Perimenopause is a major life transition that affects both the body and mind. While it’s often recognized for causing irregular periods and hot flashes, its impact on mental health can be just as significant. In this conversation, Wildflower’s co-founder Aga Grabowski, LCSW, PMH-C, CST, interviews Dr. Vesna Pirec, MD, PhD, a board-certified psychiatrist specializing in reproductive psychiatry, to explore the connection between perimenopause and mental well-being. Dr. Pirec shares insights on why some women experience more intense emotional shifts, how to distinguish between normal hormonal changes and more serious mental health concerns, and the most effective strategies for managing mood swings, anxiety, and depression during this time.
About Dr. Pirec: Dr. Pirec is a board-certified psychiatrist with over 20 years of experience in both academic and private practice. Our Wildflower team has had the pleasure of collaborating with Dr. Pirec in the care of many patients over the years, and we have deep respect for her expertise and integrative approach to psychiatry and mental health. Dr. Pirec specializes in reproductive psychiatry, providing expert care to women during key transitional phases of life, including pregnancy and postpartum, premenstrual challenges, perimenopause, and infertility treatments. With a deep understanding of the complexities of mental health, Dr. Pirec takes an individualized and holistic approach, combining integrative methods with psychopharmacology and psychotherapy. Her extensive experience, clinical expertise, and multicultural sensitivity allow her to offer compassionate, effective care tailored to each patient’s unique needs. You can learn more about Dr. Pirec and her practice by visiting her website.
Let’s now turn to Dr. Pirec for her expert insights on perimenopause!
How does perimenopause affect mental health, and why do some women experience more significant emotional challenges during this transition?
Perimenopause can be a vulnerable time for mental health, with some women experiencing new or worsening symptoms like depression and anxiety. Women with a history of depression are actually twice as likely to develop it again during this stage.
First, let’s define perimenopause: It’s the transition leading up to menopause, when periods become irregular—lasting seven days longer than usual, skipping months at a time, but never fully stopping for more than 11 months. Once a woman goes 12 months without a period, she has officially entered menopause.
Hormonal fluctuations, particularly in estradiol (a key form of estrogen during the reproductive years), are a major driver of mood changes during perimenopause. It’s not the absolute level of estrogen that matters most, but rather the sharp ups and downs. Some women are more sensitive to these fluctuations, which, when combined with life stressors, can make emotional challenges more intense. Other factors, like overall health, personal expectations, and social support, also play a role in how a woman experiences this transition.
What are the most common mental health symptoms associated with perimenopause, and how can women distinguish between normal hormonal shifts and more serious concerns like depression or anxiety?
The most commonly reported mental health symptoms during perimenopause are depression and anxiety. These symptoms don’t always meet the criteria for a clinical diagnosis, but they can still significantly impact daily life and well-being.
Depression may show up as a loss of interest in things that used to bring joy, constant fatigue, or a lack of motivation. Anxiety is also common, as estrogen has natural anti-anxiety properties, and its decline can leave women feeling more vulnerable to stress.
One challenge is that some symptoms of anxiety—like sweating, a racing heart, and feeling flushed—can overlap with hot flashes, making it tricky to tell them apart. Interestingly, women who experience depression or anxiety are twice as likely to report more frequent or intense hot flashes, though it’s still unclear whether hot flashes trigger mood issues or vice versa.
If feelings of sadness, worry, or emotional distress are persistent and interfering with daily life, it’s important to seek help rather than assume they’re just part of the hormonal rollercoaster.
Can perimenopause trigger new mental health conditions, or does it primarily worsen pre-existing ones?
Both! While women with a history of depression or anxiety may see their symptoms worsen, perimenopause can also trigger these conditions in women who have never experienced them before. In fact, about 28% of women develop new-onset depression or anxiety during this time.
Are there biological reasons why some women are more emotionally affected by perimenopause than others?
