Why it is so hard to tell apart
Perimenopause tends to arrive in the busiest, most pressured years of many women's lives, careers, teenagers, ageing parents, so there is rarely a shortage of ordinary reasons to feel stretched. At the same time, fluctuating hormones, broken sleep, and hot flushes can all feed a sense of being on edge. The two sources of strain overlap, which is exactly why they are hard to disentangle.
What the evidence actually says
A large review of prospective studies found no compelling evidence that the menopause transition universally increases the risk of anxiety, depression, bipolar disorder, or psychosis (The Lancet, 2024). That is an important corrective to the idea that midlife inevitably brings a mental health dip.
What the same review found is that specific groups are genuinely more vulnerable, particularly women with severe or sleep-disturbing hot flushes, a long transition, marked hormonal swings, or significant life stress. And the risk of major depression over the transition falls mainly on women who have experienced depression before. So the picture is not that menopause makes everyone anxious, it is that some women, for identifiable reasons, are more at risk, and they deserve to be recognised.
Why the distinction matters
Attributing every low or anxious spell to hormones carries a real cost. It can delay an accurate diagnosis and the right treatment, and it can set up negative expectations for women approaching this stage (The Lancet, 2024). Naming the difference is not pedantic. It is the difference between the right support and the wrong assumption.
That said, where broken sleep and hot flushes are clearly feeding the anxiety, easing those can lift the mood that sits on top of them, which is a useful thread to pull first.
When to talk to a GP
Please see your GP if anxiety or low mood is persistent rather than passing, if it interferes with your work, relationships, or daily life, if you have panic attacks, or if you have felt this way before. Depression and anxiety around menopause are treated on their own terms, not simply waited out. anna does not diagnose, and this article is not medical advice.