Where Movement Fits in Psychiatric Care for Depression During Perimenopause
Psychiatric care for depressive symptoms during perimenopause can include a conversation about movement, with your physical limits part of that conversation from the start. A review of exercise trials found improvements on depression symptom scales, but the evidence has limitations.[1,2] Those findings are a reason to discuss movement alongside your care. They are not a promise that movement will treat or cure depression.
At Dahlia Center, we provide virtual psychiatric and hormonal health care for women and gender-diverse adults in Illinois. Understanding the hormonal context adds depth to a psychiatric assessment, without reducing every concern to perimenopause.
Depression deserves attention during the transition
A 2024 review by Badawy and colleagues found higher odds of depressive symptoms or a depression diagnosis during perimenopause than before it. The studies described their participants as women; the findings do not establish how results vary across gender identities. The pooled odds were about 1.4 times the odds before perimenopause. That is a comparison between groups, not a statement that 40% of people will develop depression.[3]
The review did not find a statistically significant increase after menopause compared with before it. It could not directly compare perimenopause with postmenopause, so it does not establish that one stage is harder than the other.[3]
That risk is the reason we screen for depression in this age range rather than waiting for someone to bring it up, and it is the reason a conversation about movement during perimenopause is a psychiatric conversation first.
What the movement research found
Saidel and colleagues' review, published in Menopause in October 2026, included 12 randomized trials with 1,003 participants overall. Eligible studies involved participants described as women, ages 40 to 65, in perimenopause or early postmenopause. Physical activity was compared with usual care or another activity. Average depressive symptom scores improved, including in the perimenopause subgroup.[1]
The total enrollment should not be read as the sample size for every outcome. A change on a symptom scale also does not establish that a diagnosed depressive episode resolved.
The distinction between outcomes matters. Aerobic programs, including walking and dance, had the strongest depressive-symptom findings in this review. Mind-body activities, including yoga, showed improvements in psychological quality of life. Feeling better about aspects of daily life and scoring differently on a depression measure are related questions, but they are not interchangeable results.[1,2]
The university's report describes substantial differences between studies and many trials at high risk of bias. Those weaknesses limit how confidently the findings can guide an individual's care.[2]
Put the findings in proportion
Research in depression more broadly offers context. Noetel and colleagues' 2024 BMJ review included 218 trials and 14,170 participants who met clinical thresholds for major depression. It found lower depression scores with several forms of exercise compared with active controls. Confidence in the evidence was low for walking or jogging and very low for other approaches; only one study met the review's criteria for low risk of bias.[4]
This broader review does not tell us what a particular person in perimenopause should do. It also does not make an exercise schedule a prerequisite for psychiatric care. You do not need to arrive at an appointment with a successful walking routine to have your symptoms taken seriously.
Keep the psychiatric conversation bigger than exercise
Movement is one topic to bring into an assessment. Your history and what has changed in your daily life belong there too. If you have been trying to exercise your way out of low mood for months, bring that experience to your provider. It is information about what you have tried, not a reason to blame yourself or keep raising the target.
The useful conversation is specific. Describe what you can manage on an ordinary day and what happens afterward. Tell your provider what gets in the way of activities you enjoy. There is a difference between disliking a gym and being unable to stand comfortably long enough to get through a shower. A plan needs to account for that difference.
If pain or other symptoms limit activity, include them in the discussion before choosing an exercise plan. These reviews do not give us an individualized safety plan for someone with a medical condition.
Making the conversation practical
The following are suggestions for discussing preferences with your provider, rather than findings from the trials or instructions to begin exercising.
Start with what is accessible. A class that costs money and requires a free evening may be out of reach. If a short walk is something you can comfortably manage, that can be the example you discuss. If it is not, say that. You do not have to substitute an activity before describing the problem.
Consider what fits into the day you already have. You might prefer an activity linked to an existing routine over another appointment on your calendar. The point is to identify what feels possible, without turning a research finding into another obligation.
Include your preference for company. Most programs in the menopause review were group-based, but that does not prove social contact caused the changes.[2] A walking partner may sound welcome; being around people may feel like more work. Either response belongs in the conversation.
Leave room to change the plan. Ask what to do on days when your capacity is different and how you will decide whether an activity fits. A rigid target is not the only way to organize that discussion.
If you choose to keep notes, write down how you felt during an activity and later. Bring the notes to your appointment. They can help you describe your experience without having to remember a month's details on the spot.
Starting care at Dahlia Center
Prospective psychiatric care begins with a virtual Intake Assessment. Our Intake Coordinators review your concerns and help match you with the psychiatric or hormonal health provider, or combination of providers, that fits. All appointments are telehealth for patients located in Illinois.
We are in network with BCBS PPO, Blue Choice PPO, Cigna PPO, Aetna PPO, and United Healthcare/Optum PPO. We do not accept Medicare or Medicaid. See appointment and insurance information or schedule an Intake Assessment.
References
Saidel S, Hardy R, He L, Desai R, Robinson K, Spector A. The effectiveness of physical activity interventions on non-physiological symptoms of menopause: a systematic review and meta-analysis. Menopause. Published October 13, 2026. PubMed.
University College London. Physical activity may improve mood and quality of life during menopause. October 13, 2026. University report about the same review.
Badawy Y, Spector A, Li Z, Desai R. The risk of depression in the menopausal stages: a systematic review and meta-analysis. Journal of Affective Disorders. 2024;357:126-133. PubMed.
Noetel M, Sanders T, Gallardo-Gomez D, et al. Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ. 2024;384:e075847. PubMed.
