December 2025 · 21 min read

Quick Answer: Can perimenopause affect anxiety, depression and mood?

Yes. Perimenopause can trigger or worsen anxiety, low mood, panic, irritability, social withdrawal and loss of confidence. Hormonal fluctuation can affect brain chemistry, sleep and the stress response, while past mental-health history, trauma, illness and life load may add other layers.

Treatment can include MHT/HRT, antidepressants, therapy, nervous-system work or a combination. New or worsening symptoms deserve a menopause-aware clinical assessment, not an automatic assumption that they are "just stress".

If you feel at risk of harming yourself or cannot stay safe, call 000 in Australia or 111 in New Zealand. Lifeline Australia is available on 13 11 14.

You have been sitting in the supermarket car park for eleven minutes.

There is milk on the list. Bread. Dog food. Nothing that requires courage.

But your heart is racing at the thought of walking through the automatic doors. Someone might stop for a chat. You might have to smile, find the right words and behave as though standing beside the avocados is not currently asking far too much of you.

So you tell yourself you will go in after the next song. Then you drive home.

Later, a friend messages about Saturday. You love her. You miss her. Still, the invitation lands like an obligation you may not be able to survive by the time the weekend arrives.

You type, "Sounds good. Can I get back to you?" and feel guilty before you have even pressed send.

If that is familiar, this article is for you.

It does not always look like sadness

Perimenopause has an image problem. We were warned about hot flushes, strange periods and perhaps becoming a little cranky.

We were not warned that anxiety might arrive as a body sensation before there is a thought attached to it. Or that depression might feel less like crying and more like someone quietly turning the colour down on your life.

We were not warned that a woman who once organised every catch-up might begin avoiding group chats. That a confident driver might suddenly dread the motorway. That small talk could feel like an oral exam she had forgotten to study for.

Healthdirect recognises low mood, anxiety, irritability, fatigue, brain fog and heart palpitations among symptoms that can occur during perimenopause. Some women experience anxiety or depression for the first time. Others find an old condition returns or changes shape. [1]

No history of anxiety grants immunity. A long history of coping does not guarantee that you will keep coping in exactly the same way.

"I swear I've never experienced anxiety like this." — Anonymous woman in a public perimenopause forum. Lived experience, not medical evidence. [12]

What the numbers do, and do not, tell us

There is no single honest statistic for "how many women get menopause anxiety". Studies ask different questions and recruit very different groups. A survey of women already seeking help will naturally find more symptoms than a population study.

Still, the numbers make one thing clear: this is not a rare experience.

A 2024 meta-analysis involving 9,141 women found that perimenopausal women had about a 40% higher risk of depressive symptoms or a depression diagnosis than premenopausal women. [2]

A 2025 commercial survey of 19,000 US women found that 72% reported stress or anxiety. It was self-reported, not a clinical prevalence estimate, but it reflects the scale of what women are describing. [3]

The 79% figure sometimes shared online came from a small qualitative study of 14 women with vasomotor symptoms. Eleven reported recurring anxiety and insomnia. It does not mean 79% of all women will develop anxiety. [4]

Some women move through with manageable symptoms. Others experience a full-body, full-life upheaval. If your experience has been relatively easy, be grateful rather than glossy about it. The woman beside you is not weak, dramatic or playing the world's smallest violin. She may be dealing with a very different mix of biology, history, sleep, illness, stress and support.

The expert view — do not force women to choose between hormones and mental health. Dr Mary Claire Haver: "What frustrates me most is how many women are prescribed an antidepressant as a first-line response to menopausal mood changes." Her point is not that SSRIs are wrong. It is that hormonal assessment and MHT should not be skipped when new mood changes arrive alongside the rest of the perimenopause picture. [14] Professor Jayashri Kulkarni: Australian guidance on perimenopausal depression is deliberately non-binary. Where medicine is needed, treatment may be MHT, an antidepressant or both, alongside psychological and practical support. [5][15]

The five faces of perimenopause mood disruption

1. Anxiety that feels physical, not logical

For some women, anxiety arrives as a thought. For others, it is pure body.

