Hot flashes, disrupted sleep and mood disorders can be overwhelming. These symptoms (and many others) can be caused by the same thing: perimenopause. 

Every woman will experience perimenopause, yet it's rarely discussed openly. So you might have a few questions. As a psychiatrist specializing in women's mental health, I want women to know that treatment is out there. You don't have to suffer in silence. Read on to demystify perimenopause and find out how it affects women psychologically.

Perimenopause is a time of transition

As the transition to menopause, perimenopause starts with irregular periods. Menopause, or the complete stopping of menstrual periods, is signified after 12 months of no periods.* On average, women experience menopause at age 51. Perimenopause typically starts four to eight years before that.

During perimenopause, hormone levels start to change, which leads to symptoms like hot flashes, sleep disturbances, and increased risk for anxiety and depression. 

During perimenopause:

• Nearly every woman has irregular periods
• Roughly 80% experience hot flashes
• About 40% have sleep disturbances

As you can imagine, some of these symptoms cause cascading effects like poor concentration and decreased focus. This time of transition may feel incredibly disruptive, yet many women avoid treatment for perimenopause or even talking about it.

*Note: If you go 12 months without a period and then you have one after that, it could be a sign something is wrong. Be sure to call your doctor if that happens.

When lifestyle changes collide with natural changes 

In their 40s and 50s, many women reach the peak of their careers, become empty nesters or begin caring for their aging parents. These major life transitions often happen during perimenopause – and the stress can make symptoms worse. Dealing with psychological transitions and the symptoms of perimenopause at the same time can be overwhelming. 

That's why effective treatment can help all areas of your life. If you can manage your symptoms effectively, you'll have more energy and capacity to deal with life transitions, too. With severe hot flashes, some women find relief with hormone replacement therapy or oral contraceptive pills. The oral contraceptives aren't for birth control. Rather, they stabilize hormone levels and help with mood swings. Other times, nonhormonal medications can be the best option. 

Alternatively, healthy lifestyle changes can limit the symptoms of perimenopause too. 

For example, these lifestyle changes can prevent hot flashes:

• Reduce stress: Stress often makes hot flashes worse. Try exercise, meditation or yoga to reduce stress
• Avoid trigger foods: Spicy foods, caffeine and alcohol can trigger hot flashes, so limit these types of foods. Switch to fruits and veggies, which can improve your overall health
• Dress in layers: A toasty room can trigger hot flashes. Wear layers so you can take off a jacket or cardigan if you get too warm

Be sure to talk to your doctor about any holistic remedies you try, as these can interfere with prescribed medications.

How perimenopause can lead to depression

Women are 2.5 times more likely to develop depression during perimenopause. This is partly due to hormone changes, but major life changes can also increase risk of depression. If you've had depression earlier in life, that also increases your risk of depression during perimenopause. 

When prescribing medication, it's important to consider a woman's entire history and background to get her exactly the right type of treatment. Treating depression and anxiety during perimenopause is more nuanced than during other stages of life. A skilled psychiatrist will take the time to determine whether symptoms are caused by depression, anxiety, hormonal changes or some combination. Some medications that treat anxiety and depression also treat hot flashes as well.

If you've had previous issues with premenstrual dysphoric disorder, you're more likely to have hot flashes and other symptoms of perimenopause.

I work closely with primary care providers and OB-GYNs to make sure my patients get the care they need. Each woman's care team is unique to their personal experiences and symptoms. Sometimes psychotherapists get involved, especially if there's a lot of social stressors making symptoms worse.

One thing that drew me to this particular area of psychiatry is how much researchers are still learning. There are so many possibilities for understanding women's health better through research. I'm a member of both the North American Menopause Society and the International Society for the Study of Women's Sexual Health. With these two organizations, I get access to the latest research and treatments for perimenopause. 

The bottom line: Perimenopause can feel incredibly disruptive and it lasts for several years. But treatment is available to help with symptoms – like hot flashes, sleep problems, depression and anxiety. If you're struggling with any of these symptoms, I'd love to help.