Hormone replacement therapy in Minneapolis and online.

If symptoms around mood, anxiety, insomnia, focus, energy level, and libido get worse in your 40s without another explanation, it is worth considering perimenopause as the reason and HRT as a potential treatment. Psychological symptoms are often accompanied by physical symptoms, such as hot flashes and vaginal dryness.

If you experienced strong mood fluctuations around your menstrual cycle or when you had children, it is more likely that the hormonal changes of perimenopause will impact you psychologically.

The results of the 2002 Women’s Health Initiative (WHI) trial were misrepresented, and misinformation about cancer and stroke risk deprived a generation of the benefits of HRT. The WHI used oral estrogen and mainly studied women over age 60. Using transdermal estrogen patches for women in their 40s and 50s looks very different in terms of risk. We now have a much more nuanced understanding of the risks and benefits of HRT and can offer it with confidence in its safety. We will have a detailed risk-benefit discussion individualized to your health history.

Yes. Peri/menopause comes with so many psychological effects, so it makes sense that psychiatrists have this effective tool in our toolbox. I completed additional training with women’s mental health expert Dr. Kate Salama tailored for psychiatrists to learn to prescribe HRT, and it has added so much efficacy and satisfaction to my practice.

Perimenopausal symptoms can start as early as one’s 30s. If you are in menopause, it is recommended to start HRT within ten years of your last period. If you are outside of that 10-year window, we can pursue further testing to clarify your risk profile — HRT may still be possible and safe for you.

Lab testing can be part of a comprehensive, personalized approach to prescribing HRT, assessing hormonal status as well as certain risk factors. Some women have been told they are not candidates for HRT because of certain lab results, but ultimately, treatment is guided by symptoms and not the numbers alone.

Good question! Both can have their role in treating hormone-related psychological symptoms. In general, HRT is lower dose and people continue to ovulate. Birth control pills are higher dose and prevent ovulation. HRT is used more for people in late peri-menopause or menopause whereas birth control pills may be used at younger ages and earlier stages. There are many nuances, and I will take a detailed psychiatric history to determine which route could best support you.

Another great question. Perimenopause is the run-up to menopause. It can start as early as your late 30s. It is when periods start to get slightly irregular and psychological symptoms can start to show up. You are still cycling, but hormonal shifts are starting. Some people make an analogy to “reverse puberty,” but it takes even longer.

Menopause officially starts one year after your last period, on average in your early 50s.

HRT interventions need to be tailored to the stage that you are in. Like all of integrative psychiatry, this is a highly personalized form of treatment, and it is adjusted over time.

Some possible side effects include irregular bleeding, breast tenderness, bloating, headaches, nausea, and mood swings. (I hear you, we are trying to help with mood swings, not worsen them!)

We can typically minimize or eliminate side effects by adjusting dosages, timing, or the way you take it (pills, patches, gels, IUD, etc.). It can take some fine tuning, often over the first few months of treatment.