Hormones & Mental Health
Hormonal transitions produce psychiatric symptoms. Perimenopause in particular is one of the most
common causes of new-onset depression and anxiety in midlife women, and one of the most frequently
misdiagnosed.
Can perimenopause cause depression and anxiety?
Yes, and the evidence for it is strong. The years leading up to menopause carry a measurably
elevated risk of depression, including in women with no previous psychiatric history.
The symptoms are frequently attributed to something else. Sleep disruption, irritability,
difficulty concentrating, low mood, new anxiety, and a sense that you are no longer coping with
things you used to manage easily — these are commonly treated as burnout, stress or a primary
depressive episode without anyone asking about the menstrual cycle.
Perimenopause can begin in the early forties and sometimes the late thirties, often while cycles
are still regular. Many women are told they are “too young” for this to be the explanation.
Why is it missed so often?
Partly because it falls between specialties. Psychiatry does not routinely ask about hormonal
status; gynecology does not routinely assess mood. A woman with new anxiety at 45 may be prescribed
an antidepressant without anyone considering the hormonal context, or offered hormone therapy
without her psychiatric symptoms being properly assessed.
There is no blood test that definitively diagnoses perimenopause — FSH fluctuates too much
to be reliable — which means the diagnosis is clinical and depends on someone thinking to ask.
What can be done about it?
Depending on the picture, treatment may involve psychiatric medication, hormone therapy, or both.
Some antidepressants also reduce vasomotor symptoms, which can address two problems with one
medication. For some women, hormone therapy substantially improves mood; for others it does not, and
psychiatric treatment is what helps.
We provide hormone management as part of psychiatric care and coordinate with your gynecologist
where appropriate. What we will not do is treat the mood symptoms while ignoring the hormonal
context, or the reverse.
What other hormonal conditions affect mental health?
- Premenstrual dysphoric disorder (PMDD) — severe, cyclical mood symptoms
in the luteal phase. A recognized psychiatric diagnosis, and treatable. - Thyroid dysfunction — both hypo- and hyperthyroidism produce symptoms
that closely mimic depression and anxiety. Worth checking before concluding anything. - Perinatal hormonal shifts — see
perinatal and postpartum psychiatry. - PCOS — associated with elevated rates of depression and anxiety, and with
the metabolic issues covered under obesity psychiatry. - Testosterone deficiency in men, which can present as low mood, fatigue and
reduced motivation.
Is this available by telehealth?
Yes. Lab work can be ordered locally anywhere in Arizona, and this is care that works well by
video. See telehealth in Arizona.
What should I bring to a first visit?
Any recent lab work, a rough sense of your cycle history including when things changed, a list of
current medications and supplements, and — if you have one — a record of how symptoms
track across the month. That last one is genuinely useful for distinguishing PMDD from a mood
disorder that happens to fluctuate.
Treatment in Glendale and across Arizona
We see patients in person at our office in Glendale, in the Arrowhead area, and by telehealth anywhere in Arizona — Tucson, Flagstaff, Prescott, Yuma, Sierra Vista and everywhere between. Virtual visits are the same appointment with the same provider at the same fee.
Getting started
New patient evaluations are $375 and run 60 to 90 minutes. Follow-up visits are $125. We are out-of-network with all insurance and provide a superbill you can submit for reimbursement. Full detail on our fees page.
Pinnacle Psychiatry · 17505 N 79th Ave, Suite 309, Glendale, AZ 85308
Phone 623.321.2221 · Text 877.749.7502
Monday–Wednesday 8:00am–5:00pm · Thursday 7:00am–5:00pm