Is Your Low Mood Actually Hormonal?

If your doctor has recently suggested an antidepressant for mood changes, anxiety, brain fog, or low energy — and you're in your 40s or early 50s — there's something important they may not have mentioned. In women of perimenopausal age, those same symptoms are frequently driven by hormonal changes, not psychiatric ones. When the root cause is hormonal, antidepressants often provide little meaningful relief. The symptoms persist. And the actual cause goes unaddressed.

This isn't a fringe observation. It's a documented pattern, one that has now surfaced in peer-reviewed clinical research and received national media attention — including a segment that aired recently on Vegas PBS, featuring Professor Pooja Saini of Liverpool John Moores University, whose team spent years studying the intersection of perimenopausal hormones and mental health. What her research found is significant for any woman in her 40s or 50s who has been struggling to recognize herself in her own life.

The Diagnosis You May Have Received Was Incomplete

The standard clinical tool for detecting depression in primary care is the PHQ-9 — a nine-question checklist designed to identify depressive episodes. It has its place. What it was not designed to do is detect the hormonal drivers behind mood instability in perimenopausal women. Those are two different clinical problems, and a tool built for one doesn't reliably identify the other.

As Professor Saini described in a recent interview: "The medical model has traditionally interpreted women's midlife symptoms — such as low mood, fatigue or anxiety — as psychological, related to depression or stress, rather than recognising them as physiological symptoms of hormonal transition."

The result is a well-documented gap in care. A woman in perimenopause arrives at her doctor's office with new, unfamiliar mood symptoms. The doctor runs a standard screening. The screening misses the hormonal signal. She leaves with an antidepressant that doesn't address the underlying cause — and no evaluation of her hormones.

Hendriks et al., BJPsych International, 2026; Hendriks et al., BJPsych Open, 2024 — Liverpool John Moores University & Newson Clinic (957-patient cohort).

What the Research Actually Shows

Published in BJPsych International in January 2026, the study examined data from 957 perimenopausal and menopausal women attending a specialist hormone clinic in the UK. Nearly all of them — 98% — reported mood or mental health symptoms at their first appointment. More than 70% were experiencing moderate to severe emotional distress or low mood. And women who began hormone therapy reported substantial improvements in mental wellbeing.

In the companion study, women who had reported the most severe mood symptoms saw those symptoms reduced by more than 90% after beginning treatment with estradiol, progesterone, and testosterone. That's not a modest effect. For context: of the women who had seen a GP for these symptoms, 32 found hormone therapy effective. Only five reported meaningful improvement on antidepressants — and 14 reported no improvement at all.

A separate systematic review, examining 19 studies published between 1987 and 2025, found that 84% reported an association between the menopausal transition and increased emotional and psychological difficulty — with the perimenopausal phase specifically identified as the highest-risk window.

Why Your Hormones Drive Your Mood

Estrogen, progesterone, and testosterone are not only reproductive hormones. They are active regulators of the central nervous system, and their influence on mood is direct and clinically significant.

Estrogen supports serotonin synthesis and sensitizes serotonin receptors — the same neurochemical pathway targeted by most antidepressant medications. When estrogen fluctuates or declines, serotonin availability becomes unstable, and mood follows. Progesterone modulates GABA, the brain's primary calming neurotransmitter. As progesterone drops in perimenopause, the GABA system loses a major regulatory input — which can manifest as anxiety, sleep disruption, and a constant sense of unease. Testosterone supports drive, motivation, cognitive clarity, and emotional resilience in women. Its decline often reads as flatness, disengagement, or loss of interest in things that used to matter. If you're specifically wondering about testosterone therapy for women — what it is, who it's right for, and what to expect — that's covered separately.

When all three begin to shift simultaneously — which is precisely what happens during perimenopause — the downstream effects on mood, cognition, sleep, and emotional regulation can be significant. And critically: these symptoms often appear in women with no prior history of depression or anxiety. In the research above, most participants had never experienced these symptoms before perimenopause began. For a woman who has always been emotionally stable, the sudden onset of these experiences in her 40s is frequently a hormonal story, not a psychiatric one.

