Perimenopause suicidal thoughts: what the research says about hormones, risk and getting help

Thoughts of not wanting to be here sometimes show up for the first time in a woman's mid-forties, with no history of depression behind them. Perimenopause suicidal thoughts are one of the least discussed symptoms of the transition. In a 2026 study of 957 women at their first appointment with a UK menopause clinic, 16.6% said that in the previous two weeks they had thought they would be better off dead or had thought about hurting themselves.

Estrogen and progesterone do more than run the menstrual cycle. Both act on brain circuits that regulate mood, sleep and the stress response. When they swing up and down in perimenopause, mood swings with them, and for some women the swing goes far lower than ordinary sadness. Add months of broken sleep, night sweats and an appointment that ends with "it's your age," and the weight builds.

This article explains what the research says about menopause and suicide risk, why perimenopause looks like the most vulnerable stage, what the widely shared 92% HRT figure does and does not show, and which treatments have evidence behind them.

• Perimenopause suicidal thoughts and suicide risk: what the research says
• Why perimenopause suicidal thoughts cluster in the transition
• HRT and suicidal thoughts: what the 92% figure means
• Treatment for menopause suicidal thoughts and low mood
• A note on supplements, antidepressants and safety
• Frequently asked questions

Finding	What it tells you
Midlife women have the highest female suicide rate in the US	Women aged 45 to 64 had the highest rate of any female age group in 2023 and 2024, at 8.6 and 8.1 per 100,000. Age data alone does not prove menopause is the cause.
16 of 19 studies found a link	A 2025 systematic review tied the menopause transition to higher suicidality, with perimenopause the most vulnerable stage.
1 in 6 women at a menopause clinic reported suicidal thoughts	159 of 957 women answered yes to one standard questionnaire item at their first visit.
The 92% HRT figure is a score drop, not a cure rate	Among women with thoughts at the start, the average score on that item fell from 1.37 to 0.11 over about 107 days. There was no comparison group.
Antidepressants and therapy remain front-line for depression	2018 guidelines from The North American Menopause Society say so. Estrogen shows antidepressant effects in perimenopause, not after menopause.
Treatment changes the numbers	In the clinic study, the share of women reporting suicidal thoughts fell from 16.6% to 6.8% after treatment began.

Perimenopause suicidal thoughts and suicide risk: what the research says

In 2024, US women aged 45 to 64 had the highest suicide rate of any female age group, 8.1 deaths per 100,000, according to a September 2026 data brief from the CDC's National Center for Health Statistics. The same age band led in 2023, at 8.6. The overall female rate fell over that year, from 5.9 to 5.6. Midlife stayed on top.

Most women reach menopause between 45 and 55, and perimenopause starts years earlier. The ITV report that sent this topic around TikTok made the same point about UK figures. The overlap is striking, and it is also where careful reading has to start. Midlife brings divorce, caring for aging parents, teenagers, job pressure and new health diagnoses. An age table cannot separate hormones from everything else happening at 48.

Stronger evidence comes from studies that look at menopause stage directly. A 2025 systematic review in the journal Women's Health screened 3,837 records and kept 19 studies published between 1987 and 2025. Sixteen of them, 84%, reported an association between the menopause transition and increased suicidality. Perimenopausal women stood out, with higher rates than women before or after the transition. Early menopause and primary ovarian insufficiency, where the ovaries stop working before 40, carried some of the highest risk.

The review's authors were plain about the limits. Most of the studies were observational. Most relied on self-report. Studies defined menopause stages in different ways, and few followed the same women over time. That combination supports an association. It does not prove hormones cause suicidal thoughts.

What it does support is screening. A symptom that shows up in 16 of 19 studies deserves a direct question at every menopause appointment, the same way doctors ask about hot flashes.

Most appointments skip it.

Why perimenopause suicidal thoughts cluster in the transition

The review grouped risk factors into three buckets: hormonal change, psychosocial factors such as prior mental health conditions and thin social support, and cultural attitudes toward menopause. In a single woman these rarely act alone. They stack.

