Perimenopause is the transitional period before menopause when hormone levels begin to fluctuate. It often starts in a woman's 40s but may begin earlier and can last several years before menopause occurs.

Yes. Many women experience new or worsening anxiety during perimenopause due to fluctuating estrogen levels, sleep disruption, and changes in brain chemistry.

Yes. Hormonal changes during perimenopause can contribute to depression, emotional numbness, irritability, loss of motivation, and changes in mood—especially in women with a history of depression.

Estrogen supports dopamine function, which plays an important role in attention, motivation, and executive functioning. As estrogen fluctuates, many women notice increased distractibility, brain fog, forgetfulness, and emotional dysregulation.

Common symptoms include anxiety, depression, panic attacks, mood swings, irritability, insomnia, brain fog, memory problems, emotional sensitivity, decreased motivation, loss of confidence, and difficulty concentrating.

Treatment is individualized and may include medication management, lifestyle modifications, improving sleep, collaboration with your gynecologist regarding hormone therapy when appropriate, and addressing coexisting mental health conditions such as ADHD, anxiety, or depression.

For some women, hormone replacement therapy may improve mood, anxiety, sleep, and cognitive symptoms. Whether HRT is appropriate depends on your medical history and should be discussed with your gynecologist or prescribing clinician. Mental health treatment and HRT often work well together.

No. I do not prescribe hormone replacement therapy, but I frequently collaborate with gynecologists and primary care providers to help coordinate comprehensive care for women experiencing hormone-related mental health symptoms.

Many women don't realize that mental health changes can be one of the earliest signs of perimenopause—even before periods become irregular.

You may be experiencing perimenopause if you notice:

• Anxiety that suddenly appeared or became more intense
• Panic attacks without a clear cause
• Increased irritability or mood swings
• Brain fog or forgetfulness
• Trouble focusing or worsening ADHD symptoms
• Difficulty sleeping or waking during the night
• Feeling overwhelmed by tasks that once felt manageable
• Loss of confidence or feeling like you've "lost yourself"
• Symptoms that seem to fluctuate throughout your menstrual cycle

You don't have to simply "wait it out." Understanding the role hormones may play is often the first step toward feeling better.

Yes. I provide secure telehealth psychiatric evaluations and medication management for women located in Texas, New Mexico, Washington, and Delaware.