Symptoms Worth Evaluating

The perimenopausal mood symptoms that most commonly go unrecognized — or get misattributed to stress, overwork, or personality — include:

• Low mood or emotional flatness — a persistent sense of not feeling like yourself
• Anxiety that appeared recently with no obvious trigger or external cause
• Irritability or emotional reactivity that feels out of proportion to circumstances
• Brain fog — difficulty concentrating, word retrieval issues, or a sense of mental slowness
• Sleep disruption, particularly waking between 2 and 4am with a racing or ruminating mind
• Low motivation, reduced drive, or loss of interest in things that previously energized you
• A persistent sense of dread, unease, or apprehension without an identifiable cause
• Feeling overwhelmed by demands that previously felt entirely manageable

If several of these sound familiar, and particularly if you've noticed that they correlate with changes to your cycle, sleep, or energy — or if they appeared around the same time those changes began — it's worth having your hormones properly evaluated before assuming the problem is psychiatric.

What a Real Hormone Evaluation Looks Like

Evaluating hormonal contributors to mood is a different clinical exercise than a standard wellness panel. A meaningful evaluation looks at estradiol, progesterone, free and total testosterone, DHEA-S, thyroid markers, and often cortisol — and it interprets them in the context of a woman's full symptom picture, not just against a broad population "normal" range that may not reflect optimal function for her age and physiology.

It also requires time and a real conversation. Understanding how a patient is sleeping, how her cycle has changed over the past year, what's happening with her energy levels, cognitive function, libido, and emotional stability — and building a complete clinical picture — requires more than a 10-minute appointment. That's the gap in standard primary care. And it's the gap the assessment at Body Balance Medical is designed to fill.

The Hormone Optimization Assessment with Mia is structured as a comprehensive, one-hour evaluation. You leave with a clear understanding of where your hormones stand, what's driving your symptoms, and what a treatment plan would look like for you specifically. For a deeper overview of how BBM approaches hormone optimization for women and men in Las Vegas — including what to expect, treatment options, and the full program — that page is worth reading before you apply.

Mia LoPreiato, NP

Hormone & Longevity Nurse Practitioner · Biote-Certified

Mia is Body Balance Medical's hormone and longevity specialist and the provider who conducts all Hormone Optimization Assessments. She brings focused clinical expertise in women's hormone health — including the relationship between hormonal shifts and mood, sleep, cognitive function, and quality of life. Mia is Biote-certified, with training in individualized hormone optimization using bioidentical hormones. Every assessment is a full hour, and every treatment plan is built around your specific labs, symptoms, and goals — not a protocol. Read more about Mia and the full BBM clinical team.

Who the Hormone Optimization Assessment Is Right For

The assessment is a natural fit for women who:

• Are in their late 30s through mid-50s and experiencing mood, energy, or cognitive changes they can't explain
• Have been prescribed antidepressants but haven't seen meaningful improvement in how they feel
• Notice their symptoms correlate with changes to their menstrual cycle, or appeared around the same time those changes began
• Want a thorough clinical evaluation — not a rushed visit and a prescription — before deciding on a treatment path
• Are curious about whether hormone optimization could complement or reduce the need for their current medication regimen

We also regularly see women who are on antidepressants and doing reasonably well, but wondering whether there's a hormonal piece that hasn't been addressed. That's a legitimate clinical question, and it's exactly the kind of conversation the assessment is built for. Nothing about coming in for a hormone evaluation requires changing anything else first.

Body Balance Medical is a LegitScript-certified medical clinic in Summerlin, Las Vegas — serving Las Vegas, Henderson, and the greater valley. Our providers are licensed, credentialed practitioners operating within the standards of a Nevada medical practice. Named providers. Real clinical oversight. A physical location where accountability is built in from the start.

A Note on the Research

The studies cited in this article were conducted in the UK, through the Newson Clinic — a specialist hormone and menopause clinic — in partnership with Liverpool John Moores University. These are observational and qualitative studies, not randomized controlled trials. They are meaningful in scope (the largest cohort included 957 patients) and published in peer-reviewed Cambridge journals. They reflect clinical patterns that are consistent with what many providers see in practice — and with what many women experience but have not had the language or clinical framework to articulate.

This article is written for educational purposes. It is not a substitute for a clinical evaluation and should not be used to self-diagnose or to modify any existing treatment plan without the guidance of a licensed provider. If you're uncertain whether a hormonal evaluation is right for you, the honest answer is that uncertainty is exactly what the assessment is designed to resolve.

For a deeper clinical guide on perimenopause and depression — covering the biology in full, treatment options, lifestyle strategies, and an FAQ — see our companion piece: Perimenopause Depression: When Hormones Disrupt Your Mood.