Swings, not only decline

Perimenopause is not a smooth slide in estrogen. Levels spike and crash from month to month, sometimes week to week, before settling low after the final period. Guidelines on perimenopausal depression from The North American Menopause Society and the National Network of Depression Centers call perimenopause "a window of vulnerability" for both depressive symptoms and major depressive episodes. The risk rises even in women with no prior history of depression. That matches what women describe: a mood they do not recognize, arriving in a body they thought they knew.

Symptoms that wear a person down

Night sweats break sleep. Broken sleep lowers the threshold for despair, and months of it drain the reserves a person uses to argue back against dark thoughts. The same guidelines tell clinicians to treat sleep disturbance and night sweats as part of treating menopause-related depression, not as a separate complaint.

Thoughts the usual screening misses

In the 957-woman clinic study, the researchers reported that suicidal thoughts did not consistently track with overall depression questionnaire scores. A woman who scores in the moderate range on a depression screen and looks fine in a 10-minute appointment still carries them. If nobody asks the specific question, nobody hears the answer.

Put together, perimenopause loads a woman with hormonal instability, poor sleep and a new vulnerability to low mood, then too often sends her home without the right question asked.

The question is the gap.

HRT and suicidal thoughts: what the 92% figure means

The figure behind the viral clips comes from a 2026 study in BJPsych International by researchers at Liverpool John Moores University and a private UK menopause clinic. They reviewed records from 957 women who completed two mood questionnaires at their first appointment and again two to six months after starting or adjusting hormone therapy. Follow-up averaged 107 days.

Suicidal thoughts were measured with one item from a standard depression questionnaire: thoughts that you would be better off dead, or of hurting yourself. At baseline, 159 women, 16.6%, answered yes. At follow-up, 65 women, 6.8%, did. Among the women who had those thoughts at the start, the average score on that item fell from 1.37 to 0.11 on a scale of 0 to 3. That drop is the 92%.

So the figure does not mean 92% of women stopped having suicidal thoughts. It means the women who had them reported them far less often and far less intensely a few months later. The overall share with any such thoughts fell by more than half.

That is a large change, and it lines up with what many women report after starting hormone therapy. The study also has real limits, and the authors listed them:

• There was no comparison group. Some improvement in any group of distressed people happens with time, attention and the relief of finally being taken seriously.
• The women attended a private clinic and chose hormone care, so they are not typical of every woman in midlife.
• Suicidal thoughts were measured with a single item, and hormone doses and delivery routes were not recorded.
• The data came from the clinic's own records, and the clinic's founder is a co-author.

None of that makes the finding wrong. It makes it a strong signal that needs a randomized trial, not a settled answer.

Pro Tip: Doctors respond to specific words. If hormones are part of what you want to discuss, say "I have been having thoughts that I would be better off dead" out loud, and name the timing: when the thoughts started, whether they follow your cycle, and whether they began alongside night sweats or sleep loss. Specific language gets a different response than "I've been feeling low."

Treatment for menopause suicidal thoughts and low mood

The frustration at the center of the ITV report is real: some women are handed an antidepressant with no questions about their cycle, or told they are too young for menopause. The opposite mistake is also real. Estrogen is not approved to treat depression, and the NAMS guidelines state that antidepressants and psychotherapy are the front-line treatments for perimenopausal depression. The best care asks about both.

Approach	Pros	Considerations	Best for
Crisis support (988, Samaritans, emergency department)	Immediate, free, available around the clock	Short-term by design, connects you to ongoing care	Feeling unsafe, having a plan, or thoughts that feel urgent
Antidepressants (SSRIs, SNRIs)	Front-line for major depression, some also reduce hot flashes	Several weeks to work, needs close follow-up in the first weeks, never stop suddenly	Diagnosed depression, low mood across most of the day
Talk therapy (CBT and others)	Front-line for depression, skills last after treatment ends	Waitlists and cost vary	Hopelessness, rumination, anxiety alongside low mood
Hormone therapy	Evidence of antidepressant effects in perimenopausal women, especially with hot flashes	Not approved to treat depression, not effective for depression after menopause, not right for every medical history	Low mood that arrived with night sweats, hot flashes or cycle changes
Combined care	Treats mood and physical symptoms at the same time	Needs a clinician comfortable with both menopause and mental health	Women whose mood and menopause symptoms feed each other

Hormone therapy and antidepressants are not rivals. Plenty of women do best on both. If you already take an antidepressant and suspect hormones play a part, the answer is to add the hormone conversation, not to stop the medication. Stopping an antidepressant abruptly causes discontinuation symptoms and often worsens mood, so any change goes through the prescriber.