A racing heart. A tight chest. Shaky hands. An inner vibration. A rush of dread on waking. A feeling that something terrible is about to happen while you are, objectively, folding towels.

Your conscious mind then scrambles to explain the alarm. Is it my heart? My job? My relationship? Am I getting sick? The body fires first and the story follows.

Palpitations can occur in perimenopause, but new, severe or persistent palpitations should not automatically be written off as hormones. Thyroid conditions, anaemia, medicines, stimulants and heart problems can produce similar sensations. [1]

2. Low mood that feels like the colour has been turned down

Depression does not always announce itself with sobbing.

It can look like standing in the kitchen knowing there are things you usually care about and being unable to feel the caring. It can look like leaving messages unanswered because every reply seems to require a version of you who has gone offline.

Sometimes the black dog does not merely visit. It moves in, closes the curtains and starts telling convincing lies.

Hormones may be part of the cause. That does not make the depression less real. "Hormonal" is not another word for imaginary, harmless or something you should hide under the covers until it passes.

"How come I didn't feel any joy anymore? I'd lost the joy." — Davina McCall, describing the emotional flatness and unfamiliar anxiety she experienced in perimenopause. [16]

3. Mood swings and the vanishing buffer

One minute you are capable and calm. Five minutes later, someone has put a wet teaspoon on the bench and your nervous system has treated it as a declaration of war.

Then the wave passes and shame arrives.

Oestrogen and progesterone interact with brain systems involved in mood, sleep, motivation and stress response. During perimenopause, they can fluctuate sharply rather than declining in a tidy straight line. The result can be less emotional buffer between a small trigger and a large reaction. [1][5]

4. Social withdrawal and the shrinking world

The invitation arrives and your body says no before your mind has opened the calendar.

You start by keeping weekends flexible. Then you cancel at the last minute. Then people stop asking because they assume you need space, and you are too embarrassed to explain that space has become both your safest place and your loneliest one.

Withdrawal can grow from anxiety, low mood, broken sleep, sensory overload or fear that you cannot perform the old version of yourself. It can also become a loop. The less you go out, the more unfamiliar going out feels.

5. The wired-but-tired collapse

You are exhausted enough to cry at 9pm. Then your head touches the pillow and your brain opens twelve tabs.

Poor sleep is not a side issue. Night sweats, lighter sleep, early waking, pain, palpitations and worry can all keep the nervous system activated. Months of broken sleep can make any human more anxious, reactive and less able to recover from ordinary life.

Mood care that ignores sleep is trying to mop the floor while the tap is still running.

Who may be more vulnerable

Perimenopause does not create the same experience in every woman. Some nervous systems appear more sensitive to reproductive hormone change.

Healthdirect advises particular vigilance if you have experienced depression or anxiety, postnatal depression, or severe premenstrual symptoms. A history of PMDD or pronounced PMS may signal sensitivity to hormonal fluctuation. It is not destiny, but it belongs in the conversation with your doctor. [1]

The same is true of trauma.

Sometimes midlife feels as though Pandora's box has opened. Experiences you thought you had packed away begin pressing at the lid. That does not mean perimenopause manufactures memories or that every difficult emotion is trauma.

It may mean hormone change, poor sleep, chronic stress, illness and caregiving leave less energy for keeping old pain neatly compartmentalised. Research links greater trauma exposure and adverse childhood experiences with higher menopause, PTSD and depression symptom burdens, although the mechanisms are still being studied. [6][7]

This is not a reason to go digging through your past alone. It is a reason to tell a trusted clinician if old memories, fear, nightmares, hypervigilance or grief have returned.

Worth saying at your appointment — the history your doctor needs to hear: "I have had postnatal depression, PMDD, anxiety, depression or trauma symptoms before, and this feels new or much worse." "My world is getting smaller. I am avoiding people, driving, shops or work." "I am having thoughts that frighten me, even if I do not intend to act on them." Those details are clinically important. They are not oversharing.

When it becomes the dark place

This section is difficult because it needs to be.

