Lately, you might feel off. Maybe you’re anxious for no clear reason, tearful one day, and irritable the next. Sleep is hard to come by, and your mind feels foggy. You might blame work, family, or simply getting older. But your hormones could actually be playing a big role.
If you’re between your late 30s and early 50s, perimenopause — the transitional phase leading up to menopause — may already be underway. And for women of color, this conversation is especially urgent.
What Is Perimenopause, Really?
Perimenopause is the years-long hormonal shift before your last period. Estrogen and progesterone don’t drop steadily; they go up and down a lot. These changes affect more than your cycle; they also affect your brain.
When estrogen and progesterone levels change during this time, they affect important brain chemicals like serotonin, norepinephrine, and dopamine. These hormones also influence stress response, inflammation, and brain health. Simply put, your hormones help regulate your mood. When they become unpredictable, your mood can too.
Menopause can bring psychological symptoms like anxiety, low mood, irritability, feeling disconnected, trouble sleeping, and low self-worth. All of this happens because hormonal changes affect the brain.
The Numbers Are Hard to Ignore
This isn’t just anecdotal. During perimenopause, women are 2 to 5 times more likely to develop a mood disorder like major depression and about 1.5 times more likely to develop an anxiety disorder, compared to before perimenopause.
A 2024 study found that women are 40% more likely to experience depressive symptoms and be diagnosed with depression during perimenopause than women who haven’t yet entered this transition. Additionally, about 4 in 10 women experience mood symptoms during perimenopause that feel like PMS. These include irritability, low energy, tearfulness, and difficulty concentrating, and may occur for years with no predictable pattern.
Why Women of Color Face a Greater Burden
There’s something the usual menopause conversation often misses: this experience can be even tougher for women of color.
Black women reach menopause about 8.5 months earlier than white women and often have more severe symptoms like hot flashes, depression, and trouble sleeping. Yet, they are less likely to get hormone therapy or mental and medical health care.
Latina and Black women experience menopausal symptoms for an average of 10 years, compared to 6.5 years for white women, and tend to experience them more intensely. Meanwhile, compared with white women, Black and Latina women were 26% and 32% less likely, respectively, to be prescribed hormone therapy for menopause symptoms, according to Healthline in a major U.S. study.
Research in the Journal of Women’s Health shows that structural racism, including barriers in housing, education, jobs, healthcare, and the justice system, makes it harder for women of color to get help for mental health challenges during menopause.
The ongoing stress of dealing with racism, money problems, and caregiving isn’t separate from your perimenopause experience. It’s part of it.
You’re Not Losing Your Mind — But You Do Need Support
A common and harmful myth is that depression or anxiety during perimenopause is just a normal part of aging you have to put up with. That’s not true. These are treatable medical conditions.
Treatment options include proven medications for mental health conditions, and hormone therapy can also help with mood symptoms during this stage of life. Research shows that women with more psychological resilience have fewer depressive symptoms and a better quality of life during perimenopause, no matter their hormone levels. Therapy, support from others, and lifestyle changes are all helpful tools.
Only about half of women in perimenopause, menopause, or after menopause talk to a healthcare provider about their symptoms. Even fewer — just 21% of menopausal women — get treatment for depression. This gap isn’t acceptable.
5 Steps to Take Right Now
1. Recognize what’s happening. Keep track of your mood changes, sleep, and cycle. Patterns are important, and having notes gives you more confidence when talking to your doctor.
2. Find a provider who understands menopause. Ask directly, “Are you trained in perimenopause care?” Look for clinicians connected to The Menopause Society or telehealth services for midlife women.
3. Ask about every option. Hormone therapy, SSRIs/SNRIs, therapy, and lifestyle changes like exercise, better sleep, and stress reduction are all backed by research. You deserve to know all your choices, not be dismissed.
4. Build your support network. Having social support helps protect against depression and anxiety during perimenopause. Find people, in person or online, who understand what you’re going through.
5. Speak up for yourself. If your symptoms are ignored, insist on being heard. Ask for referrals and bring someone you trust to appointments. Your experience matters as real clinical information.
Perimenopause isn’t a quiet change. For many, it’s a major shift that affects the whole body, especially mental health. But knowing what’s happening gives you power. The fog can clear, anxiety can lessen, and relief is possible. The first step is knowing it’s real.
Are you navigating perimenopause and mental health? Share this article with a sister, a friend, or a colleague who needs to see herself in this story.
Sources: PMC (2025); ScienceDirect (2024); The Lancet (2024); ACOG; Greater Good Science Center (2025); University of Michigan School of Public Health (2022); Journal of Women’s Health (2024); Healthline; SWAN Study.
MARCH 2026