Menopause Myth #15: Depression or Perimenopause? How to tell the difference

“Have you considered antidepressants?”

A 47-year-old woman sits across from me, tears streaming down her face. She’s been experiencing overwhelming anxiety for nearly a year. Panic attacks seemingly out of nowhere. Irritability that feels completely out of character — she snapped at her teenage daughter yesterday and felt terrible. Low mood. Difficulty concentrating. Waking at 3am with her mind racing, unable to get back to sleep.

She’s been to her GP three times in the past six months.

Each time: “This sounds like anxiety and depression. Let’s try an SSRI.”

She’s been taking sertraline (an antidepressant) for 12 weeks. It’s helped slightly — the panic attacks are less frequent, the crying has reduced. But she still doesn’t feel right. She still wakes at 3am. She still feels irritable and on edge. She still doesn’t recognize herself.

“Maybe I need a higher dose?” she asks. “Or a different antidepressant? My GP says some people need to try several before finding one that works.”

Then I ask a question no one else has asked her: “What’s happening with your periods?”

She looks surprised. “They’re all over the place. Sometimes 23 days, sometimes 50. Really heavy when they come. I didn’t think that mattered.”

It matters enormously.

I explain that her mood and anxiety symptoms — which everyone has been treating as primary mental health issues — are almost certainly hormonally driven. She’s experiencing perimenopausal mood symptoms, not clinical depression or generalized anxiety disorder.

“But… I’ve never had mental health problems before,” she says. “I thought depression meant you had to be sad all the time. I’m not sad — I’m anxious and irritable.”

This conversation happens in my practice almost daily.

Women experiencing hormone-driven mood and anxiety symptoms during perimenopause are being diagnosed with and treated for primary mental health conditions — when the root cause is hormonal fluctuations affecting neurotransmitter systems.

Understanding the difference between depression/anxiety disorders and hormonally-driven menopause mood symptoms is crucial — because they require different (or additional) treatment approaches.

The Problem: Overlapping Symptoms

Why are hormonally-driven menopause mood symptoms so often mistaken for depression or anxiety disorders?

Because the symptoms are biochemically identical.

Depression/Anxiety Disorder Symptoms:

Low mood, sadness, loss of pleasure
Anxiety, panic attacks
Irritability, mood swings
Sleep disruption (difficulty falling asleep, early waking, unrefreshing sleep)
Fatigue, low energy
Difficulty concentrating, brain fog
Feeling overwhelmed
Emotional reactivity
Changes in appetite
Physical tension
Sense of not feeling like yourself

Perimenopausal Mood Symptoms:

Low mood, sadness, loss of pleasure
Anxiety, panic attacks
Irritability, mood swings
Sleep disruption (difficulty falling asleep, early waking, unrefreshing sleep)
Fatigue, low energy
Difficulty concentrating, brain fog
Feeling overwhelmed
Emotional reactivity
Changes in appetite
Physical tension
Sense of not feeling like yourself

See the problem? The symptom lists are identical.

Why? Because both conditions affect the same neurotransmitter systems (serotonin, GABA, dopamine) in the same brain regions — just via different pathways.

Depression/anxiety disorders: Primary dysfunction of neurotransmitter systems

Perimenopausal mood symptoms: Neurotransmitter systems disrupted by hormonal fluctuations

Same symptoms. Different root causes.

How Hormones Affect Mood

To understand why perimenopause causes mood symptoms, we need to understand how oestrogen affects the brain.

Oestrogen and Serotonin

Serotonin is the neurotransmitter most associated with mood regulation. Low serotonin is implicated in depression and anxiety.

Oestrogen profoundly affects serotonin:

Increases serotonin production (more raw material available)
Increases serotonin receptors in the brain (more binding sites)
Reduces serotonin breakdown (it stays active longer)
Enhances serotonin transmission between neurons

When oestrogen levels decline or fluctuate wildly during perimenopause, all of these effects diminish or become erratic.

Result: Reduced serotonin availability and activity → symptoms identical to depression and anxiety.

Oestrogen and GABA

GABA (gamma-aminobutyric acid) is the brain’s primary calming neurotransmitter. It inhibits neural activity, creating calm and reducing anxiety.

Oestrogen enhances GABA function — making it more effective at calming the nervous system.

When oestrogen fluctuates wildly during perimenopause, GABA function becomes erratic.

