You're in your late 30s or early 40s, and something feels... different. Maybe it's the brain fog that makes you forget why you walked into a room. Perhaps it's the anxiety that seems to come from nowhere, or the mood swings that leave you feeling like a stranger in your own body. Your periods might still be regular, and your labs come back "normal," but you know something has shifted.
If this sounds familiar, you're not alone—and more importantly, you're not imagining it.
Perimenopause, the transitional phase leading up to menopause, can begin as early as your late 30s—sometimes a full decade or more before your periods actually stop. Yet despite affecting millions of women, it remains one of the most misunderstood and under-discussed phases of women's health.
While many people associate menopause with hot flashes and night sweats, the reality is far more complex. The hormonal fluctuations of perimenopause can profoundly impact your mental and cognitive health, often in ways that catch both women and their healthcare providers off guard.
During perimenopause, estrogen levels don't just decline—they fluctuate wildly, sometimes spiking higher than they were in your 20s before plummeting to new lows. This hormonal rollercoaster affects neurotransmitters like serotonin, dopamine, and GABA, which regulate mood, anxiety, and cognitive function.
The result? Symptoms that can feel bewildering and isolating:
These aren't character flaws or signs of weakness—they're legitimate medical symptoms of a significant hormonal transition.
Here's where many women get stuck: they seek help from healthcare providers, undergo blood tests, and are told everything looks "normal." The problem is that traditional hormone testing often misses the nuanced picture of perimenopause.
Hormone levels fluctuate dramatically from day to day during perimenopause. A single blood draw might catch you on a day when estrogen is relatively high, masking the fact that it plummeted just days before. Additionally, many providers aren't trained to recognize that symptoms can be severe even when hormone levels appear "normal" on paper.
This is where a symptom-driven approach becomes crucial.
At Conscious Psychiatry, we understand that perimenopause and menopause isn't just a gynecological issue—it's a whole-person experience that requires comprehensive, compassionate care. We treat perimenopause as a clinical diagnosis based on your symptoms and lived experience, not just laboratory values.
We believe that when a woman says she feels different, she deserves to be heard and validated. Our approach prioritizes how you feel over what your labs show, because we understand that the most sensitive indicator of hormonal changes is often your own experience.
This doesn't mean we ignore medical testing—we use it as one piece of a larger puzzle that includes your symptoms, medical history, and overall well-being. But we never dismiss your concerns simply because a number on a lab report falls within the "normal" range.
When appropriate, hormone replacement therapy (HRT) can be transformative for perimenopausal women. However, we approach HRT with both scientific rigor and individual care:
FDA-Approved Options: We prefer to use only FDA-approved bioidentical hormones, including transdermal estradiol, micronized progesterone, and when appropriate, low-dose testosterone gel. These options have robust safety data and can be precisely adjusted to meet your individual needs. If needed for financial reasons, testosterone cream may be compounded. However, we will have an informed consent discussion to carefully weigh the pros and cons, as compounded medications can be less consistent in dosing.
Research consistently shows that HRT is the most effective treatment for menopausal symptoms. Studies demonstrate that transdermal estradiol with micronized progesterone has an excellent safety profile, particularly when started within 10 years of menopause onset.
Why We Don't Use Pellets: Unlike some clinics, we don't offer hormone pellets. Pellets are not FDA-approved, cannot be adjusted once placed, and often lead to overdosing and unwanted side effects. We believe in treatments that can be carefully monitored and modified as your needs change.
Individualized Care: HRT is often appropriate for women under 60 or within 10 years of menopause, and sometimes earlier in perimenopause when symptoms significantly disrupt daily life. We work with each patient to determine the lowest effective dose and safest long-term plan.
Mental health doesn't exist in a vacuum, and neither does hormonal health. That's why we work closely with therapists, primary care providers, and OB-GYNs to ensure you receive comprehensive care.
Our integrated approach might include:
While HRT can be life-changing for many women, it's only one part of optimal perimenopausal care. True wellness during this transition requires attention to multiple aspects of health:
The psychological aspects of perimenopause deserve the same attention as physical symptoms. We integrate mental health support throughout treatment, recognizing that this transition can trigger grief, identity shifts, and complex emotions about aging and life changes.
