Over twenty percent of women will experience a major depressive episode in their lifetimes, a prevalence that reflects a greater risk than is found among men. Perimenopause is commonly defined as a time of hormonal fluctuation that typically occurs in women 40-55 years of age with changes in menstrual patterns. It has been demonstrated that women may be at a particularly high risk for depressive symptoms during perimenopause. Hormone replacement therapy, particularly estrogen, may help with mood symptoms in the perimenopause. However, hormone replacement therapy (HRT) has become increasingly controversial in light of the findings of the Women's Health Initiative study. In that study, HRT was associated with an increased risk of some serious health problems without many of the benefits which had been previously attributed to HRT. Since the report of these results, HRT use has declined and other agents such as antidepressants have been used as an alternative treatment for depression in perimenopausal women.