Information provided in the “Ask the Doctors” column is not meant to take the place of individual consultation with a qualified health care provider. See your health care provider to discuss specific questions about your health, medication and treatment plan.

Question: I am approaching menopause and have noticed my moods becoming less stable. I’m being treated for my mood disorder, but how will menopause affect my illness? What can I do to keep my moods stable?

Alan J. Gelenberg, M.D. and Marlene P. Freeman, M.D.: It is very common for women to suffer more from mood and anxiety disorders through the perimenopause (the 2-8 years leading up to the stopping of menstrual periods). Symptoms of perimenopause in all women can include irregular periods, hot flashes, insomnia and anxiety. Unfortunately, perimenopause is often a destabilizing time for women with mood disorders; women with major depression, bipolar disorder or anxiety disorders usually experience an increase in symptoms during this time. Women may be especially vulnerable to depressive symptoms during perimenopause due to declining levels of estrogen. Estrogen itself may be an antidepressant.

If you are not already on hormone replacement therapy, the first step is to consult with a medical professional about that possibility. There are many different formulations of hormone replacement therapy available, with variable types and amounts of estrogen and progesterone. Some even have testosterone as well, which might help with libido. Some women need to try more than one formulation before finding the one that helps most. Your doctor may also need to re-adjust your antidepressant or mood stabilizer.

Women often encounter increased stress at this time of life. Children may be leaving home, marital or relationship issues may be arising, and, in a society that values youth, women may feel especially discouraged or conflicted about growing older. Individual or group psychotherapy can offer support and insight into these life transitions.

Alan J. Gelenberg, M.D., is Professor and Head of the Department of Psychiatry, College of Medicine at the University of Arizona, and a member of DBSA’s Scientific Advisory Board. Marlene P. Freeman, M.D., is Director of the Women’s Mental Health Program at the University of Arizona Department of Psychiatry.