Perimenopause: Assessment and Management Considerations for Psychiatrists

Perimenopause is associated with significant psychiatric morbidity, including depressive episodes, sleep disturbance, and cognitive symptoms. Despite this, perimenopause remains underrecognized in psychiatric settings, and many women do not receive timely or appropriate care. This article provides psychiatrists with a practical framework for identifying perimenopause in clinical practice, including how to take a reproductive history and apply validated screening tools. The article reviews mood disorders, sleep disturbance, and cognitive changes during perimenopause and the biological, psychological, and social factors that contribute to symptom burden. Evidence-based treatment options including antidepressants, cognitive-behavioral therapy, and hormone therapy are reviewed.