Perimenopause: Stuck in the Middle with You


By: Maura L. Johnson, LCSW, PMH-C

The feelings may come and go, both in frequency and intensity. Maybe it’s feeling more irritable or having less patience for things that had never been bothersome in the past. Your menstrual cycles may seem more intense, particularly with mood swings. If you choose to share this with a medical provider, they may chalk it up to depression, anxiety, or stress. And while these are certainly possible, if you are in your early to mid-40s (sometimes late 30s), it’s possible you are experiencing perimenopause. While the physical symptoms of this can be quite bothersome (hot flashes, menstrual cycle changes, etc.), I will be focusing on the issues I most often encounter in my practice: mood changes and anxiety.


While most of us as women are familiar with menopause, the subtle shift into perimenopause may be quite unexpected. Generally speaking, these symptoms may begin to appear between ages 40-44, but they may also be in our mid to late 30s (Source: Mayo Clinic). As our levels of estrogen begin to rise and fall irregularly, we may begin to notice behavioral changes, such as low mood, irritability, sleep issues and depression. However, many women in this age range are also in the thick of balancing family, work and activity schedules, which can easily be labeled as the cause(s) for their stress. When women in their 40s present for therapy with these symptoms, I often consider perimenopause as an underlying factor. While this may not be the most comfortable thing to consider, acknowledging it helps guide treatment in the right direction.


So, what can be done to help alleviate these symptoms? Common medical treatment methods may include antidepressants such as SSRIs for both depression and anxiety, oral contraceptives to regulate periods, estrogen/hormone therapy and medications for insomnia. If you are seeking a more natural/complementary approach, therapy, diet, exercise and supplement therapy can also be helpful. Supplements such as MENO work to target the symptoms of both perimenopause and menopause through use of vitamins and plant supplements. Please consult with your medical provider prior to taking supplements, especially if you are taking any other medications.


I often see women struggle for validation of their symptoms, particularly in obtaining the correct diagnostic testing of their hormone levels. Consider asking your medical provider for a full hormone panel if you suspect perimenopause is the cause of your symptoms. There are also kits available through companies such as EverlyWell and ModernFertility that allow you to conduct these tests in the privacy of your own home. We often work on strategies such as Mindfulness Based Stress Reduction and acceptance and Commitment Therapy (ACT) in my office to improve coping strategies. Both can be very helpful in making this transitional time in our lives more enjoyable. Please also know that you are not alone in this, and help is available; you deserve to feel your best and enjoy your life!