Perimenopause and anxiety and depression

I provide therapy and support for women with perimenopause. I focus on psychoeducation and remind them that this time frame is challenging and that most of society will not even acknowledge it. Perimenopause can begin as early as 35 and ends after your last period when menopause begins, which is usually sometime around 52. 

I've seen this period of perimenopause referred to in an article as puberty in reverse. However, I've rarely heard this discussed or seen doctors educate women about it. Women are unprepared for perimenopause and do not understand what's happening to their bodies. It is not at all uncommon to experience depression or anxiety, or both during perimenopause. You may feel extreme mood swings, have trouble remembering or experience not feeling like yourself. Women may have brain fog and feel overwhelmed at any point during this time of life. Some months may feel like extended versions of PMS symptoms, and you may have months or years of no libido or increasing libido. 

Why? Our bodies are going through a withdrawal from hormones, similar to what an addict would experience. It can be painful. Our hormones control everything! Furthermore, as a woman, you may find that no one seems to know or understand this process, and doctors seemingly have no sensitivity or knowledge about this.


ESTROGEN AND PROGESTERONE

The two main hormones are estrogen and progesterone. In perimenopause, this process of decline  is unpredictable. The decline may be gradual at times, and sometimes, the hormones will fluctuate wildly. These fluctuations often contribute to anxiety and depression. 

Estrogen dips are responsible for hot flashes and memory problems. Progesterone fluctuation can cause bloating and loss of sex drive. 

 For women, a slowing down of metabolism and weight gain is problematic for many beginning in their late thirties and increasing through each decade. Women highly correlate weight and youth with our sense of worth. From an early age, we are trained to believe as we age we become less valuable because our attractiveness decreases. For this reason, our slowing metabolism often contributes to issues of anxiety and depression. 

Additionally, women often care for children, our parents, and our spouses and have increased work responsibilities in our careers around perimenopause. Just when we need to reduce our stress and care for our bodies in the most gentle way possible, we are putting it through the most stress. These issues often contribute to anxiety and depression in perimenopausal women. 

Finally, there is no societal support for us during this time. Unlike society's understanding of teens going through puberty, no one seems to say of us when we are struggling, "It's just hormone withdrawal" It's just perimenopause, cut her some slack!" Lack of support and compassion from those around us often contribute to anxiety and depression. 

Some Symptoms of Perimenopause

  • hair loss
  • anger
  • bloating
  • hot flashes
  • heavy bleeding
  • missed periods, shorter periods, longer periods, irregular periods
  • sadness
  • fatigue 
  • mood swings
  • aches and pains
  • cramps and bloating
  • early  morning wakening
  • trouble sleeping
  • weight gain
  • depression
  • anxiety
  • acne 
  • breast pain
  • insomnia
  • sore breasts
  • nausea
  • irritability
  • headaches

Perimenopause and Depression and Anxiety 
Good mental health 
Tips to help


  • In my office, when I am providing therapy for women who are in perimenopause or any women for that matter, I will always encourage them to keep two calendars, one to track their menstrual cycle, the other to track moods and sleep habits. Observe any pattern that may be present. Is there a pattern that coincides with hormone jumps and plunges? 
  • Observing these patterns can help you to come up with a care plan during difficult times. Although these patterns may change due to the unpredictability of perimenopause, it can help you see that you are not crazy, understand when to reduce your stress, and get more in tune with your body. 
  • Find support in female friendships. Other women who are experiencing these same issues can help you feel less isolated and alone. 
  • Being to prioritize sleep and exercise for health. The kinds of exercise you do may need to change due to loss of muscle mass and bone density. Consult with your doctor
  • Get annual physicals with a doctor. Learn how to feel good about taking care of yourself when society doesn't encourage real self-care. 
  • Look for outside support if you have too much on your plate. Stress needs to be reduced during this timeframe because your body is withdrawing from hormones.
  • Watch the alcohol intake. Alcohol will disrupt your sleep cycle, which is already going to be unpredictable. 
  • Seek help from a therapist who is familiar with perimenopausal issues so that you have extra support 
  • Make sure your doctor has an understanding of female hormones. A sensitive and knowledgeable approach to the struggles with sleep, mood, and nutrition is essential


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Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.