For women in the middle years
Perimenopause anxiety and depression
You are not imagining it, and you are not simply getting older.
One of the most common stories I hear begins the same way. A woman in her forties, competent and steady for decades, finds herself newly anxious, sleepless, tearful, or foggy. She has been told her labs are normal. She has been offered a prescription after a short visit, or told this is simply what this season feels like.
Perimenopause is a neurological event as much as a hormonal one. Estrogen and progesterone do not decline smoothly. They swing, and those swings reach deep into the systems that govern mood, sleep, and stress response. Anxiety that arrives for the first time at forty-four is often physiology, not character.
What I look at
A full psychiatric history, with particular attention to timing. Symptoms that track with the cycle tell a different story than symptoms that never lift. Laboratory evaluation where it is warranted, including thyroid and iron studies that are frequently missed. Sleep, which is both a casualty and a driver of this season. And the life itself, because perimenopause tends to arrive alongside aging parents, launching children, and work at full weight.
How treatment works
There is no single protocol, because no two women arrive with the same picture. Treatment may include medication, chosen carefully and at the lowest effective dose. It includes sleep and metabolic work, because a body that cannot rest cannot heal. It includes coordination with your gynecologist or primary care clinician when hormonal treatment is on the table, so that each part of your care knows what the others are doing. And it includes time, which is the thing this diagnosis most often lacks elsewhere.
A note on faith
Vine & Branch is an openly Christian practice. If you wish it, faith can be part of how we understand suffering and hope in this season. If you do not, it will not be pressed on you. Either way, you will be taken seriously.
Common questions
Can perimenopause cause anxiety and depression?
Yes. Fluctuating estrogen and progesterone affect serotonin, GABA, and other systems that regulate mood and sleep. Many women experience their first significant anxiety, low mood, or intrusive worry during perimenopause, even with no prior psychiatric history. It is physiological, and it is treatable.
What are the psychiatric symptoms of perimenopause?
Common symptoms include new or worsening anxiety, low mood or tearfulness, irritability, brain fog, poor sleep, loss of motivation, and a sense of not feeling like yourself. Symptoms often fluctuate with the cycle before becoming more constant.
How is perimenopausal mood change treated?
Treatment begins with a careful history and, where indicated, laboratory evaluation of thyroid, iron status, and other contributors. From there, a plan may include medication, sleep and metabolic work, coordination with your gynecologist or primary care clinician around hormonal treatment, and therapy referral. The aim is to treat causes, not only symptoms.
Is this just part of aging that I should accept?
No. Suffering through it is not a requirement. The years of perimenopause are often a woman's busiest and most demanding, and feeling well during them matters. Effective, evidence-based treatment exists.
Do you prescribe hormone therapy?
Hormone therapy decisions belong with your gynecologist or primary care clinician. My role is the psychiatric side of the picture, and I coordinate closely with the clinicians managing your hormonal care so the full plan works together.
Care for this season, in Brentwood and across Middle Tennessee.