A doctor who dismisses the hormone question is not the last doctor available. The Menopause Society's online practitioner search lists clinicians certified in menopause care, and many offer telehealth.

Know when to seek professional evaluation:

• You have any thoughts of ending your life, even brief ones that pass: call or text 988, or tell your doctor this week
• You have made a plan or feel you might act: call 988 or go to an emergency department now
• Low mood has lasted most days for two weeks or more
• Dark moods follow a pattern in your cycle, arriving in the days before a period
• Your mood worsened after starting, stopping or changing an antidepressant or hormone therapy
• Night sweats or insomnia have broken your sleep for weeks

A note on supplements, antidepressants and safety

No supplement treats suicidal thoughts. That includes Botavive's. If you are reading this because the thoughts are yours, the first step is a person, not a product: the 988 Lifeline, a doctor or someone you trust.

Supplements also carry a specific risk for women on antidepressants. St. John's wort and 5-HTP both increase serotonin activity. Taken with an SSRI, SNRI or several other prescription drugs, they raise the risk of serotonin syndrome, a reaction that needs urgent care. St. John's wort also weakens the effect of many medications, including hormonal birth control and blood thinners. Botavive Tranquility and Botavive Dream both contain St. John's wort and 5-HTP. If you take an antidepressant, do not start either one, or any product with those ingredients, without your doctor's or pharmacist's approval.

Supplements belong later in a plan, after a clinician has seen you and your mood is steadier, as support for sleep or everyday stress. They are never a substitute for treatment.

Frequently asked questions

Does perimenopause cause suicidal thoughts?

The research shows an association, not a proven cause. A 2025 review found 16 of 19 studies linked the menopause transition to higher suicidality, most strongly during perimenopause. Hormone swings, broken sleep, prior mental health history and limited support all appear to contribute.

What does the 92% HRT figure mean?

It comes from a 2026 study of 957 women at a UK menopause clinic. Among women who had suicidal thoughts at their first visit, the average score on one questionnaire item fell 92% after about three and a half months of hormone therapy. The share of all women reporting such thoughts fell from 16.6% to 6.8%. The study had no comparison group, so it is a promising signal rather than proof.

Should I stop my antidepressant and ask for HRT instead?

No. Do not stop an antidepressant on your own. Antidepressants and therapy remain front-line treatments for depression, and hormone therapy is not approved to treat it. If you think hormones are part of the picture, ask your prescriber about adding a menopause assessment to your current treatment.

Do these thoughts go away after menopause?

The 2025 review found perimenopause carried higher rates of suicidality than the years after the final period, so for many women the worst window is the transition itself. Waiting it out is not a plan. In the clinic study, the share of women with suicidal thoughts more than halved within months of starting treatment.

How do I bring this up with my doctor?

Say it plainly: "I have been having thoughts that I would be better off dead." Then add the context that points to menopause: your age, cycle changes, night sweats, sleep loss, and whether the thoughts follow your cycle. If you feel dismissed, ask for a referral or book with a certified menopause practitioner, and call 988 in the meantime if the thoughts get stronger.

Sources

1. Garnett MF, Zehner AM, National Center for Health Statistics, 2026. Changes in suicide rates in the United States from 2023 to 2024, NCHS Data Brief No. 572. cdc.gov/nchs/products/databriefs/db572.htm
2. Hendriks O, McIntyre JC, Rose AK, Sambrook L, Reisel D, Crockett C, Newson L, Saini P, 2025. Menopause and suicide: a systematic review. Women's Health. doi.org/10.1177/17455057251360517
3. Hendriks O, Kamal A, Saini P, Rose AK, Reisel D, Newson L, McIntyre JC, 2026. Improving detection and treatment of psychological distress during menopause: evidence from a clinical hormone replacement therapy cohort. BJPsych International. doi.org/10.1192/bji.2025.10094
4. Maki PM, Kornstein SG, Joffe H, et al., 2018. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Journal of Women's Health. doi.org/10.1089/jwh.2018.27099.mensocrec

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