Low mood

A heaviness that settles in and stays. The NHS website says a low mood can make you feel sad, anxious or panicky, angry or frustrated, and low on confidence, and can leave you tired or sleeping badly. It often lifts after a few days or weeks.

The NHS lists low mood among the symptoms of menopause and perimenopause. NICE NG23 uses the term depressive symptoms for low mood that does not meet the criteria for a diagnosis of depression, and has separate recommendations for each. This page is about the first; only a clinician can say which you have.

Flat. Heavy. The things you used to look forward to feel like chores: a wedding, a phone call from your sister, cooking for Eid. You laugh at the right moments and feel nothing behind it. Some days it tips into tears, other days into snapping at everyone.

In Urdu many women say dil nahin lagta, my heart is not in it. It rarely sounds medical, which is how it gets missed.

The European Menopause and Andropause Society (EMAS) says depressive symptoms are more common in perimenopause than in the years before it: they affect 45 to 68% of women in perimenopause, against 28 to 31% before.

The Pakistan Menopause Society's recommendations describe mood changes, along with memory and concentration problems and poor sleep, as the neuropsychological symptoms of the menopause. They also note that women with a past history of depression or anxiety are at higher risk of those symptoms getting worse during the transition (section 7.2).

Sleep is part of it. The NHS website says mood symptoms can feel worse when you are not sleeping and very tired, so sleep disruption and low mood often travel together.

Life is part of it too. The NHS low mood page lists pressure at work, family and relationship difficulties, caring for someone, money worries, illness and bereavement among the causes. Sometimes, the NHS says, there is no obvious reason at all.

• The NHS website suggests talking to someone you trust, peer support, regular exercise, regular meals and mindfulness. It also suggests setting small targets, and not leaning on alcohol, cigarettes or other drugs to lift your mood.
• The Pakistan Menopause Society says mental health problems in Pakistan are often missed because of stigma. It describes mindfulness as practical, low-cost and culturally adaptable, and asks doctors to involve the family in counselling, since support at home shapes how women look after their health (section 4.2.4).

NICE NG23 tells doctors to consider HRT for depressive symptoms that started around the same time as other menopause symptoms, and to consider CBT when low mood comes with hot flushes or night sweats (1.5.21 and 1.5.22). The PMS recommendations say MHT, their word for HRT, may improve mood, sleep and quality of life, especially alongside hot flushes, and list CBT, stress management, support groups and education about the menopause. They keep antidepressants for moderate to severe mood disorders, after a specialist has assessed them (section 7.2).

That order matters. The Rawalpindi audit of women treated for depression, presented at a conference in 2024, found that treatment had mainly been antidepressants, used by 82%, and that 8% had received psychological counselling, while 78% had perimenopausal symptoms nobody had recognised (Gul, 2024). If an antidepressant is offered, asking what it is for is a fair question.

The NHS website says to see a GP if your low mood has lasted more than 2 weeks, you are struggling to cope, or the things you are trying are not helping.

The Pakistan Menopause Society lists severe depression and suicidal thoughts among the red flags that need evaluation or referral (section 2.3).

The PMS recommendations themselves describe salah, dhikr and dua as daily practices that help with emotional regulation (section 4.2.4.7). Some women still ask whether feeling this low means something is wrong with their faith. That is a question for a qualified scholar, and it is not a reason to keep your mood from your doctor.

At home, low mood is easy to read as being ungrateful or difficult. A name for it, and a page to show the family, can help.