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Is it my hormones, or am I actually depressed?

How to tell a hormonal dip from a depression that needs treating, and what to ask your doctor.

4 min read

It's 3am, heart racing for no clear reason, and the question loops again: is this my hormones, or am I actually depressed? What you feel is real and has a physical cause. During the menopause transition, the risk of depressive symptoms is two to four times higher than before [1][4]. Asking the question at all means you're reading your own signals well.

Your mood dip has a real biological cause

What you're going through is not in your head. Estrogen helps your brain make and use serotonin and dopamine, the chemicals behind mood, motivation and pleasure [2].

In perimenopause, the problem isn't only that levels fall. It's that they go on a rollercoaster: up, down, back up. Studies show it's this variability, more than the low level itself, that weighs on mood [3].

This is not a minor thing. The risk of depressive symptoms is two to four times higher during the transition, even in women who have never had depression [1][4][5]. A large share of women report low mood, irritability or anxiety through this passage [6].

Add hot flushes that shatter your nights: chronic broken sleep feeds low mood directly [13]. None of this is imaginary, and none of it is your fault.

Sources (7)
  • [2] Soares CN. Depression and Menopause: Current Knowledge and Clinical Recommendations for a Critical Window. Psychiatr Clin North Am. 2017;40(2):239-254.
  • [3] Joffe H, de Wit A, Coborn J, et al. Impact of Estradiol Variability and Stress on the Risk of Depression During the Menopause Transition. J Clin Endocrinol Metab. 2020;105(7):e2607-e2620.
  • [1] Bromberger JT, Kravitz HM. Mood and menopause: findings from the Study of Women's Health Across the Nation (SWAN) over 10 years. Obstet Gynecol Clin North Am. 2011;38(3):609-625.
  • [4] Freeman EW, Sammel MD, Lin H, Nelson DB. Associations of hormones and menopausal status with depressed mood in women with no history of depression. Arch Gen Psychiatry. 2006;63(4):375-382.
  • [5] Cohen LS, Soares CN, Vitonis AF, et al. Risk for new onset of depression during the menopausal transition (Harvard Study of Moods and Cycles). Arch Gen Psychiatry. 2006;63(4):385-390.
  • [6] British Menopause Society / Women's Health Concern. Menopause and mental health factsheet. 2022.
  • [13] Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018;13(3):443-456.

Hormonal dip or depression: duration and lost pleasure tell them apart

Three concrete markers help you tell the difference: duration, intensity and loss of pleasure.

A hormonal dip fluctuates. You have bad days, then clear patches where you feel like yourself again. A real depression doesn't let go: it's there most of the day, nearly every day, for at least two weeks [7].

The signal that matters most is anhedonia (a lasting loss of pleasure). Even what you used to love does nothing for you. It's linked to a drop in dopamine and to inflammation in the brain [8].

Watch out for the double trap. Blaming everything on hormones can delay care for a real depression. On the flip side, an underactive thyroid (hypothyroidism) mimics almost every sign of depression: fatigue, slowing down, low mood [9]. Guidelines also advise against prescribing an antidepressant first-line for hot flushes alone, with no diagnosis of depression [10].

The goal isn't to pick a side. It's to investigate: the cause on one hand, the state on the other.

Sources (4)
  • [7] Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. Menopause. 2018;25(10):1069-1085.
  • [8] Bekhbat M, Treadway MT, Felger JC. Inflammation as a pathophysiologic pathway to anhedonia: mechanisms and therapeutic implications. Curr Top Behav Neurosci. 2022;58:397-419.
  • [9] American Thyroid Association. Thyroid Disease and Women. 2021.
  • [10] National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). 2024.

What to ask for: thyroid check, hormones, or antidepressants

You don't have to prove what you feel. You can walk in with a specific request.

What you can ask for:

  • A thyroid check (a TSH blood test), because a sluggish thyroid mimics depression [9].
  • A real assessment of your mood: how long, how intense, with or without loss of pleasure.
  • Keep in mind that over 45, a single estrogen blood test means little, since levels swing day to day; the diagnosis rests on your symptoms [10].

On treatment, it depends on what you sorted out. Menopause hormone therapy (MHT), using transdermal estradiol, can lift mood during perimenopause. One trial showed estradiol plus progesterone roughly halved the onset of depressive symptoms, most of all in early perimenopause [11]. In another, estradiol brought remission in nearly 7 women in 10, versus 2 in 10 on placebo [12].

But MHT is not a treatment for an already-established depression [7][10]. That one is treated differently, and it works:

  • Cognitive behavioural therapy (a structured talking therapy), first-line for mild to moderate cases [10].
  • Antidepressants (SSRIs or SNRIs) for moderate to intense depression; some also ease hot flushes [7][10].
  • Regular physical activity, as a complement [7].

Needing an antidepressant is neither a failure nor a weakness: it treats a real illness. If you leave without a clear answer, you're entitled to a second opinion.

Sources (5)
  • [9] American Thyroid Association. Thyroid Disease and Women. 2021.
  • [10] National Institute for Health and Care Excellence (NICE). Menopause: identification and management (NG23). 2024.
  • [11] Gordon JL, Rubinow DR, Eisenlohr-Moul TA, et al. Efficacy of Transdermal Estradiol and Micronized Progesterone in the Prevention of Depressive Symptoms in the Menopause Transition. JAMA Psychiatry. 2018;75(2):149-157.
  • [12] Soares CN, Almeida OP, Joffe H, Cohen LS. Efficacy of estradiol for the treatment of depressive disorders in perimenopausal women: a double-blind, randomized, placebo-controlled trial. Arch Gen Psychiatry. 2001;58(6):529-534.
  • [7] Maki PM, Kornstein SG, Joffe H, et al. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. Menopause. 2018;25(10):1069-1085.

If thoughts turn dark: the 3114 line is there, day and night

Let's name this plainly. If dark thoughts show up, the wish for it all to stop, the sense that those around you would be better off without you, this is never a hormonal fate. It's an emergency signal that deserves an immediate response.

In France, the 3114 is the national suicide prevention line. It's free, reachable 24/7, and trained professionals listen without judging you [14].

Keep these markers:

  • Dark thoughts or thoughts of death: call the 3114.
  • Immediate danger: call 15 (the SAMU) or 112.
  • You can also go to an emergency department, or ask someone you trust to go with you.

Having dark thoughts doesn't make you weak. It means the pain has crossed a threshold and needs help now. That help exists, and it works.

Sources (1)
  • [14] Ministère de la Santé et de la Prévention. Dispositif national de prévention du suicide 3114. 2021.

Between "it's nothing" and "it's hopeless" lies a third path: observe, name, ask. Starting tonight, log your mood, your pleasure and your sleep day by day: a vague feeling becomes data you can show. Then book an appointment with one clear question: "Is this a dip from the transition, or a depression to treat, and can we check my thyroid?" What you feel counts. And if the thoughts ever turn dark, the 3114 is there, day and night.

This article is for information only and does not replace the advice of a health professional. If a symptom worries you, talk to a doctor.

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