Anxiety, rage and brain fog have a cause.
Hormone shifts can bring on anxiety, irritability and low mood, even in women who have never had them before. We treat your hormones and your mood together, with counselors and psychiatric clinicians on the same team as your menopause care.
- Same clinicians every visit
- Bridgewater, Nutley & telehealth statewide
- Just about every insurance, including Medicaid
It's not just stress, and it's not in your head
Estrogen affects the brain chemicals that regulate mood, sleep and focus. When it swings up and down in perimenopause, many women feel the change before they notice anything happening with their periods.
Anxiety
New worry, racing thoughts or a sense of dread, sometimes with a pounding heart that feels like panic.
Irritability & rage
A shorter fuse than you've ever had, and anger that feels out of proportion and out of character.
Low mood
Flatness, tearfulness or losing interest in things you enjoy. Risk is higher if you've had depression, severe PMS or postpartum depression before.
Brain fog
Losing words, forgetting names, struggling to concentrate. Real, common, and for most women temporary.
How we treat mood in perimenopause
Mood symptoms in midlife rarely have one cause. Poor sleep, night sweats, work and family stress and hormone changes all feed each other. Treating only one piece usually isn't enough, so we look at all of them.
- Treat the sleep first. Night sweats and 3 a.m. waking make every other symptom worse. Fixing sleep often lifts mood on its own.
- Hormone therapy can improve mood during perimenopause, especially when hot flashes are part of the picture. Hormone therapy
- Antidepressants are the main treatment for moderate or severe depression, and some also reduce hot flashes.
- Counseling with our counselors, in person or by video, and a referral for CBT when it fits.
- Medical acupuncture can help with anxiety, stress and sleep alongside other treatment. Acupuncture for anxiety and sleep
What we rule out
Thyroid disease, anemia, low vitamin B12 or vitamin D, sleep apnea and medication side effects can all cause fatigue, low mood and fog. As a full primary-care practice we check for them, instead of assuming it's all hormones. Thyroid care
Feel like yourself again.
Most new patients are seen within a week, in person in Bridgewater or Nutley, or by video anywhere in New Jersey.
Sleep and insomnia
Trouble sleeping is one of the most common complaints of the menopause transition, and one of the most treatable.
- CBT for insomnia is the most effective long-term treatment and works better than sleeping pills. We refer you to a therapist who offers it.
- Treating night sweats with hormone therapy or a non-hormonal medicine stops the wake-ups at their source.
- Micronized progesterone taken at bedtime, as part of hormone therapy, helps many women sleep.
- Checking for sleep apnea, which becomes more common after menopause and is often missed in women.
Brain fog
If you're losing words mid-sentence or walking into rooms and forgetting why, you're not imagining it. Research on the menopause transition shows a real, measurable dip in memory and processing speed for many women. For most it improves after menopause.
Better sleep, treated hot flashes, steady mood, regular exercise and correcting any thyroid or vitamin problem all help in the meantime. If memory problems are severe, getting worse or worrying your family, we'll look further.
If you are in crisis
If you are thinking about harming yourself, call or text 988, the Suicide & Crisis Lifeline, any time, day or night. If you are in immediate danger, call 911.
When depression needs more
Our practice includes psychiatric clinicians who work alongside your menopause and primary-care team. They can adjust medicines, combine treatments and see you as often as you need.
If depression hasn't improved after at least two antidepressants, there are further options, including Spravato (esketamine) nasal spray at our treatment centers. You won't have to start over with a new practice to get there. Mental health care
Mood and brain fog questions
Can perimenopause cause anxiety and depression?
Yes. The hormone swings of perimenopause raise the risk of anxiety and depression, including in women who have never had either before. Women with a past history of depression, or of mood changes around their periods or after pregnancy, are at higher risk.
Is perimenopause rage real?
Yes. Irritability and sudden anger that feel out of character are common in perimenopause, often made worse by poor sleep and night sweats. They respond to treatment, and you don't have to simply put up with them.
Will hormone therapy help my mood?
It can. Estrogen can improve mood during perimenopause, especially when hot flashes and poor sleep are feeding the problem. It is not a substitute for antidepressants in moderate or severe depression, and it helps mood less after menopause than during the transition.
Is brain fog in menopause permanent?
No. For most women, trouble with word-finding and concentration improves after the menopause transition. Treating sleep, hot flashes, mood and any thyroid or vitamin problems often helps sooner.
Can antidepressants help hot flashes too?
Yes. Some low-dose antidepressants, such as paroxetine, venlafaxine and escitalopram, reduce hot flashes as well as easing anxiety and low mood, so one medicine can treat both.
Do you offer counseling?
Yes. Our practice includes counselors and psychiatric clinicians, and they work with your primary-care and menopause clinicians. Counseling is available in person or by video.
What if my depression hasn't responded to treatment?
If depression hasn't improved after trying at least two antidepressants, we offer further options, including Spravato (esketamine) nasal spray at our treatment centers. Our psychiatric team can tell you whether it's a good fit.
- Maki PM, et al. Guidelines for the evaluation and treatment of perimenopausal depression: summary and recommendations. Menopause 2018;25(10):1069–1085.
- The 2023 Nonhormone Therapy Position Statement of The North American Menopause Society. Menopause 2023;30(6):573–590.
- The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause 2022;29(7):767–794.
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