Depression That Looks Different

Depression in peri/menopause doesn’t always look like “classic” major depressive disorder (MDD). To meet criteria for MDD, symptoms must be present nearly every day for a set time. By contrast, hormone-driven depression during peri/menopause is often inconsistent.

Women can feel heavy, flat, or tearful one week and then lighter the next. This pattern of symptoms “coming and going” is one reason so many women are blindsided.

And it’s because of this that many GP’s and mental health professions, don’t recognise it. (NB - the All About Her therapists do though!)

Professor Jayashri Kulkarni, a leader in this field, developed the MENO-D scale to capture these unique features. Her research highlights that peri/menopausal depression often presents differently and requires a different lens of understanding.

Common Symptoms of Peri/Menopausal Depression

  • Irritability and sudden mood shifts
  • Loss of drive or motivation
  • Lowered confidence and self-esteem
  • Emotional flatness or joylessness
  • Overwhelm with daily responsibilities
  • Tearfulness or emotional sensitivity
  • Poor concentration and forgetfulness

How Hormones Play a Role

  • Oestrogen supports serotonin, dopamine, and norepinephrine - key neurotransmitters for mood. As oestrogen fluctuates, mood regulation becomes unstable.
  • Oestrogen also modulates the stress response. With less buffering, cortisol spikes more easily, fuelling irritability, fatigue, and low mood.
  • Progesterone decline removes its natural calming effect, further tipping the balance toward mood instability.

This means depression in peri/menopause is as much about biology as psychology. It’s why it looks different, and why it feels inconsistent.

What to Remember

For some women, peri/menopause brings their very first experience of depression, which can be deeply unsettling and confusing - especially when there’s no history of low mood in the past.

If depression is resurfacing, it doesn’t erase the progress you’ve made before. The work you did remains valuable - it gave you insight and resilience.

What’s happening now is hormonally driven, appearing in the midst of new life stressors, and filtered through the perspective of your midlife wisdom.

Support and Treatment

Effective treatment often involves a layered approach:

  • Therapy to work through thoughts, emotions, and identity shifts
  • Lifestyle supports - movement, rest, nutrition
  • Hormone therapy (HT), which can improve both physical and emotional symptoms
  • Antidepressants, when recommended by a doctor
  • Trauma-informed or somatic approaches when past experiences resurface

If depression is affecting your quality of life in peri/menopause, contact us here. There are effective supports available, and you don’t have to navigate this alone.