Mood disruptions are a known symptom of perimenopause, and my experience is that anxiety is at the top of that list (with irritability running a close second). It’s also possible that this is an anxiety disorder that is not related to hormones.
The options in treatment start with lifestyle: addressing nutrition, exercise, stress management—all of those things you know but may not be implementing as well as you should. Do it now!
Then there are anti-anxiety medications. There are a variety of options to consider, and your primary care provider can help you navigate the choices and trade-offs.
Then there is estrogen. Studies suggest estrogen works as well as mood meds for perimenopausal mood disruptions. If you are still menstruating, estrogen alone is all that is necessary (no progesterone); if you are missing many periods, then adding progesterone may be necessary. Usually I’ll start women on a transdermal estradiol 0.1 mg 2 times per week. I recommend women do this for 3 months and then reassess to see if it is beneficial—and explore other options if it’s not.
I hope this is helpful and that you find a path to less anxious days!
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.
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