Sleep, nutrition, movement, and stress management aren't just "nice to have"—they're essential components of hormonal health. We help you identify practical strategies that fit your life and support your overall well-being.
Clinical studies show that regular exercise, particularly resistance training, can significantly improve mood symptoms during perimenopause. Additionally, Mediterranean-style dietary patterns rich in omega-3 fatty acids and phytoestrogens have been associated with reduced perimenopausal symptoms.
Sometimes, simply understanding what's happening in your body can be profoundly healing. When you realize that your symptoms have a biological basis, it can reduce self-blame and open the door to effective treatment.
We recognize that every woman's perimenopausal journey is unique. That's why we offer two distinct pathways to ensure you receive the most appropriate care:
Best for women with both emotional and physical symptoms, or when psychiatric medications may need adjusting
This comprehensive approach is ideal if you're already taking psychiatric medications or if anxiety, depression, or cognitive problems are your primary concerns. Your care team includes both our Psychiatric Mental Health Nurse Practitioners (PMHNPs) and our Women's Health Nurse Practitioner (WHNP), working collaboratively to address both your mental health and hormonal needs.
Best for women whose main concerns are physical symptoms like hot flashes, night sweats, and cycle changes
This pathway is designed for women who don't need psychiatric medication management but want expert guidance on hormone therapy for physical symptoms. You'll work directly with our WHNP, who specializes in evidence-based hormone treatment.
Many women suffer unnecessarily because they don't realize that help is available, or they've been told their symptoms are "just part of aging." Here are signs that you might benefit from professional support:
Remember: perimenopause is a natural life transition, but that doesn't mean you should suffer through it.
If you suspect you might be entering perimenopause, start by tracking your symptoms. Note patterns in your mood, energy, sleep, and physical symptoms alongside your menstrual cycle. This information can be invaluable in helping your healthcare provider understand what you're experiencing.
Pay attention to:
Perimenopause doesn't have to be endured—it can be navigated with knowledge, support, and appropriate treatment. At Conscious Psychiatry, we're committed to helping women not just survive this transition, but thrive through it.
Your symptoms are real, your concerns are valid, and effective help is available. Whether you're dealing with mood changes, physical symptoms, or both, we're here to provide the compassionate, evidence-based care you deserve.
If perimenopause is disrupting your daily life, don't wait. Reach out to discuss how we can help you feel like yourself again—both physically and emotionally. Because you don't have to navigate this journey alone.
Conscious Psychiatry is a specialized mental health practice that takes a holistic, evidence-based approach to women's mental wellness throughout all life stages. Founded by Jordan Gough, a Psychiatric Nurse Practitioner with extensive experience in critical care, our practice combines traditional and alternative treatment options to provide comprehensive, personalized care.
Our Philosophy: We believe that every individual deserves to be heard, supported, and empowered on their journey to better mental health. Our approach is rooted in empathy, empowerment, and evidence-based practices, ensuring that you feel validated and understood throughout your treatment.
Specialized Services:
Our Approach: We treat the whole person, not just symptoms. By integrating mental health support, hormone therapy when appropriate, and lifestyle medicine, we help women navigate life's transitions with confidence and optimal well-being.
Insurance and Accessibility: We accept insurance for psychiatric evaluations and follow-ups, making mental health care accessible. Our hormone therapy services are offered on a transparent, self-pay basis to ensure the comprehensive time and attention this specialized care requires.
Located in Denver, Colorado, Conscious Psychiatry serves women throughout the region who are seeking compassionate, expert care during perimenopause, menopause, and beyond. We're here to help you reclaim your mental wellness and thrive through life's changes.
Contact us today to learn how we can support your journey to optimal mental and hormonal health.
Perimenopause timing and mental health effects:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834516/
HRT safety and timing hypothesis:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146066/
Exercise and perimenopausal mood symptoms:
https://pubmed.ncbi.nlm.nih.gov/31247588/
Mediterranean diet and menopausal symptoms:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468752/
Transdermal estradiol safety profile:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390137/
