07 Aug 8 Things You Need to Know About Perimenopausal Mood Changes
First Signs of Perimenopause. Anxiety, Depression, & Panic.
Complaints of perimenopausal mood changes are often overlooked or ignored. Women in perimenopause are often told by their primary care doctor that their mood changes are due to stress.
Stress makes it and everything worse but it doesn’t cause perimenopausal mood changes.
When at age 45, I mentioned to my doctor that my period was late for the first time and I was unusually depressed, he told me I was “just stressed.” My period came 10 days later and within a few days, the depression was gone. It wasn’t stress. It was perimenopause.
Tip #1: Seek Out a Doctor Specializing in Perimenopause
If you are a woman over age 35 experiencing unexplained & unusual, cyclical mood changes, seek out a doctor specializing in perimenopause. Most primary care doctors and ob/gyns are not hormone specialists.
Although they do great work, most primary care doctors and ob/gyns are not hormone specialists. Neither are psychiatrists.
Perimenopausal women with severe mood changes are sometimes diagnosed with a mental health disorder.
They are prescribed anti-anxiety medications or antidepressants. These medications can be life savers! They have their use even if the cause is perimenopause but they may not be needed lifelong if the underlying hormonal imbalance can be treated.
One patient comes to my mind. She’d had a partial hysterectomy in her 30s. Partial hysterectomies leave the ovaries but remove the uterus. No uterus – no periods. She came to see me in her late 40s. Her doctor had diagnosed her with anxiety and panic disorder. She started the medication the doctor prescribed but was hesitant to accept her doctor’s diagnosis. She’d never been anxious before.
Her anxiety came on suddenly and without cause.
I asked her if her anxiety was worse or better at certain times of the month. She said yes. Upon further questioning, we could see there was a monthly pattern. It was cyclical! It can be difficult to time estrogen and progesterone testing in women without periods but we got lucky. Blood work showed that her luteal phase progesterone was very low.
I prescribed a low dose oral progesterone. She improved and within months was able to go off the anti-anxiety medication. She took progesterone for a few years to get her through perimenopause. She is now in her late 50s, off progesterone, and doing well.
*Never stop any prescribed medication unless under doctor supervision. This is especially true for anti-anxiety and depression medications. Many of these need to be tapered slowly.
Tip #2: Oral bioidentical progesterone can help some perimenopausal mood changes.
A cycling woman makes a lot of progesterone…except right before her period when it goes from high to almost nothing. Progesterone bathes the brain in neurochemicals that create a sense of calm. Take it away, and the opposite occurs-a mood altering storm! Call it PMS (premenstrual syndrome), PMDD (premenstrual dysphoric disorder), or just moody.
Because perimenopausal mood changes are usually cyclical, progesterone can be used for as little as one week per month. It can also be used at different dosages during the month. I’ll sometimes prescribe a low dose to be started a few days after a period starts and then doubled 2 weeks later until the period, when moodiness/PMS are at their peak.
Tip #3: Most perimenopausal women can’t tolerate high doses of bioidentical progesterone.
The bioidentical progesterone you get from your local pharmacy starts at 100 mg. That does works for most menopausal women. Younger women in the early to mid stages of perimenopause usually cannot tolerate these higher. It causes severe bloating and breast tenderness.
This is why I use lower doses that are compounded. We gradually increase the dose over the years. 100 mg oral progesterone is the bioidentical industry standard…for menopausal women! Unfortunately, science is slow to recognize the needs of perimenopausal women.
Tip #4: Topical over the counter bioidentical progesterone cream doesn’t always help mood changes.
Technically, it can’t get into the brain. When applied to the skin, the progesterone doesn’t go through the liver. The liver makes forms of progesterone that can get into the brain. Clinically, some of my patients claim the topical progesterone helps their moods.
Tip #5: Not all perimenopausal women can take progesterone.
Fibroids + menstrual periods + progesterone = LARGER FIBROIDS. Progesterone, especially bioidentical, can even cause periods in women who are postmenopausal who have a history of fibroids. It’s not supposed to but it does. Both topical, over the counter and prescriptive progesterone.
If you are a perimenopausal woman with fibroids, do not despair. There are ways we can support you through perimenopause.
Women with a progesterone hormone receptor positive cancer or a history of this, cannot take topical or oral progesterone. Most oncologists don’t want women with a history of breast or reproductive cancers to take progesterone, even if it was not found to have hormone receptors.
Tip #6: Estrogen can make perimenopausal anxiety worse.
“Having hot flashes and periods? Estrogen will help, and since you’re having periods, you don’t need to take progesterone.” This is true but perimenopausal women’s estrogen is going up and down like a roller coaster. It can rise sky high, higher than any younger woman’s. High estrogen causes severe panic and anxiety. It creates estrogen dominance which in turns causes the worst mood changes. I’ve seen it cause PMDD, premenstrual dysphoric disorder.
Tip #7: Testosterone. Women have it and they need it. Without it, anxiety and depression ensue.
“Testosterone made all my anxiety melt away. Now, it’s me who falls asleep when my head hits the pillow. My husband is the one up worrying!”
Testosterone does more than fuel your libido, it makes you feel like you can take on the world. Low testosterone has long been seen as a cause of moodiness, anxiety and depression in men but not women. The mainstream medical community does not acknowledge that women need testosterone. We don’t have a lot but in perimenopause, a woman’s testosterone level can drop by two to three fold.
Tip #8: Non-hormonal therapies help.
Herbal and nutraceutical therapies are not as strong as the hormonal therapies. I use them for women in the early stages of perimenopause or pre-perimenopause.
Some of the nutraceuticals I use are:
- GABA for anxiety and insomnia.
- L-Theanine & B6 for anxiety.
- Liver detox for PMS and anxiety.
- DIM & Calcium D Glucarate for estrogen dominant anxiety and PMS.
- Adrenal tonics for stress. Stress may not cause perimenopause but it makes it worse!
- Exercise, proper nutrition, sleep, and any stress reducing activity that fits your lifestyle.
Do not self-treat.
Before starting any herbs, supplements, diets, or exercise, please consult with a doctor. Although usually safe and without side effects, I’ve seen B6 increase anxiety (due to genetics) and DIM cause some uncomfortable side effects.
There’s no need to suffer for years with perimenopause.
Get help now!
Dr. Kimberly Brown, ND, LAc
Naturopathic Doctor
(408) 357-3422
San Jose Integrative Medicine
Follow us on Facebook
Dr. Kimberly Brown ND is a specialist in perimenopause. She has helped thousands of other women through perimenopause and beyond.
For more information and to discover how Dr. Kimberly Brown ND can help you, click here to schedule an appointment to find out how you can feel better.
Follow & join Dr. Brown live on Instagram every 1st and 3rd Wednesday at 5:30 pm PST.