Result:

Anxiety and panic (nervous system can’t calm itself)
Feeling “wired” even when exhausted
Difficulty relaxing
Hypervigilance, being “on edge”
Racing thoughts

Oestrogen and Dopamine

Dopamine affects motivation, pleasure, reward, and goal-directed behavior.

Declining oestrogen impacts dopamine function.

Result:

Low motivation (“I can’t be bothered”)
Anhedonia (inability to feel pleasure in things you used to enjoy)
Flat affect (feeling emotionally numb)
Loss of interest in activities
Difficulty initiating tasks

The Key Point

When oestrogen fluctuations affect serotonin, GABA, and dopamine, the resulting symptoms look exactly like depression and generalized anxiety disorder — because the same neurotransmitter systems and brain regions are affected.

A GP seeing these symptoms has no easy way to distinguish whether they’re caused by primary mental health issues or hormonal fluctuations — unless they ask about menstrual changes and consider the timing and context.

And many GPs don’t make that connection.

How to Distinguish Hormonally-Driven Mood Symptoms from Primary Mental Health Issues

This is challenging because symptoms overlap so significantly. But certain patterns suggest hormonal involvement:

TIMING Suggests Hormonal Cause:

Symptoms began or significantly worsened in your 40s or early 50s:

No previous history of depression or anxiety (or only mild, well-controlled symptoms previously)
Sudden onset or gradual escalation during perimenopause age
New mood symptoms after years of stable mental health

Timing coincides with menstrual changes:

Symptoms started around the time periods became irregular
Or symptoms intensified when periods changed pattern
Connection may not be obvious initially (women don’t always connect mood changes to period changes)

Cyclical pattern (if still having periods):

Symptoms fluctuate with menstrual cycle
Worse in certain phases (often luteal phase — 7-10 days before period)
“Good weeks” and “terrible weeks” with no obvious external trigger
Pattern of escalating symptoms before period, some relief after period starts

Timing around other hormonal transitions:

Started or worsened after coming off hormonal contraception
Started after pregnancy or while breastfeeding
History of PMS, PMDD, or postnatal depression (suggests sensitivity to hormonal fluctuations)

ASSOCIATED SYMPTOMS Suggest Hormonal Cause:

Other perimenopausal symptoms present:

Hot flushes or night sweats (even if mild)
Sleep disruption beyond just anxiety-related insomnia
Brain fog, memory problems, difficulty concentrating
Joint pain, muscle aches
Changes in libido
Vaginal dryness
Changes in periods (irregular timing, heavier/lighter flow, longer/shorter cycles)
Physical symptoms suggest hormonal involvement

The more perimenopausal symptoms present alongside mood symptoms, the more likely hormones are primary driver.

CHARACTER of Symptoms Suggests Hormonal Cause:

Irritability and rage (more than sadness):

Sudden, intense anger that feels disproportionate
Snapping at loved ones, losing temper easily
Feeling like you’re “about to explode”
Rage that feels foreign, not like your normal self
This pattern is very common in perimenopause, less typical of classic depression

Anxiety more prominent than depression:

Overwhelming anxiety or panic
Racing thoughts, catastrophic thinking
Physical anxiety symptoms (heart racing, chest tightness, difficulty breathing)
Less of the profound sadness typical of major depression
Anxiety often the primary symptom in perimenopausal mood changes

Feeling “not like myself”:

Strong sense of personality change
“I don’t recognize myself”
“This isn’t who I am”
Particularly if this feeling is very distressing
Common description in hormone-driven symptoms

Emotional lability (mood swings):

Rapid shifts from fine to tearful to angry to fine again
Crying over things that normally wouldn’t make you cry
Mood shifts feel unpredictable, not linked to events
More characteristic of hormonal fluctuations than stable depression

RESPONSE TO TREATMENT Suggests Hormonal Cause:

Antidepressants provide partial relief but don’t fully resolve symptoms:

Panic attacks reduced but underlying anxiety persists
Crying less but still don’t feel “right”
Mood slightly better but energy, motivation, sense of self still off
This pattern is very common — antidepressants help somewhat (because they affect serotonin) but don’t address root hormonal cause

Symptoms fluctuate despite stable medication:

On same dose of antidepressant but symptoms vary week to week
Suggests underlying hormonal fluctuations still driving symptoms

Sleep improves but mood doesn’t fully normalize:

Antidepressant helps sleep but other symptoms persist
Or: Begin sleeping better (with sleep interventions or HRT) but mood still problematic
Suggests multiple contributing factors

RISK FACTORS for Primary Mental Health Issues:

The following suggest primary depression/anxiety disorder MORE likely (though can coexist with hormonal factors):

Long history of mental health issues:

Depression or anxiety since teens, 20s, 30s
Previous episodes of major depression requiring treatment
History of severe anxiety disorder, OCD, panic disorder before perimenopause age

Family history:

Strong family history of severe mental illness (bipolar disorder, severe depression, schizophrenia)
Multiple first-degree relatives with depression/anxiety

Pattern of symptoms:

Constant, stable severity rather than fluctuating
Symptoms began well before perimenopause age (teens, 20s)
No relationship to menstrual cycle
Symptoms progressively worsening over many months/years rather than fluctuating

Severity:

Suicidal ideation (always requires immediate psychiatric assessment regardless of cause)
Psychotic symptoms (hallucinations, delusions)
Severe functional impairment (can’t work, care for self, leave house)
These require psychiatric intervention regardless of whether hormones are also involved

Significant life stressors:

Major trauma, loss, or life events precipitating symptoms
Abusive relationship, financial crisis, bereavement
Though perimenopause can worsen response to stressors

Important Note:

These are NOT mutually exclusive.

You can have BOTH:

Perimenopausal hormonal mood symptoms AND
Co-occurring or pre-existing depression/anxiety disorder

Both need addressing for optimal outcomes.

Why Getting the Diagnosis Right Matters

Why does it matter whether mood symptoms are primarily hormonal vs. primarily psychiatric?

Because Treatment Differs:

If Primarily Hormonal:

HRT often dramatically improves symptoms by stabilizing oestrogen levels (which stabilizes neurotransmitter function)
Response can be profound — women describe “feeling like myself again”
Antidepressants may provide partial help but often insufficient alone
Lifestyle interventions crucial (sleep, stress management, exercise)

If Primarily Psychiatric:

Antidepressants are primary treatment
May need therapy (CBT, other modalities)
HRT unlikely to resolve symptoms (though may still be appropriate for menopause symptoms)
May require psychiatric specialist input

If BOTH (very common):

May need both HRT AND antidepressants
Address hormonal component with HRT
Address mental health component with antidepressants and/or therapy
Comprehensive approach = best outcomes

Treating Only Mental Health When Hormones Are Primary Driver:

What happens when hormone-driven symptoms are treated as only mental health:

Antidepressants provide partial but not complete relief:

Woman told “give it more time” or “try higher dose” or “try different antidepressant”
Months or years spent titrating medications
Some improvement but never feeling fully well
Because root cause (hormonal fluctuations) not addressed

Other perimenopausal symptoms worsen:

Hot flushes, night sweats untreated (disrupt sleep, worsen mood)
Cognitive symptoms (brain fog, memory issues) persist
Joint pain, physical symptoms ignored
Sexual dysfunction (vaginal dryness, loss of libido) not addressed

Long-term health risks unaddressed:

Bone density not monitored (osteoporosis risk increases post-menopause)
Cardiovascular risk not assessed
Genitourinary syndrome of menopause develops (progressive, won’t improve without treatment)

Woman blames herself:

“The medication isn’t working because I’m not trying hard enough”
“Maybe I’m just broken”
“Maybe this is just who I am now”
When actually the wrong intervention is being used for the primary problem

Missing Mental Health Issues When They Coexist:

Conversely, if a woman has BOTH hormonal mood symptoms AND depression/anxiety disorder:

Treating only hormones may not fully resolve symptoms:

HRT helps significantly but some symptoms persist
Underlying depression/anxiety still needs addressing
May need antidepressants AND HRT

Severe mental health issues may be minimized:

Suicidal ideation attributed solely to “hormones”
When actually requires immediate psychiatric intervention
Any suicidal ideation requires psychiatric assessment regardless of cause

The point: Comprehensive assessment considering BOTH hormonal and mental health factors = best care.

The Evidence: HRT for Mood Symptoms

What does research show about HRT for perimenopausal mood symptoms?

NICE Guidelines (2015)

NICE recognizes that HRT can effectively treat low mood that arises during perimenopause.

The guidelines state that HRT should be considered for mood symptoms before or alongside antidepressants.

