Mood and menopause: when to consult, and exactly what to ask

Feeling low in perimenopause is neither rare nor imagined. Mood symptoms are common during this transition ^[1]. You're not overreacting, you're responding to a real signal.

Estrogen helps your brain regulate serotonin, the chemical that keeps your mood steady. In perimenopause it doesn't just quietly drop: it swings up and down without warning. It's this variability, not low levels alone, that destabilises your mood ^[3][4].

A second mechanism piles on. As progesterone's calming by-products fall, the brake on your stress system weakens and cortisol can run high ^[4]. Night sweats and hot flashes fragment your sleep, and broken sleep in turn feeds low mood and irritability ^[5].

So your low mood is a physical response, not a lack of willpower. Trying to 'cope' alone means asking your brain to out-muscle its own chemistry. And that chemistry can be treated.

The threshold isn't collapse. It's the point where what you feel stops you living the way you want. When low mood settles in almost every day, most of the day, for more than two weeks, it's no longer passing. That's the exact line doctors use to name a depressive episode ^[7], and treatment is recommended at that point ^[6].

Loss of pleasure is the clearest signal. The things that used to lift you do nothing now, or take enormous effort. That's not tiredness, it's disconnection.

Look at the concrete impact on your days:

• you struggle to get up, to concentrate, to finish ordinary tasks
• you withdraw, you cancel, you stop calling people
• your sleep breaks, you wake at 3am and can't drift off
• you're on edge, or the opposite, switched off
• you eat much more, or much less, than before

One detail changes everything: if you've had strong premenstrual syndrome, depression after childbirth, or a mood dip on the pill, your brain is likely more sensitive to hormonal shifts ^[3]. That's valuable information for your doctor, and one more reason not to wait.

Some signals no longer leave room for the 'right moment' question. You don't wait.

Thoughts that life isn't worth living, that others would be better off without you, a sense of losing control or not being safe with yourself: these are emergency signals. They don't make you weak. They're a symptom, like a fever, and they can be treated. Assessing this risk is part of caring for depression, and it's always better to speak up early ^[7].

In France, 3114 is the national suicide prevention line, free and confidential. If the danger is immediate, call 15.

Walking in with a precise request changes everything. Doctors work with dated facts: the more concrete you bring, the more seriously you're heard. Instead of 'I'm tired and sad', say: 'for seven weeks I've woken at 3am most nights, lost all pleasure, and cancelled three plans for lack of energy'.

Here's the checklist to ask for, by name:

• a thyroid test (TSH): an underactive thyroid mimics depression, and is worth ruling out first ^[8]
• a deficiency check (iron, ferritin, vitamin D, B12), which can also imitate low mood ^[8]
• a mood screen using the PHQ-9, a validated nine-question tool ^[2]
• a referral for cognitive behavioural therapy (CBT), recommended as first-line ^[6]
• whether menopausal hormone therapy (MHT) could help your mood, especially if you also have hot flashes ^[2]

Because yes, this is treatable. CBT, concrete work on your thoughts, matches antidepressants for moderate depression ^[9]. Some antidepressants, like venlafaxine or escitalopram, also ease hot flashes ^[2]. Taking them is neither a failure nor a life sentence.

If a doctor brushes off your request, you're allowed to insist or ask for a second opinion ^[2]. A tracking app can log your symptoms day by day and prepare a clear recap, so you arrive with facts, not empty-handed.