Cognitive and mood-related changes are common during the menopause transition, particularly in perimenopause, and can significantly affect daily functioning and quality of life. Approximately 40–60% of women report cognitive symptoms such as forgetfulness, difficulty concentrating, memory lapses, and “brain fog.” At the same time, fluctuating hormone levels can contribute to anxiety, irritability, mood swings, and depressive symptoms, while pre-existing mental health conditions may worsen during this stage. Although major depressive disorder (MDD) is less common than general depressive symptoms, research suggests the risk of new or recurrent MDD may increase two- to fourfold during perimenopause. Reassuringly, many cognitive symptoms tend to stabilize and improve after menopause.
Treatment options for mood concerns during menopause may include menopausal hormone therapy (MHT), which can also improve sleep, genitourinary symptoms of menopause (GSM), and help prevent bone loss.
Non-hormonal prescription options such as SSRI or SNRI antidepressants may also be beneficial.
Lifestyle strategies play an important role and can include regular physical activity, mindfulness practices, journalling, cognitive behavioural therapy (CBT), good sleep hygiene, healthy dietary habits, and engaging in mentally stimulating activities such as reading or learning new skills.