Research Evidence:

Randomized controlled trials show:

Oestrogen has antidepressant effects in perimenopausal women experiencing depressive symptoms
Some studies suggest oestrogen is as effective as traditional antidepressants for perimenopausal depression
Effect is specific to perimenopausal women (oestrogen doesn’t work as antidepressant in men or non-menopausal women)

For anxiety symptoms:

Women on HRT report lower anxiety scores than women not on HRT
Stabilizing oestrogen levels reduces anxiety symptoms in many perimenopausal women
Particularly effective for anxiety related to sleep disruption (HRT improves sleep → improves anxiety)

Mechanism:

HRT stabilizes oestrogen levels (or smooths fluctuations)
This stabilizes serotonin, GABA, and dopamine function
Neurotransmitter systems function more normally
Mood and anxiety improve

British Menopause Society Position:

The British Menopause Society states that HRT should be first-line treatment for mood symptoms that emerge during perimenopause, with antidepressants considered if HRT alone is insufficient or contraindicated.

Clinical Experience:

In my practice, I regularly see:

Women whose mood/anxiety symptoms dramatically improve with HRT (often within 4-8 weeks)
Women who’ve been on antidepressants for months with partial improvement who, after adding HRT, finally feel “like themselves again”
Women who don’t need antidepressants at all once hormones are stabilized
Women who need both HRT and antidepressants (and that’s perfectly fine — address all contributing factors)

HRT for perimenopausal mood symptoms is evidence-based and can be transformative.

When Do You Need Both HRT and Antidepressants?

For some women, the answer isn’t “HRT or antidepressants” — it’s BOTH.

You May Need Both If:

Pre-existing mental health condition:

History of major depression or severe anxiety disorder (before perimenopause)
Previous episodes requiring treatment
Perimenopause can trigger relapse or worsening
Addressing hormones helps but doesn’t replace ongoing psychiatric treatment

Severe symptoms requiring immediate stabilization:

Suicidal ideation, self-harm
Severe panic disorder, debilitating anxiety
Psychotic symptoms
Psychiatric intervention takes priority while HRT is initiated
HRT takes weeks to months for full effect; antidepressants may be needed for immediate symptom management

HRT alone doesn’t fully resolve symptoms:

Some women find HRT dramatically improves mood and anxiety but not completely
Adding antidepressant alongside HRT provides complete relief
This is common and appropriate

Significant life stressors contributing:

Major trauma, loss, relationship breakdown, financial crisis
Hormonal stabilization helps but life circumstances still causing distress
May need therapy and/or medication alongside HRT

Contraindications to HRT:

Genuine contraindications (rare, but they exist)
In these cases, antidepressants primary treatment option
Certain SSRIs/SNRIs have evidence for treating menopausal hot flushes as well as mood (paroxetine, venlafaxine)

Taking Both is NOT Failure:

Some women feel they’ve “failed” if they need both HRT and antidepressants.

This is incorrect.

Many women need both — and that’s perfectly appropriate if it’s what helps you feel well.

The goal is comprehensive treatment addressing all factors contributing to symptoms — not limiting yourself to one intervention when multiple are needed.

Antidepressants and Menopause: Important Considerations

If you’re taking or considering antidepressants during perimenopause:

Some Antidepressants Worsen Certain Menopause Symptoms:

SSRIs/SNRIs can cause:

Sexual dysfunction (reduced libido, difficulty reaching orgasm, reduced arousal)
Weight gain (particularly certain SSRIs like paroxetine, mirtazapine)
Emotional blunting (feeling less intensely, including positive emotions)
Night sweats (paradoxically, some antidepressants worsen sweating)

If you’re experiencing these side effects:

Discuss with prescriber
May be able to switch to different antidepressant with fewer sexual side effects (e.g., bupropion)
Or adjust dose
Weigh benefits vs. side effects

Some Antidepressants Interact with Tamoxifen:

If you’ve had breast cancer and are on tamoxifen:

Some SSRIs (particularly paroxetine, fluoxetine) significantly reduce tamoxifen effectiveness
This is a serious interaction — can reduce cancer treatment efficacy
If you need antidepressant while on tamoxifen, use one that doesn’t interact (e.g., citalopram, venlafaxine)

Starting Antidepressants During Perimenopause:

Be aware:

May take 4-6 weeks to reach full effect (sometimes 8-12 weeks)
Initial side effects (nausea, headache, increased anxiety) often improve after 1-2 weeks
Dose may need adjusting over time
Consider hormonal component — would HRT also be appropriate?

