One of the problems with perimenopause is that many women – especially those under 45 – don't realise they're going through it. Another problem is the trouble it can wreak with mood and mental health. Nutritionist Claire Turnbull shares her own personal story, and five invaluable tips for taking care of your body and mind during perimenopause.
I first started antidepressants at the age of 19 after reaching a point when I believed that the world would be better off without me. Thankfully, my flatmate intervened, and helped me get support, so I am still here to tell the story.
For years leading up to that day, and ever since then, I have been on a turbulent journey trying to manage my mental health. Depression, anxiety, post-natal psychosis, panic attacks, and further episodes of wanting to disappear forever. It has often been a difficult ride.
There have been times when things have gone well for months, when my world has felt lighter and my head clearer. But I've always been aware that another dark period may be just around the corner.
After experiencing post-natal depression following the birth of my youngest child in 2017, I eventually reached a period where I was managing pretty well for a few years. I had developed a toolkit that was helping me manage. My knowledge of nutrition and fitness combined with my training in positive psychology and wellbeing was working well.
But then my forties arrived, and things got messy again.
It was a Monday morning in April 2023. I had just dropped my boys off at school and needed to head to a meeting, but I was unable to move. A wave of despair came over me, and I sat in my car crying uncontrollably.
Nothing out of the ordinary had happened. It was just a normal weekday, with the usual rush to get lunch boxes done and everyone out the door for school and work. But I couldn’t stop the tears from coming. After crying until there was nothing left in me, I realised that for several months, maybe longer, I hadn’t been feeling right, but this felt different from my previous struggles.
The despair was there, along with hopelessness and panic, but it was much more up and down, far more inconsistent and unpredictable than ever before. It was also combined with rage, intolerance, and a loss of my sense of self. I noticed too that it seemed to follow a pattern around my menstrual cycle, which made me wonder whether hormones were playing a part.
From the car, I rescheduled my work meeting and called the doctor, who luckily had a cancellation. I drove to his practice, then waited in the car park outside for two hours until my appointment, just staring out the window. I walked in, burst into tears, and explained what was going on.
I asked my doctor if this could have something to do with my age and hormones, as it was different from past mood struggles. She said that I was too young for my hormones to be affecting how I felt in this way (I was 41), and that the best course of action was to restart antidepressant medication. I still felt there was more to understand, but I was desperate for relief, so I started taking them. After a couple of weeks, some of the despair started to lift, but unlike previous times, I still wasn’t feeling right or like myself.
So, I decided to dig deeper. I called my brother, who has trained as both a pharmacist and a medical doctor. He has a detailed understanding of medications and knows my long history of antidepressant use. He encouraged me to seek advice from another doctor who understood perimenopause and could assess whether menopausal hormone therapy (MHT, also known as HRT) might have a role in managing how I was feeling.
I took his advice and saw a GP who specialises in women’s health. She carried out a full assessment of my symptoms and advised me to start MHT. With her guidance, I also gradually came off my antidepressants. My mood improved considerably, along with other symptoms I now realise were related to perimenopause.
While the average age of menopause in New Zealand is 52, perimenopause can begin years before that, often in your forties, but sometimes earlier. So, for me, at 41, it was something worth considering.
Since then, I have met so many women personally and through my work who have had similar experiences: previous mental health challenges resurfacing, or mood difficulties appearing for the first time. Some had been prescribed antidepressants without a wider discussion about whether perimenopause might also be contributing, and what other support and treatment options could be considered.
My experience does not mean that MHT is the right answer for everyone. Depending on your symptoms and medical history, you may find that lifestyle changes, therapy and/or antidepressants are right for you. Or it could be that a combination of those things with MHT is your best approach.
I've shared my story in the hope that others facing challenges will feel better informed of the options available; and more confident about asking your doctor about whether perimenopause could be part of the picture. If possible, try to book with a GP who understands both mental health and perimenopause.
Looking back, here are five key things I wish I'd known.
1. This can be a more vulnerable time for mental health
The International Menopause Society’s latest guidance recognises perimenopause as a time of increased vulnerability to depression. A research review involving more than 9000 women found 40% higher odds of depressive symptoms or a depression diagnosis during perimenopause compared with before this transition. Difficulties can appear for the first time or return after years of feeling well. So, like me, if you feel unlike yourself – please remember, you deserve support, not self blame!
2. Hormones affect more than your periods
Oestrogen plays a role in brain systems involved in regulating mood. During perimenopause, levels fluctuate rather than simply declining steadily, which may contribute to anxiety, irritability, and feeling overwhelmed. Tracking your mood, sleep and menstrual cycle can help you explain changes to your doctor. Other contributors, including thyroid problems or iron deficiency may also need exploring, particularly iron deficiency if you have heavy periods.
3. What’s on your plate and in your glass matters
While no specific diet is proven to treat perimenopausal mood difficulties, research suggests Mediterranean style eating may help reduce depressive symptoms. Aim for five to six servings of vegetables and a couple of servings of fruit each day, alongside beans and lentils, wholegrains, nuts, seeds, olive oil and fish.
While getting adequate protein is talked about endlessly in this phase of life, protein alone is not a complete mental health strategy. The overall pattern of what you eat matters more than focusing on one nutrient.
It is helpful to review what you drink too. Caffeine can worsen anxiety and disrupt sleep, so notice how you feel and consider cutting back or switching to decaf options. Alcohol may feel relaxing initially, but it can worsen low mood and anxiety, and even relatively low amounts can disrupt sleep. Try reducing it or taking a break and notice the difference. Personally, I find I can’t really tolerate alcohol anymore, much as I like a good gin.
4. Movement supports your mind too
A large review of clinical trials found benefits for depression from walking or jogging, strength training and yoga. Start with something manageable, such as a ten-minute walk, and build from there. Outdoor activities, including walking in nature and gardening, also show promise for mental wellbeing, although the evidence is less certain. These findings concern mental health generally, rather than perimenopause specifically. Moving with a friend can make it more fun and easier to keep going.
5. Sleep and support deserve attention
Poor sleep and low mood can feed into each other. Keep your waking time reasonably consistent and allow time to wind down. Persistent insomnia or night sweats deserve help. Treatment for perimenopause symptoms or structured therapy for insomnia may be needed.
Tell someone you trust what is happening and ask for practical help. These everyday tools can support treatment, but needing medication or therapy does not mean you haven’t tried hard enough.
The information in this column is not intended as individual medical advice. If you 're concerned about your mental health, please seek professional medical advice, and do not stop or change prescribed medication without clinical guidance.
Claire Turnbull is a registered nutritionist with an honours degree in dietetics, a wellbeing educator and author.
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