Depression, anxiety, and severe irritability are common during the years leading up to menopause and can worsen over time if not addressed. Some of this shift in mood can be attributed to the quite abrupt changes of hormone levels in women during their late 30s to mid 50s. Women can be found to complain of insomnia, hot flashes, and brain “fog” also during this time. Treating any of these symptoms requires recognizing the direct impact of the fluctuating reproductive hormones on brain chemistry. Reproductive hormones like estrogen are regulators of the neurotransmitters implicated in mood disorders - serotonin, dopamine, norepinephrine, glutamate, and GABA. For example, estrogen boosts the production of and inhibits the breakdown in serotonin and dopamine. These two neurotransmitters are essential in mood, sleep, pleasure, and focus. Estrogen is also key in enhancing excitatory glutamate signaling, which is essential for brain energy. An estrogen drop commonly triggers an increase in norepinephrine levels, which is a neurotransmitter involved in the stress response. This surge is linked to symptoms like hot flashes, night sweats, increased blood pressure, and anxiety. Estrogen also helps modulate the neurotransmitter GABA. When estrogen drops abruptly, the body's GABA-producing mechanisms often struggle, leading to lower GABA availability. Because GABA is the brain’s main "calming" neurotransmitter, this decline causes increased anxiety, irritability, sleep disruptions, and cognitive fog.
Working with a skilled provider who understands the delicate interplay between mental health and hormonal health can be the most crucial step in finding relief from mood symptoms. Together, you and your provider can explore an approach to help manage your perimenopausal mood symptoms, whether it be cognitive-behavioral therapy (CBT,) psychiatric medications, hormone therapy, supplements, lifestyle changes, or a combination of these. Here at NWP, we will work closely with your health and wellness providers to ensure a team-based approach.