Don’t stop abruptly:

Antidepressants need to be tapered gradually (under medical supervision)
Stopping suddenly can cause withdrawal symptoms

What You Should Do

If You’re Experiencing Mood or Anxiety Symptoms in Your 40s-50s:

Step 1: Self-Assessment

Ask yourself:

Did these symptoms start or worsen in my 40s?
Have my periods changed (timing, flow, length)?
Do I have other perimenopausal symptoms (hot flushes, night sweats, sleep issues, brain fog, joint pain)?
Do symptoms fluctuate in a pattern (better some weeks, worse others)?
Have I noticed symptoms worse at certain times in my menstrual cycle?
Do I feel “not like myself”?

If YES to several of these: Hormonal involvement is likely.

Step 2: Track Symptoms

Keep detailed diary for 1-2 months:

Mood symptoms (anxiety, low mood, irritability, mood swings)
Sleep quality
Menstrual cycle (if still having periods — when they occur, how heavy)
Physical symptoms (hot flushes, joint pain, headaches, etc.)
Energy levels
Cognitive symptoms (brain fog, concentration, memory)

Look for patterns: Do symptoms worsen before period? Do they fluctuate week to week?

Step 3: Discuss with Healthcare Provider

Bring your symptom diary.

Say: “I’ve been experiencing [anxiety/low mood/irritability] that started around age [X]. My periods have [changed in this way]. I have other symptoms including [hot flushes/sleep disruption/brain fog]. I’ve tracked my symptoms and noticed [pattern]. I’m wondering if hormones could be contributing to my mood symptoms. Can we discuss whether HRT might be appropriate alongside/instead of antidepressants?”

Being specific and informed:

Shows this isn’t a vague request
Directs conversation productively
Makes hormonal connection clear

Step 4: If Already on Antidepressants

If you’re currently on antidepressants and:

They’re helping somewhat but not completely
You still don’t feel “like yourself”
You have other perimenopausal symptoms
Your periods have changed

Ask your GP: “Could hormones be contributing to my mood symptoms alongside mental health? Would it be worth trying HRT in addition to my antidepressant to address the hormonal component?”

Important: Don’t stop antidepressants without medical supervision.

The plan should be:

Add HRT alongside antidepressant (not instead of)
Give HRT 3-6 months to reach full effect
Reassess whether antidepressant still needed once HRT effect established
If appropriate, taper antidepressant gradually under medical supervision

Step 5: If Dismissed or Told “It’s Just Depression”

If your GP dismisses hormonal connection:

Ask: “Can you explain why you don’t think hormones are contributing, given my age and that my periods have changed?”
Request: “Can you refer me to a menopause specialist for second opinion?”
Consider: Seeing different GP in practice, or seeking private menopause specialist

Don’t accept “it’s just depression/anxiety” without consideration of hormonal factors — particularly if timing, symptoms, and context suggest hormonal involvement.

Lifestyle Factors That Support Mood During Perimenopause

Regardless of whether you use HRT, antidepressants, both, or neither — lifestyle interventions are crucial:

Sleep (Absolutely Critical)

Sleep deprivation catastrophically worsens mood and anxiety.

Without adequate sleep, it’s nearly impossible to feel mentally well.

Prioritize:

7-9 hours nightly
Consistent schedule
Address night sweats (HRT often dramatically helps)
Optimize sleep hygiene (cool room, dark, quiet, no screens before bed)
Limit caffeine (none after midday)
Limit alcohol (disrupts sleep architecture)

Exercise (Powerful Antidepressant)

Regular physical activity is one of the most effective interventions for mood and anxiety — comparable to antidepressants for mild-moderate depression.

Aim for:

150 minutes/week moderate aerobic activity (brisk walking, cycling, swimming)
2-3 sessions/week strength training
Daily movement (walking counts!)

Exercise increases:

Serotonin, dopamine, endorphins (natural mood boosters)
BDNF (brain-derived neurotrophic factor — supports brain health and neuroplasticity)
Energy, sleep quality, sense of accomplishment

Stress Management (Daily Practice)

Chronic stress amplifies every perimenopausal symptom, particularly mood and anxiety.

Daily practices:

Breathwork (box breathing, physiological sighs, any practice with longer exhale than inhale)
Meditation or mindfulness (even 10 minutes daily)
Yoga, tai chi, gentle movement
Time in nature
Social connection (face-to-face, phone, meaningful interaction)
Boundaries (saying no, protecting time and energy)
Therapy or counseling if needed

These aren’t optional extras — managing stress is foundational to mental health during perimenopause.

Nutrition (Blood Sugar Stability)

Blood sugar instability worsens mood and anxiety.