"I fell into something so dark in December that it scared me." — Gabrielle Union, speaking publicly about suicidal thoughts during perimenopause and the help she sought. [17]

Midlife is a serious mental-health period for women. In England and Wales, women aged 50 to 54 had the highest female suicide rate in 2023. In the United States, women aged 45 to 64 had the highest female rate in 2022 and 2023. In Australia in 2024, the median age of women who died by suicide was 44.7. [8][9][10]

Those figures do not prove menopause caused those deaths.

A 2024 systematic review found a complex and mixed relationship between menopause stage and suicidal thoughts or behaviour. The responsible conclusion is not "menopause causes suicide". It is that midlife women in severe distress need earlier recognition and support that considers hormones, mental health, physical health and life circumstances together. [11]

If your mind is telling you that the people you love would be better off without you, treat that thought as a sign of pain, not a reliable verdict. You do not need to wait until you have a plan. Tell someone today.

Urgent support — if you feel unsafe or may act on suicidal thoughts. Australia: Call 000 in immediate danger. Lifeline is available 24/7 on 13 11 14 or text 0477 13 11 14. Suicide Call Back Service is available on 1300 659 467. New Zealand: Call 111 in an emergency. Call or text 1737 for free 24/7 support. Move away from anything you could use to harm yourself, go where another person is, and say the plain sentence: "I do not feel safe alone right now."

A Peek Behind the Curtain: When my world became very small

When the rock crumbled

Depression had visited me before, particularly at some of the most hormonally and emotionally intense points of my life.

I had three premature babies in my thirties, each one earlier than the last. Later, my marriage disintegrated and I found myself rebuilding while raising a teenager and three children under seven in my early forties.

I knew what depression felt like. Or at least, I thought I did.

Nothing prepared me for the black hole I fell into in my early fifties.

My children had always known me as the rock in our home. Then the rock did not simply crack. It crumbled.

Home became my castle walls

It did not happen overnight. At first, I simply developed an aversion to making plans.

Someone would ask on Monday whether I wanted to do something on the weekend, and I would think, What if Saturday arrives and I cannot face it?

Sometimes I avoided committing. Sometimes I said yes, felt anxious about it all week, and cancelled at the last minute.

One weekend became a month. A month became six months.

Home became my castle walls. Inside them, I felt safe. But those walls also kept everyone else out, and that safety came at a cost.

My heart would race at the thought of the supermarket, the automatic doors, someone initiating conversation, or having to make small talk. It seemed easier to stay home on my comfortable couch, with Lola curled beside me, watching Netflix where nobody needed anything and nothing unexpected could happen.

Tow-Truck Tarnz

This was particularly hard to understand because, in my younger years, I had been the life of the party and probably the most audacious member of my social group.

My nickname had been Tow-Truck Tarnz.

One night, after the Gold Coast taxi rank proved impossibly long, I planted myself like Wonder Woman in the middle of the highway and stopped a convoy of tow trucks to ask for a lift home.

Not my safest decision, admittedly. But it was very much me.

I was bold. Social. Unafraid of looking ridiculous. It was hard to believe that such a force of personality could shrink to the point where leaving the lounge room felt overwhelming.

Fortunately, I had friends who could still see Tow-Truck Tarnz inside the shell of the woman I felt I had become.

The darkest place

At my lowest point, I genuinely could not imagine that life would ever feel better. I believed the best of it was behind me. I felt like a burden to the people I loved.

In that completely distorted state, the thought that they might be better off without me seemed not only believable, but logical.

Looking back, I can see that it was neither.

I was fortunate. People around me noticed I was no longer myself. I retained enough insight to say I was not safe inside my own thoughts, and I received help.

Then Lola arrived. My little Cavoodle stayed beside me when I was bedridden, permanently on my lap when I was in a wheelchair, and later beside me as I began taking short walks again.

She did not fix me. Her warmth, closeness and uncomplicated presence simply gave my nervous system something steady to return to.

What helped me climb out

What helped was not one thing.

HRT and an SSRI were both part of my picture. So was nervous-system work with a body-based therapist, and a retreat where I learned about circadian rhythm and what a body needs to enter rest and repair.

