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Perimenopause, Mood Disorders, and possible side effects of Treatment with Antipsychotic


Sex Hormones, Brain, Gut and Physical Symptoms

I've encountered numerous women with diagnoses spanning Bipolar Disorder, Fibromyalgia, Depression, Anxiety, to Functional Neurological Disorder. Notably, many of their symptoms parallel estrogen fluctuations or deficiencies.


This blog explores the reasons for symptom overlap, common treatments, potential side effects, and achievable responses through rebalancing hormones. Let's begin with a discussion about eggs.

1. Age 37: The Prelude to Change:

- Egg Countdown: Around age 37, a pivotal shift occurs in your reproductive system as egg counts decline steeply, potentially intensifying premenstrual symptoms. Many women in this age group, informed about perimenopause, seek ways to balance cyclical hormone fluctuations. Antidepressants often provide minimal relief for fluctuation or deficiency-related depression or anxiety.

2. Common Diagnoses Amidst Change:

- Companions in Transition: Perimenopause often brings common diagnoses such as depression, anxiety, bipolar disorders, fibromyalgia, and IBS. Bipolar disorders involve longer mood cycling, and for those diagnosed in their 30s or 40s, tracking cycles and symptoms becomes crucial. Anxiety heightens in the luteal phase, and irregular cycles may lead to prolonged symptoms.

- Fibromyalgia: Varying in severity, symptoms include severe tiredness, muscle and joint aches, brain fog, and poor sleep. These closely align with perimenopause or menopause, more severe with longer gaps between periods.

- Postnatal Hormone Dip: Postnatal depression, baby blues, or psychosis within the first four months post-delivery relate to a significant dip in estrogen. Addressing this hormonal dip aids in alleviating related symptoms.

3. Antipsychotics and Hormonal Pauses:

- Antipsychotics, crucial for managing mood disorders, may induce reversible menopause-like symptoms. Understanding this mechanism is essential for effective management.

Antipsychotics can affect the hormonal system, particularly by influencing the levels of prolactin, a hormone associated with breastfeeding. Elevated levels of prolactin can interfere with the normal menstrual cycle and suppress ovarian function, leading to a temporary state that resembles menopause.

Here's a simplified breakdown:

  • Prolactin Elevation: Antipsychotics can lead to an increase in prolactin levels in the blood. This elevation is a common side effect of many antipsychotic medications.

  • Impact on Menstrual Cycle: Elevated prolactin can interfere with the normal regulation of sex hormones, such as estrogen and progesterone, which are crucial for the menstrual cycle.

  • Ovulatory Disruption: The disruption in sex hormone levels can suppress ovulation and lead to irregular or absent menstrual periods. This effect is similar to what happens during menopause, where the ovaries produce fewer hormones.

  • Menopause-Like Symptoms: As a result, women may experience menopause-like symptoms, including hot flashes, changes in libido, and mood swings. These symptoms are reversible once the medication is adjusted or discontinued.


4. Metabolic Syndrome and Cardiovascular Implications:

- Antipsychotics contribute to metabolic syndrome, heightening cardiovascular risks. Prioritizing overall health becomes crucial during these crossroads.

5. Neurotransmitters: Architects of Mood:

- Estrogen as a precursor for neurotransmitters like dopamine and serotonin makes hormonal imbalances trigger emotional turbulence. Balancing these is vital for mood stability.

9. Gut-Brain Connection:

- Maintaining harmony in the gut-brain connection through a balanced diet is integral for emotional well-being during perimenopausal transitions. IBS type symptoms are common in perimenopause and menopause symptoms. Estrogen plays a crucial role in the gut, influencing various aspects of its function and health. Here are some key roles of estrogen in the gut:

  • Maintaining Gut Integrity: Estrogen helps to maintain the integrity of the gastrointestinal tract by supporting the mucosal lining. This lining serves as a barrier that protects the gut against harmful substances, toxins, and pathogens.

  • Modulating Inflammation: Estrogen has anti-inflammatory effects in the gut. It helps regulate the immune response, preventing excessive inflammation. This is important for overall gut health and can contribute to the management of conditions associated with inflammation, such as inflammatory bowel diseases (IBD).

  • Regulating Motility: Estrogen influences the smooth muscle function of the gastrointestinal tract, playing a role in regulating gut motility. This can impact the speed and coordination of muscle contractions, affecting the movement of food and waste through the digestive system.

  • Affecting Microbial Balance: Estrogen may influence the composition of the gut microbiota, the community of microorganisms living in the digestive tract. A balanced microbiota is essential for digestion, nutrient absorption, and overall gut health.

  • Addressing Hormonal Changes: Fluctuations in estrogen levels, such as those occurring during the menstrual cycle or menopause, can affect gut function. Some women may experience changes in bowel habits, bloating, or other gastrointestinal symptoms during different hormonal phases.


11. Individualizing Mental Health Support:

- Seeking personalized care from providers understanding a woman's cycle, lifestyle, reproductive history, and family history is crucial for a comprehensive understanding and management of mood symptoms associated with sex hormone imbalances.

12. Empowerment Amidst Hormonal Shifts:

- Embracing the transformative journey empowers women to navigate complexities. Knowledge, self-awareness, open conversations about symptoms, exploring management options, and seeking help from a comprehensive health professional contribute to this empowering journey.


By Dr Purity Carr

GP & Menopause Doctor

Harvey. WA

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