Support stable blood sugar:

Protein at every meal (20-30g per meal)
Fiber (vegetables, fruits, whole grains, legumes)
Limit refined carbohydrates and sugar (white bread, pastries, sugary snacks cause crashes)
Don’t skip meals (going long periods without eating → blood sugar drops → mood crashes, anxiety spikes)
Consider timing (eating earlier in day may support better blood sugar control)

Limit Alcohol (Significant Impact)

Alcohol significantly worsens mood and anxiety despite initial relaxing effect.

Alcohol:

Is a depressant (worsens mood over time)
Increases anxiety (particularly next-day “hangxiety”)
Disrupts sleep (worsens everything)
Interferes with antidepressant effectiveness
Triggers hot flushes

Many women find that reducing alcohol to 1-2 drinks per WEEK (not daily) dramatically improves mood, anxiety, and sleep.

Try 2-4 weeks alcohol-free and observe the impact.

Social Connection (Protective Factor)

Isolation worsens mood and anxiety. Connection improves them.

Prioritize:

Meaningful relationships
Regular contact with supportive people
Letting go of draining relationships
Joining communities (online or in-person) of women going through similar experiences
Asking for help when needed

Even brief positive social interactions improve mood — don’t underestimate the power of connection.

When to Seek Urgent Help

Some symptoms require immediate professional support, regardless of whether they’re hormone-driven or psychiatric:

Seek Urgent Help If You’re Experiencing:

Suicidal thoughts or self-harm urges:

Contact: GP immediately, crisis helpline (Samaritans 116 123 — UK, available 24/7), go to A&E if in immediate danger
Suicidal ideation is ALWAYS a psychiatric emergency regardless of cause

Psychotic symptoms:

Hallucinations (seeing/hearing things that aren’t there)
Delusions (fixed false beliefs)
Severe paranoia
Requires immediate psychiatric assessment

Severe functional impairment:

Can’t care for yourself (hygiene, eating, basic needs)
Can’t leave house due to anxiety/depression
Can’t work or function in any capacity
Requires intensive psychiatric support

Manic symptoms:

Extremely elevated mood, racing thoughts
Reduced need for sleep (feeling fine on 2-3 hours)
Impulsive, risky behavior
May indicate bipolar disorder — requires psychiatric assessment

Don’t wait for a routine GP appointment if experiencing these symptoms — seek immediate help.

The Bottom Line

Distinguishing between depression/anxiety disorders and hormone-driven perimenopausal mood symptoms is challenging — because symptoms are biochemically identical.

Both affect the same neurotransmitter systems (serotonin, GABA, dopamine) in the same brain regions — just via different pathways.

Suspect hormonal cause if:

Symptoms began or worsened in your 40s-50s
Timing coincides with menstrual changes
Cyclical pattern (good weeks, terrible weeks)
Other perimenopausal symptoms present (hot flushes, sleep disruption, brain fog, joint pain)
Irritability/rage more prominent than sadness
Antidepressants help partially but don’t fully resolve symptoms
Strong sense of “not feeling like myself”

Many women have BOTH hormonal symptoms AND mental health issues — both need addressing.

Treatment differs:

Primarily hormonal: HRT often dramatically effective, antidepressants may help but often insufficient alone
Primarily psychiatric: Antidepressants primary treatment, therapy important
BOTH: May need both HRT and antidepressants — comprehensive approach = best outcomes

HRT for perimenopausal mood symptoms is evidence-based:

NICE Guidelines support it
Research shows oestrogen has antidepressant effects in perimenopausal women
Can be transformative for hormone-driven symptoms

Lifestyle interventions crucial regardless:

Sleep optimization (7-9 hours, address night sweats)
Regular exercise (powerful antidepressant)
Daily stress management
Blood sugar stability
Limit alcohol (significantly worsens mood/anxiety)
Social connection

Don’t accept “it’s just depression/anxiety” without exploration of hormonal factors — particularly if timing, symptoms, and context suggest hormonal involvement.

You deserve comprehensive assessment considering ALL potential factors — hormonal, psychiatric, lifestyle, life circumstances — and treatment addressing what’s actually driving your symptoms.

Feeling like yourself again is possible.

Need Support?

If you’re struggling with mood or anxiety symptoms during perimenopause and need help determining whether hormones are involved and what treatment approach would be most effective, I can help.

As a registered nurse and prescriber specializing in menopause care, I provide comprehensive assessment addressing both hormonal and mental health factors.

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