I realised my nervous system had barely switched off for decades. I had become very good at pushing through and very poor at feeling safe enough to stop.

I had to teach my body the difference between on and off. Morning light. Regular sleep and wake cues. Breathwork. Somatic work. Gentle movement. Less forcing. More repetition.

None of it worked because I did it once.

The more consistent I became, the more colour returned. I could see choices again. I could feel pleasure before I trusted it would stay.

I did not choose between medical support and nervous-system support. I needed both.

The people who held the light

Recovery was not a dramatic movie moment. My life returned in small pieces: a short walk, a trip to the shops, staying at an event for half an hour, making a plan and keeping it.

Bit by bit, my life began to grow larger again. It is still growing.

To the girlfriends who have stood beside me for decades and continued to see a flicker of light when I felt surrounded by darkness, thank you. You held the light until I could carry it again. I shine brightly today, in no small part, because you never stopped believing that I would.

The hardest part was not knowing whether I had lost myself permanently. I had not. Tow-Truck Tarnz was still there, even when I could not feel her.

This is part of why I do what I do with SOMA. Women need language, medical care, gentle daily anchors and people who keep seeing their light before the world becomes unbearably small.

With warmth, Tarnia Mullan Founder, SOMA Wellness Co.

"My life did not return all at once. It came back in small pieces, until the world that had become so narrow slowly began opening again." — Tarnia, Founder, SOMA Wellness Co.

What actually helps

The goal is not to find the one virtuous answer. It is to work out what is happening, how much it is affecting your life, and which layers of support belong in your plan.

1. Put hormones and mental health in the same room

Book a longer GP appointment if possible. Say it plainly: "My mood has changed, my functioning has changed, and I want to discuss perimenopause and mental health together."

Bring the timeline: cycle changes, sleep, night sweats, panic, low mood, palpitations, irritability, withdrawal, loss of confidence and any history of PMDD, postnatal depression, trauma, anxiety or depression.

A menopause-aware GP can also check for thyroid problems, iron deficiency, medication effects, sleep apnoea, alcohol, pain and other illness.

2. MHT and antidepressants are not rival teams

For new mood symptoms arriving with other perimenopause changes, MHT deserves a proper discussion. For clinical depression or anxiety, an SSRI or another antidepressant may be appropriate. Some women need one. Some need the other. Some need both. [1][5][14]

An antidepressant is not evidence you have failed, and MHT is not a badge of doing menopause correctly. The right option depends on your history, risks, symptoms and preferences. Speak with a menopause-trained GP rather than being forced into an either-or answer.

3. Work from the body up as well as the mind down

Talking matters. So can body-based therapy, trauma-informed therapy, somatic work, breathwork and gentle movement.

When anxiety begins as a racing heart, tight chest or wave of dread, the body may need repeated cues of safety before the thinking brain can make sense of anything.

4. Treat sleep and circadian rhythm as part of mood care

A nervous system that has been waking at 3am for months is not starting each day from neutral.

Morning light, a consistent wake time, less stimulation at night, treatment for hot flushes or sleep apnoea, and a repeated evening downshift can all matter. Better sleep may not solve everything, but untreated sleep disruption can keep amplifying everything.

5. Re-enter life gently, not heroically

Do not make your first outing a crowded event requiring shapewear and three hours of small talk.

Start with one person who does not need you to perform. A ten-minute walk. A coffee with permission to leave early. A voice note that says, "I have gone quiet, but I have not stopped caring." One honest text can be a bridge back to a safe person.

What it feels like → what support may look like:

You are functioning, but feel frayed, wired, flat or unlike yourself. Track the pattern. Protect sleep. Rebuild safe connection. Use regular light, movement and nervous-system practices. A botanical ritual may sit here as one supportive layer if it is compatible with your health and medicines.
Your world is shrinking, symptoms last more than two weeks, or work and relationships are affected. Book a longer appointment with a menopause-aware GP. Discuss MHT, antidepressants, therapy, body-based support and relevant medical checks. You may need more than one approach.
You feel unsafe, cannot function, or are thinking about suicide. This is professional and urgent-care territory. Use the crisis contacts in this article. Do not rely on a supplement, botanical ritual, retreat or Facebook group to carry a severe episode.

