Perimenopausal depression (PMD) is a kind of mental disease that occurs during the perimenopausal period accompanied with typical clinical manifestations of emotional depression, anxiety, and thinking retardation. The pathogenesis of PMD mainly includes hormone levels, neurotransmitters, inflammatory reactions, and brain-derived neurotrophic factor. It has been suggested that Traditional Chinese medicine affects PMD. In this review, the pathogenesis of PMD is discussed in order to provide a reference for mechanistic research and treatment of PMD.