Low mood and depression in menopause

Low mood that feels new, heavier, or harder to shake can appear during perimenopause, sometimes alongside anxiety, irritability, or disrupted sleep. UK guideline NICE NG23 lists effects on mood — including depressive symptoms — among the core symptoms associated with menopause.

A 2026 systematic review pooling 12 observational studies in roughly 9,900 peri- and postmenopausal women found that women with heavier hot flash and night sweat burden had meaningfully higher odds of depressive symptoms — adjusted odds ratios ranged from 1.67 to 2.99 across the studies that reported them. The evidence was rated low certainty, and because most studies were cross-sectional snapshots, they cannot prove that vasomotor symptoms cause depression — only that the two tend to occur together, sometimes through shared pathways like poor sleep.

Depressive symptoms, or depression?

NICE NG23 draws an important distinction:

• Depressive symptoms that don't meet the criteria for a diagnosis of depression, with onset around the same time as other menopause symptoms, may respond to HRT or menopause-specific CBT.
• Depression that is suspected or already diagnosed should be managed using both menopause guidance and the standard depression-treatment guideline — the two are meant to work together, not instead of each other.

Only a clinician can tell which situation applies to you, so a new or worsening low mood deserves an assessment rather than a guess.

What can help (graded by evidence)

Option	Evidence grade	What guidelines say
Hormone therapy (HRT)	Moderate	NICE NG23 says HRT may be considered for depressive symptoms (not full depression) with onset alongside other menopause symptoms
Cognitive behavioral therapy (CBT)	Strong	Level I evidence from The Menopause Society (2023); also a NICE-recommended option, alone or alongside other treatments
Standard depression care (if diagnosed)	Strong	NICE recommends following its depression-in-adults guideline together with menopause-specific care
Over-the-counter herbal remedies, cannabinoids	Not supported	Not recommended by The Menopause Society (2023), Levels I–II

See our Does It Work? evidence directory before trying any supplement marketed for mood or "hormone balance."

Getting help now

Track your mood and plan your appointment

Logging when low mood happens — alongside sleep, hot flashes, and stress — in our private symptom tracker can help your clinician see the pattern.