Perimenopausal Depression & Anxiety

What is Menopause?

Menopause is a normal stage of aging for women, when their menstrual periods permanently stop and they are no longer able to become pregnant. Menopause typically occurs between the ages of 45 and 55, with the median age being 51.

What is Perimenopause?

Perimenopause is the period of time leading up to menopause, when hormonal changes and fluctuations are occurring, that lead to menopause.

When individuals talk about symptoms such as hot flashes, night sweats, insomnia, mood swings, and anxiety related to this change of life, they are typically referring to symptoms during perimenopause. Perimenopause can be very difficult to manage (physically and emotionally) as there are significant hormonal shifts that are occurring during the perimenopausal period, that can lead to physical and emotional distress.

What are the Physical Symptoms of Perimenopause?

Physical Symptoms of Perimenopause may include:

• Irregular menstrual cycles, which may become shorter, longer, lighter, heavier, more frequent or less frequent. Basically, there are significant changes from one’s “normal” regarding their menses and associated symptoms. These symptoms are irregular and less predictable.
• Hot flashes
• Night Sweats and difficulty with sleep
• Joint and muscle discomfort
• Pain during sexual activity

Why does Perimenopause Cause Depression, Anxiety and other Psychiatric Symptoms?

Healthy brain chemicals such as Serotonin, Norepinephrine and Dopamine (the same chemicals that many anti-depressants work to increase) can be affected by hormones such as Estrogen and Progesterone. During the perimenopausal period, there are significant shifts in the production of these hormones, which can lead to psychiatric symptoms, such as increased anxiety, and even depression.

Individuals who have a history of depressive illness (such as major depressive disorder, bipolar disorder or pre-menstrual dysphoric disorder) are particularly vulnerable to depression during the perimenopausal period.

The perimenopausal period is particularly challenging, as fluctuations in these hormones are not consistent, which can lead to intense mood swings and an inability to predict one’s emotional well-being, month-to-month, week-to-week, and even day-to-day.

How Does Perimenopause Affect Sleep and Cause Insomnia? 

Difficulty with sleep and insomnia are common throughout the perimenopausal period. One of the reasons for this is due to the hot-flashes and night sweats, that are extremely common during this period of time.

What Treatments are Available for Perimenopausal Anxiety, Insomnia & Depression?

Individuals struggling with anxiety, depression, insomnia or other psychiatric symptoms during perimenopause would likely benefit from the collaboration between a Women’s Mental Health Expert and their primary care provider and/or OGBYN.

In particular, if a woman has a history of psychiatric illness (including depressions), we believe that it’s vital to include a mental health professional in one’s treatment.

Our Women’s mental health experts are able to perform a through Psychiatric evaluation, and with a signed release, coordinate services with your medical provider.

• Hormonal patches, oral medications and/or low-dose birth control pills may be a helpful option for individuals struggling with perimenopausal symptoms.
  • Of note, hormonal therapy may not be safe for individuals who smoke, have elevated blood pressure, have a history of blood clots, or suffer from other medical conditions.
• Psychiatric medications may be necessary, if symptoms are not responding appropriately to hormonal therapy, if symptoms are moderate or severe, if individuals are advised against hormonal therapy due to risks, or if an individual has a history of psychiatric illness, pre-dating perimenopause. Medications utilized may include (but are not limited to) anti-depressants such as SSRIs, SNRIs, Wellbutrin and others.
• Psychotherapy may also be an effective tool, by itself, or in-conjunction with, medication management.

When Should I get an Evaluation for Treatment of Perimenopausal Anxiety, Depression or Insomnia?

We recommend that individuals schedule a psychiatric evaluation with a women’s behavioral health specialist, when Perimenopausal Psychiatric symptoms include:

• Depression, Sadness or feelings of hopelessness
• Anxiety or feeling overwhelmed
• Increases in irritability or anger
• Difficulty with sleep, that affects one’s energy level or mental well-being
• Changes in appetite or weight
• Decreased ability to be present, or enjoy the things that one typically enjoys
• Difficulty with focus or memory
• Crying episodes
• The use of poor coping mechanisms in an attempt to improve symptoms (such as alcohol or substance use, self-harm, or others)
• When symptoms cause distress in relationships, academic or occupational life.
• When an individual has thoughts of suicide
  • Call 911 or 988 if this occurs, prior to scheduling an appointment.

Do You Offer Both In-office and Virtual Online Psychiatric Appointments for Perimenopausal Anxiety, Depression and Insomnia?

Yes, we offer both in-office and virtual online psychiatric appointments for the treatment of Perimenopausal psychiatric symptoms.

Why Choose Rittenhouse Psychiatric Associates for my Women’s Mental Health Treatment, and Perimenopausal Symptom management?

The providers at Rittenhouse Psychiatric Associates are academically oriented providers, most of whom teach, or have taught, at academic institutions. Our providers are Board Certified Psychiatrists and Psychiatric Nurse Practitioners and we have several licensed and doctoral level therapists and psychologists. We are experienced in working with individuals who struggle with various psychiatric conditions, including Women’s mental health difficulties and Perimenopausal Depression, Anxiety and Insomnia.

• A Dedicated Director of Women’s Mental Health, Dr. Emily Bernstein, with a focus on Perimenopausal Psychiatric symptoms and related conditions.
• Board Certified Psychiatrists and Psychiatric Nurse Practitioners
• Licensed Therapists and Doctoral Level Psychologists
• Academically Oriented providers, most of whom teach, or have taught, at local Academic Institutions, such as Johns Hopkins Hospital & The University of Pennsylvania.
• Appointments generally available within 2 weeks.
• In-office and online Virtual Appointments for the treatment of Perimenopausal Anxiety, Depression and Insomnia.
• Providers experienced in treating co-occurring psychiatric conditions.
• Providers who are welcoming to all individuals.