New Study Reveals Correlations Between Perimenopause and Mental Health Conditions: OB/GYNs Respond

“Cambridge University Press dropped this article 15 hours ago, and every single healthcare provider who treats women over the age of 30 has got to read this,” says Mary Claire Haver, OB/GYN at the start of her recent viral TikTok video.

Dr. Haver, a menopause specialist, goes on to explain that the recent article she is referring to addresses a crucial topic: the physical and psychological risk factors of fluctuating hormone levels during perimenopause and menopause. More specifically, the implications of this stage of life on women's mental health.

“Estrogen has a profound impact on our brains, and when it fluctuates and declines in perimenopause and menopause, it changes the levels of our neurotransmitters in the brain,” she explains. “Now, it’s important to note that not all women will experience this, but many will. We see worsening of pre-existing disorders and new onset of disorders in perimenopause and menopause.”

For people in perimenopause and menopause who are being treated for mental health conditions, you may notice that your prescribed medications have less results, don’t work at all or you may need much higher doses for the same effect, continues Dr. Haver. This is to be expected, she explains, as women in these phases of life respond less to selective serotonin reuptake inhibitors (SSRIs).

What did the study on perimenopause mental health find?

The study, published in the British Journal of Psychiatry , considered results from other relevant scholarly articles that addressed menopause, perimenopause, hormone replacement therapy (HRT) and various mental health disorders.

The psychological symptoms that could be attributed to a typical menopause include anxiety, low mood, paranoia, anhedonia (loss of motivation, excitement, pleasure), irritability, dissociation, insomnia and feelings of low self-worth, say researchers.

“These symptoms come about because of the impact of hormonal changes on the brain. Psychological symptoms associated with menopause may be sufficiently severe to reach ‘caseness’ for a mental disorder or may exacerbate underlying pre-existing mental disorders.”

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Schizophrenia

Women with schizophrenia are at risk of an exacerbation of their psychological symptoms , which study authors say may be due to declining estradiol levels which protect the brain. The reduction in estradiol also impacts how the body metabolizes medications, the study says, ultimately reducing efficacy for the same dose.

Depression

Potential perimenopause symptoms also may include depression . Additionally, women with a pre-existing depressive disorder are at risk of relapse in the perimenopausal period, the study states, and may find that antidepressants which had previously helped are no longer effective or that a much higher dose is required to have the same effect. There also may also be a slightly different quality to the symptoms compared with symptoms of depression well before approaching menopause.

Anxiety

Anxiety is another common symptom of perimenopause and is more likely to occur in those with a pre-existing diagnosis or sensitivity towards anxiety. Anxiety symptoms are also strongly linked to vasomotor symptoms (hot flashes and night sweats).

Trauma

Adversity during early life is associated with mental health conditions. These experiences have also been found to cause earlier menstruation, potentially earlier menopause and a significant spike in vasomotor symptoms. Existing studies also suggest that estrogen may help regulate the physiological effects of trauma, so dropping levels of the hormone in midlife might lead to more severe symptoms of post-traumatic stress disorder (PTSD) .

Can HRT help improve perimenopause mental health?

HRT is often used to restore declining levels of hormones in perimenopause, and researchers state that it should also be considered as a part of mental illness treatment plans.

“In new-onset low-mood associated with the perimenopause, HRT (oestradiol and progesterone if needed) is the first line of treatment, and there is no evidence that antidepressants are beneficial,” say researchers. “Current guidelines are to treat perimenopausal depression as any other depressive episode. However, it is known that peri- and postmenopausal people do not respond to selective serotonin reuptake inhibitors as effectively as other demographics, and rates of discontinuation due to adverse events are significant.”

Oestradiol therapy, on the other hand, has been shown to be beneficial in the treatment of perimenopausal depression both on its own and with even greater effect when combined with antidepressants, the study says.

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Those findings are consistent regarding vasomotor symptoms which correlate with anxiety. Venlafaxine, an antidepressant and nerve pain medication, is approved for the treatment of vasomotor symptoms (which often correlate with anxiety) in perimenopause, but HRT has been shown to be more effective.

Oestradiol is also thought to support protection against psychotic symptoms, the study found, and there have been case reports of new onset perimenopausal psychosis failing to respond to antipsychotics but responding to HRT as a sole agent or in addition to medication.

“A hypothesis with face validity is that using HRT to treat perimenopausal symptoms will optimize quality of life (e.g. improving sleep and reducing psychological distress and physical symptoms) and is likely to reduce the risk of relapse in schizophrenia,” say researchers.

OB/GYN responds to new study on perimenopause mental health

Changes in mood and mental health during perimenopause are extremely common, confirms Tara Scott, MD, OB/GYN and Medical Advisor at digital menopause and health resource Versalie. In addition to the conditions addressed in the study, this can also include cognitive issues like brain fog. As the decline in estrogen can also disrupt sleep, this can worsen mental health symptoms. Along with anxiety, some women can also experience new onset panic attacks, notes Dr. Scott.

While many women are treated with SSRIs which sometimes can alleviate symptoms, often these medications do not treat the root cause of the mood shifts, she notes, adding that studies do confirm taking hormones when appropriate can have positive effects on mental health.

“The first step is knowing that menopause is not one-size fits all,” offers Dr. Scott. “Every person’s experience can be very different! Many of us know about the hot flashes and night sweats, but there are over 34 symptoms – including symptoms that affect our mental health.”

More on perimenopause:

Struggling to Stay Awake? Perimenopause Exhaustion May Be the Reason Why

Can You Get Pregnant During Perimenopause? Doctors Reveal the Odds

The Best Exercise Routine for Perimenopausal Women To Burn Fat

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan .