Question
Why is it difficult to distinguish perimenopausal symptoms from psychiatric conditions, and what overlap should clinicians watch for?
Answer
Many symptoms of perimenopause closely resemble those of common mental health conditions, making differentiation challenging. Physical symptoms such as heart palpitations, sleep disturbances, and vasomotor changes can mimic anxiety and panic attacks. Cognitive symptoms, frequently grouped under the term "brain fog," include forgetfulness, slowed thinking, difficulty concentrating, and language deficits, mirroring what is seen in pregnancy and the postpartum period. Emotionally, perimenopause is associated with increased depression, anxiety, low energy, irritability, moodiness, and tearfulness, all of which overlap heavily with conditions routinely seen in counseling.
The degree of overlap is substantial. When comparing shared symptoms, there are ten symptoms shared between perimenopause and ADHD, nine between perimenopause and major depressive disorder, and nine between perimenopause and generalized anxiety disorder. Roughly 80% of women experience perimenopausal symptoms, with about 70% reporting some cognitive deficits. Recognizing this overlap is essential so that clinicians consider whether the symptoms before them are rooted in a psychiatric diagnosis, a hormonal transition, or some combination of both.
This Ask the Expert is an edited excerpt from the course, "Navigating Perimenopause: Hormonal Transitions and Mental Health Implications," presented by Jenna Miles, M.Ed, LPC, LPC-S, PMH-C.
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