Q: What can I do to manage mood swings and anxiety in perimenopause?

You say you still have monthly periods, and also have “horrible mood swings and anxiety.” You’re feeling sympathy for your husband! There are three options that come to mind to address your anxiety and mood:

The first option might be using an oral contraceptive, the safety of which depends on your health risks and requires a discussion with your health care provider. Oral contraceptives suppress your ovarian function so you no longer “cycle,” reducing the hormone fluctuations and improving mood.

Another option is using estradiol, which is used continuously all cycle long. We feel most of the disruptive symptoms are due to a fall in estrogen, so if we can support estrogen levels throughout the cycle, it can significantly improve mood.

The third option is using a “mood medication” to treat the underlying anxiety and mood swings. Usually this is with a medication from the class of meds called SSRIs (Selective Serotonin Reuptake Inhibitors) which includes Prozac, Lexapro, Celexa, Zoloft and many others.

Whichever of those options you might pursue, it’s most important to address lifestyle. Exercise is at the top of the list to benefit mood, recommending 45 to 60 minutes 5 days a week. Make sure you are getting 7 or more hours of sleep/night. Reduce consumption of sugar and processed carbs, eating whole foods as much as possible. Manage stress and practice yoga—it really can help!