Yes. Some women are naturally more sensitive to hormonal fluctuations, especially changes in estrogen (estradiol), progesterone, and testosterone. Those who go through perimenopause for a longer period—sometimes up to 14 years—may also be more vulnerable to mental health struggles.
Genetics, stress levels, overall health, and lifestyle factors all play a role in how a woman experiences this transition.
What are some effective treatments for managing mood swings, anxiety, or depression related to perimenopause?
There are several treatment options, and a combination approach often works best:
Lifestyle changes: Regular exercise, a balanced diet, good sleep habits, and stress management techniques
Psychotherapy: Talk therapy, cognitive behavioral therapy (CBT), or mindfulness-based approaches
Medications: Antidepressants, anti-anxiety medications, or hormone replacement therapy (HRT) when appropriate
Supplements & natural remedies: Certain vitamins, minerals, and herbal supplements can help, though they should be used with guidance from a healthcare provider.
The key is finding a tailored approach that works best for each woman’s unique needs.
How do lifestyle factors, such as diet, exercise, and sleep, impact mental health during perimenopause?
Lifestyle habits play a significant role in how a woman feels during perimenopause. Sleep disturbances are common, with many women struggling to fall asleep, waking up too early, or feeling unrested. These issues should be addressed through good sleep hygiene, relaxation techniques, and, when necessary, medication. Regular exercise can also make a noticeable difference—just 30 minutes of aerobic activity, even something as simple as brisk walking, can improve mood, reduce stress, and enhance overall well-being. Nutrition is another key factor; eating a variety of nutrient-dense foods and incorporating supplements when needed, under medical guidance, can help support both mental and physical health.
Are antidepressants or anti-anxiety medications commonly prescribed for women struggling with perimenopausal mood disorders?
Yes, they are commonly prescribed and can be very effective. However, they aren’t the only option. There’s still a lot of room to improve awareness about other supportive treatments, like lifestyle modifications, supplements, and hormone therapy when appropriate. A holistic approach often leads to the best results.
What natural or alternative treatments have shown promise for mental health support during perimenopause?
There are several natural options that some women find helpful, including:
- Black cohosh – May help with hot flashes and mood stability
- Ginseng – Known for energy and stress management
- Magnesium glycinate – Can help with anxiety
- Ashwagandha – Supports sleep and reduces stress
- Rhodiola root – May help with anxiety and fatigue
- Serylis – A combination of pollen extract, vitamin E, and pumpkin seed extract for mood support
It’s important to remember that while these can be helpful, they should be used under medical supervision to ensure safety and effectiveness.
What advice would you give to women who feel dismissed by their doctors when they bring up mental health concerns during perimenopause?
Advocate for yourself. If you feel like your concerns aren’t being taken seriously, don’t hesitate to seek a second opinion. Your health matters, and you deserve to be heard.
In addition to finding the right healthcare provider, building a strong support system is crucial. Having a network of friends, family, or even a support group can make a big difference. Lack of social support is actually a bigger risk factor for mental health struggles than things like an “empty nest” or being single.
How can women advocate for themselves and seek the right support for their mental health during this stage of life?
The good news is that awareness about perimenopause and its impact on mental health is growing. There are gynecologists, psychiatrists, and therapists who specialize in this area and can offer proper guidance and treatment.
Women should feel empowered to: ask their doctor for a thorough evaluation and discuss all available treatment options; seek out specialists if their current provider isn’t knowledgeable about perimenopause-related mental health concerns; and join support groups to connect with others going through similar experiences
Perimenopause is a natural stage of life, but that doesn’t mean women have to suffer in silence. Help is available, and no one should feel alone in navigating this transition.
Wildflower Center for Perinatal and Family Mental Health is the heart of Wildflower Center for Emotional Health, reflecting over a decade of dedication to perinatal and reproductive mental health, including the challenges of perimenopause. With a foundation in clinical expertise, transformative education, and advocacy, we lead the way in advancing care, support, and awareness in this specialized field. Whether you’re seeking mental health services or a professional looking for training, consultation, or educational programming, we are here to support you.
