Your Mental Health and Perimenopause

Feeling moody? Irritable? Depressed? Less interested? More anxious? Less connected? Less confident or lower self worth? And has all of this been happening or worsening since you’ve entered into perimenopause or menopause (even surgical menopause)? In November 2023, Cambridge University Press published an articled titled, “Severe Mental Illness and the Perimenopause.” I’m so grateful that more write-ups like this are happening to educate women! In perimenopause, hormones such as estradiol, progesterone, and testosterone start changing for the worse leaving us with changes in our brain hormones like DHEA, serotonin, oxytocin, GABA, and dopamine. While you might not have heard of some of these hormones before, know that they play a huge role in your mood!

The decline of estradiol (one of our big estrogen hormones) negatively impacts every single system in our body. This includes our brain health. In perimenopause and menopause, research shows we are more prone to depression, psychotic episodes, feeling less connected or confident, insomnia, brain fog and memory changes.

When progesterone declines, we are more prone to anxiety and insomnia.

When testosterone declines, we are prone to feeling less confident and less energetic. While libido is often associated with testosterone, understand that estradiol and progesterone play a role as well! It’s hard to feel ‘in the mood’ if you’re anxious, depressed, or chronically sleep deprived!

The Cambridge article mentions the controversial Women’s Health Initiative (WHI) study that single handedly caused all the panic around hormone replacement therapy (HRT) use and women.

Thankfully, the authors state, “…more reassuring outcomes following re-analysis of the data mean that the benefits of HRT can be more readily appreciated without concern about causing harm if appropriate HRT is prescribed.”

They advocate for transdermal body-identical estradiol in the form of a patch or gel with micronised progesterone capsules. Unfortunately, there is currently no FDA approved form of testosterone form women in the United States for perimenopause and menopause. This is a real disservice to everyone! Many hormonally educated doctors are prescribing testosterone off-label. This might include compounding testosterone, using testosterone pellets, or using the FDA approved male testosterone at much lower doses for women.

The authors also note that body identical hormone replacement therapy maybe taken in conjunction with psychotropic medication. However, for women in perimenopause and menopause who are experiencing these mental health symptoms for the first time, they may benefit from HRT alone and not need anti-depressant medication.

However, zero shame if you need or use an anti-depressant or anti-anxiety medication! Protect your mental health!

As a side note, there are other more functional ways to co-support a woman’s mental health changes that can include therapy, nutrients, minerals, and amino acids in addition to foundational groundwork given all these changes. This is why meeting with a functional health practitioner can really help to determine where you’re at in the process.

What do you need to take away from this? You’re not crazy. You might feel crazy but it’s the changing of your hormones and this transition into perimenopause and menopause. You’re also not alone! Millions of women are experiencing this right now! Lastly, there are options to help. If your practitioner is not well versed in hormones, that’s okay. Time to find another practitioner who knows and understands what you’re going through.