Psychiatric Care During Perimenopause

What is Integrative Psychiatric Care During Perimenopause?

Feeling down, sad, and easily overwhelmed or upset can be very common symptoms of menopause and perimenopause. Other psychological symptoms include feelings of low self esteem, having reduced motivation or interest in things, anxiety and panic attacks, irritability, and mood swings. The reason for these mood changes is due to the significant drop in reproductive hormones (estrogen and progesterone) during perimenopause.

The decline in reproductive hormones has a direct impact on other hormone and neurotransmitter signaling (including those involving serotonin, norepinephrine and dopamine) which can fuel anxiety, depression, and high stress levels. Estrogen also helps to support the sharpness of your thinking skills and when levels reduce, it can lead to forgetfulness or brain fog – which can, in turn, lower your mood further.

If you have a history of premenstrual syndrome (PMS) or postpartum depression, you may be at higher risk for experiencing mood changes during perimenopause. Those with high levels of stress, poor sleep, and poor physical health are also at a higher risk for mood symptoms during this time.

How can we help?

For most women experiencing low mood, anxiety, irritability, or mood swings, it is a combination of treatment approaches that works best. Numerous lifestyle factors can impact the way you feel. Optimal nutrition is paramount. Eating a variety of fruits and vegetables and limiting overly processed foods, excess salt and sugar and white refined carbohydrates can be beneficial. Foods high in essential fats such as Omega 3 oils, and those rich in B vitamins, calcium and vitamin D can also help improve your mood. Protein intake is essential for mental health wellness. Regular physical activity, such as swimming, brisk walking, jogging or an exercise class can boost endorphins – hormones that relieve pain and reduce stress. Psychotherapy such as cognitive behavioral therapy (CBT) has been shown to help with menopausal low mood and anxiety, insomnia and interestingly, and even physical symptoms such as menopausal hot flashes. These alternative treatments are even more important for women who do not wish to, or cannot take, Menopausal Hormone Therapy (MHT).

Psychiatric medications are often used during perimenopause and menopause to help manage anxiety and depression, as well as attention/focus difficulties. It is common to use a class of medications called SSRIs or SNRIs for mood issues during this phase of life. These are medications known in the mainstream as Lexapro, Prozac, Zoloft, and Cymbalta (among others). Some of these medications can also be very helpful in treating hot flashes.

Here, at Northeast Women’s Psychiatry, it is not uncommon for women to be using a combined approach of utilizing SSRIs/SNRIs as well as Menopausal Hormone Therapy, in conjunction with lifestyle modifications. The goal is to have as many resources as possible in order for patients to optimally manage their mental health and wellness during this time of change.