[Fluctuating hormones, fluctuating mood? Depression in perimenopause].

Perimenopause is characterized by fluctuating and ultimately declining estrogen and progesterone levels and is associated with an increased risk of depression. Approximately 35% of women experience depressive symptoms, and up to 24% may develop a depression during the perimenopause. The etiology is multifactorial, involving both psychosocial and biological factors such as an individual vulnerability to hormonal fluctuations ('hormonal mood sensitivity'). Neurobiological mechanisms include interactions between the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-adrenal axes, as well as modulation of GABAergic signalling by allopregnanolone. Genetic and epigenetic factors may further contribute. Diagnosis is primarily clinical; routine hormone measurements are not recommended. Management includes psychoeducation, lifestyle interventions, and consideration of menopausal hormone therapy in selected cases, alongside standard treatment for depression when indicated. Increased awareness and targeted assessment of perimenopausal mood symptoms may improve recognition and care for this population.