I’m a doc who does HRT. I commonly see people have flares in hallucinations, mania, suicidal ideation, ADD, rage, insomnia, and dep/anxiety due to hormone fluctuation. Especially starting in the mid-30s. Perimenopause psych symptoms can start years before periods become irregular. Flares are also common after pregnancy losses, deliveries, and phases of abnormal menses. If you’ve been stable on meds for years, and then out of nowhere you have a problem—think about it. My treated people have fewer hospital admissions and much better symptom control. Don’t bother testing hormone levels—it’s not helpful. They fluctuate so much hour to hour that it is impossible to interpret them. Usually, progesterone is the first hormone to drop and it is easy to take and cheap. Not your doc but there you go. (Yes, I know about the meno sub-reddits. They don’t need the PSA. I’m trying to reach the 35yo who is in despair.)
Edited to add pregnancy-related info.
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Thank you for this info. I have a hormone deficiency and find that it absolutely tanks my mental health.
Is HRT, other than like vaginal estrogen cream, generally well tolerated in people who have had psychological effects from birth control?
Getting some comments, HUGE DISCLAIMER HERE. I’m not your doctor and every body and treatment, risk and benefit, is nuanced. I will speak from general experience. What I say is from my practice and may not be supported in medical literature.
You mean like I just had a hysterectomy which removed my Mirena two weeks ago and my emotions are ALL OVER THR PLACE?!?
Thank you for this. Is there a specific kind you can recommend? I’m looking online and see anywhere from $20-$50 per bottle. Is there something you can recommend in the lower price range?
Had a miscarriage a couple of years ago and for months afterward I thought I was having a full on psychotic break when I PMS’d each month. I even told my idiot therapist I was worried it was hormonal and she told me I was developing bipolar disorder. She is no longer my therapist and my hormones eventually rebalanced. Super appreciative someone is posting this.
Diagnosed with ADHD at 35, diagnosed with perimenopause at 38. My neuropsych and my OB have quite literally saved my life by prescribing me the appropriate meds (Adderall and HRT meds).
I’ve been thinking of talking to my doctor about HRT as I’m 36 and my ADHD/depression/anxiety/OCD/CPTSD worsened considerably when I had to switch to a progesterone-only birth control last year. I was told taking estradiol was riskier after age 35 and because I have high blood pressure.
Will that stop me from getting HRT or is that different? I want my life back.
Thanks for sharing your experience. Any thoughts on prescribing estrogen-containing HRT to patients with a CHEK2 mutation? And I know you mention progesterone, but is it fine to start on (bio-identical) estrogen in the early 40s?
So, I asked to have my hormones checked by my doctor. She told me there is no point, as all it would tell me is where I am in my menstrual cycle. Is that true or should I seek a second opinion?
Also, for anyone with bipolar 2 (or epilepsy) that takes Lamictal, hormones can dramatically impact absorption of medication.
Oral hormones tanked my Lamictal blood levels. My doctor wasn’t aware that there would be a contraindication (!!!).
Estrogel and vaginal estrogen have not messed with my meds. I had a Mirena already so medication was already at the therapeutic level.
Medication levels can be adjusted to account for the absorption issues but need to be supervised. I opted for HRT that wouldn’t require med changes since I’ve been stable for 10 years.
Thank you so much for this. I saw a study that PTSD can get a lot worse in perimenopause. I really hope more research and especially better treatment for all who need it happens asap. I hope you don’t mind if I ask a few questions:
Is it true the FDA is possibly in the process of changing its stance against HRT? If it does change, will that result in better insurance coverage of it?
Is there a certain level of estrogen that is the ideal goal to reach when prescribing HRT, that gives better results?
Also, I have a quick question just to set my mind at ease from stressful uncertainty – I will of course be discussing this with my medical providers. Can someone with abnormally low FSH still be in perimenopause? I know it’s terribly complicated! I have been searching desperately online and can’t find any info on this whatsoever.
Can iron deficiency screw up those hormones?
Can the estradiol cream make migraines worse? I have occipital neuralgia and I did notice that right before my period starts my head would get worse. I’ve been on continuous birth control so these are for break through periods I’ve had.
Thank you for this! My mental health is in the toilet the week before my period, like I legitimately wish I was not alive, and it’s no way to be. I need to speak with a doctor about this. I did IVF to have my kid and it made me leery of taking hormones, but I feel like I’m in hell right now.
I have PMDD, and both my endocrinologist and psychiatrist have presented me with exactly three treatment options.
1 – Hormonal birth control (kind of helped but then I started getting migraine auras and they made me stop them).
2- Lose some weight (I’m down nearly 75lbs, hasn’t made a difference for the PMDD)
3- I don’t know, maybe go on some walks or try some breathing exercises I guess (I’ve been mentally ill since I was 11, I’m now 33 – I’ve tried that)
You’re telling me there are other options? I’ve been on psych meds for decades but they don’t touch the monthly fluctuations.
Edit: what kind of doctor do I need for this? Is it still an endocrinologist?
I have been feeling like I’m seeing things out of the corner of my eye now for like a year or more and it’s driving me crazy because it’s messing with my anxiety. Now I’m on a GLP-1 and the anxiety is awful maybe because I’m losing weight and that disrupts hormones? Thanks for sharing because I know my hormones are out of whack and I need to take this seriously. I haven’t felt like myself in a long time.
i have always been sensitive to hormones (brutal periods since day zero, horrible reactions to birth control pills, rough PMS) and have been asking my PCPs over the past 5 years that i suspect i have some hormonal problem and they refuse to make a referral.
I am here to testify that this is absolutely the case with one of my elder care clients. She was in her late 70s, and had dementia as well as preexisting paranoid psychosis, that was well managed with meds. Although HRT is contraindicated in elderly women, she’s still on it (now in her 80s) because her doctor tried to discontinue it twice, and both times she had terrible ongoing psychotic breaks.
She would sneak out of the house in the middle of the night and hitchhike to the ER. She was hearing voices, and accused everyone around her of trying to kill her. I had to.wrestle a knife away from her at one point. It broke my heart to see her so full of fear and anguish.
As soon as her meds were restored she was her wonderful sweet self again.
What kind of doctor would someone seek? Gynecologist? endocrinologist?