Perimenopausal depression (PMD) is a common condition among women transitioning to menopause, characterised by various physical and psychological symptoms. This review explores the aetiology, clinical manifestations, and latest treatment approaches for PMD, highlighting the complexity and multi-factorial nature of the disorder. Key treatment strategies include hormone replacement therapy (HRT), antidepressants, traditional Chinese medicine (TCM), cognitive-behavioral therapy (CBT), and lifestyle modifications. Comprehensive and individualised treatment plans are essential for effectively managing PMD and improving the quality of life for affected women.