"Your body deserves whatever level of support it needs."

Not the most natural-looking support. Not the support your friend needed. The support that helps you stay safe and come back to yourself.

A note about St John's Wort — natural does not mean interaction-free. Standardised St John's Wort products may help some people with mild-to-moderate depression, but it is not a casual substitute for an antidepressant or professional assessment. It interacts with many prescription medicines and should not be combined with SSRIs, SNRIs or other serotonin-affecting medicines without prescriber or pharmacist guidance. It may also worsen anxiety in some people. [22] SOMA deliberately does not use St John's Wort.

Where to reach out — Australia and New Zealand support. Menopause-aware care: The Australasian Menopause Society Practitioner Directory lists Australian and New Zealand clinicians who have chosen to show an interest in midlife and menopause. Directory inclusion is not a formal endorsement, so ask about their experience with mood symptoms, MHT and mental-health care. Australia: Your GP is a good first step. Healthdirect is available on 1800 022 222. Beyond Blue offers free 24/7 brief counselling on 1300 22 4636. Lifeline is available 24/7 on 13 11 14 or text 0477 13 11 14. Call 000 in immediate danger. New Zealand: Start with your GP or call Healthline on 0800 611 116. Call or text 1737 for free 24/7 emotional support. Call 111 in immediate danger.

Where SOMA can sit: a daily support layer, not the crisis layer

If you are unsafe or unable to function, skip the product page and use the professional-support box above.

For women who are still functioning but feel frayed, wired, low or unable to switch off, the SOMA Duo can sit alongside the medical, psychological and lifestyle support that is right for them.

Vitalitea Daylight contains tulsi and lemon balm, botanicals studied in human trials in relation to stress, mood and sleep, alongside gotu kola as the morning focus anchor. Serenitea Moonlight contains passionflower, lemon balm and chamomile, botanicals studied in relation to sleep quality, calm and a more settled night. [18][19][20][21]

Those studies used specific extracts, preparations and doses. This is ingredient-level evidence, not proof that the finished infusions treat anxiety, depression, PMDD, panic attacks or suicidal thoughts.

The value of the Duo is repetition: a morning cue for steadier days and an evening cue that helps mark the move toward rest. It can sit beside MHT, SSRIs, therapy and GP care. It does not replace them. → Explore the SOMA Duo

SOMA Circle — for the woman who does not want to carry this alone. SOMA Circle is the community side of what we do: a private Facebook space for women to ask questions, share the messy middle and be understood without giving the long explanation. Our monthly North Brisbane gatherings rotate through nervous-system practices such as somatic movement, breathwork, sound bowls and meditation. Think of it as a small taste of a retreat brought to the suburbs. Circle is not therapy or crisis care. It is belonging, co-regulation and the relief of being with women who understand the transition from the inside. → Discover SOMA Circle

For the woman who thinks everyone else is coping

The woman down the street may be fine. Or she may be sitting in her car before walking into Woolies, doing the same quiet calculations you are.

Midlife women are highly practised at appearing functional. They attend the meeting, answer the family chat and remember the birthday while privately wondering how much longer they can keep carrying their own mind.

You are not broken because this transition has asked more of you than it asked of somebody else.

And if you moved through with a few hot flushes and an irregular cycle, please be kind to the woman who did not. By luck, biology, history, support or some combination, your road was gentler. That is something to appreciate, not a measure of moral fitness.

As someone who has come through the other side, I would not wish the darkest version of this on anyone. But the world can open again. Sometimes it begins with one appointment, one honest text, one night of better sleep or one person who keeps seeing you before you can see yourself.

One sentence to send — when you do not know how to ask for help: "I am not coping the way I usually do. I think perimenopause may be part of it, but I need help with how dark and anxious I feel now." Send it to your GP, a trusted friend, your partner or the person most likely to come and sit beside you without asking you to make it sound tidy.