Emily Mendez, 50
Perimenopause started at age 47
7+ symptoms, including irregular periods, trouble sleeping, brain fog, hot flashes, anxiety, mood swings, dry skin, itchy skin
For me, perimenopause was a turbulent journey that turned my life upside down. It all started with irregular periods, vaginal dryness, and trouble sleeping. Best of all (not!) were the hot flashes that would jolt me awake in the middle of the night.
But what concerned me the most was the brain fog. I would forget what I was doing just 5 minutes prior. This was very troubling for me. After a bit of searching online, I discovered that brain fog was pretty common during perimenopause.
Despite knowing that brain fog was a frequent feature of perimenopause, I couldn’t shake the persistent feeling that something was very wrong with me. I was convinced that I had a brain tumor or even early dementia. So, I talked to my doctor about my concerns. He chalked it up to normal age-related memory changes.
Facing a mental health crisis
After I had been experiencing brain fog for about a year, I developed other alarming symptoms. I would have episodes of sleeping just hours for days at a time — or sometimes not sleeping at all. My moods, usually very stable, would become erratic and unpredictable. I also had significant anxiety. During one of these episodes, I had unusual thoughts and behavior. An ambulance was called. I was taken to the emergency room, where they sedated me. I woke up the next morning in a psychiatric hospital.
When I talked to the psychiatrist later in the day, she confirmed that I had no previous mental health history. We talked about the timeline of my symptoms and any stress I was under. I told her that one of my stressors was the perimenopause symptoms.
The psychiatrist diagnosed me with a brief psychotic episode but didn’t prescribe any medications. She believed that this was an isolated event, triggered by fluctuating hormones and stress. Nevertheless, I stayed in the hospital for 3 days for observation. Upon discharge, the doctor referred me to a neurologist to rule out other brain issues. She also encouraged me to follow up with my gynecologist for the perimenopause symptoms.
I saw my gynecologist. I also made an appointment to see a neurologist. One of my doctors prescribed the antidepressant citalopram to help with depression symptoms.
An unexpected trigger
About a month after I started taking citalopram, I had another psychiatric episode. I was once again taken to the hospital. This time, I was hospitalized for 3 weeks. During this hospitalization, I was diagnosed with bipolar 1 disorder.
The doctors explained to me that I had bipolar disorder and that citalopram had likely triggered a manic episode. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), like citalopram, can increase the likelihood of a manic episode in people who have bipolar disorder.
What is bipolar disorder?
Bipolar disorder is a serious brain disorder that causes unusual shifts in moods, behavior, and activity levels. Bipolar 1 disorder (which I have) causes manic episodes. During these episodes, the person may experience bursts of energy, a decreased need for sleep, pressured speech, irritability, and grandiose thoughts.
Manic episodes may alternate with depressive episodes, in which a person has no energy, a low mood, and little motivation. In severe cases of bipolar disorder, suicidal ideation, and psychotic symptoms may be present.
I was completely taken by surprise by this diagnosis and initially refused to accept it. I felt confused and overwhelmed about what I was experiencing. As a former psychotherapist, I knew the symptoms of bipolar disorder very well. However, this diagnosis didn’t seem to fit. I had no previous mental health symptoms.
The average age of onset for bipolar disorder is in the mid-20s. I was in my late 40s. So, I simply thought the doctors were wrong. I chalked up the issues I was experiencing to perimenopause. Consequently, I would stop taking medications, which would ultimately lead to a relapse of symptoms and re-hospitalization.
It took some time, but eventually, I came to accept that this was more than just perimenopause and that I had bipolar disorder.
Perimenopause and bipolar disorder: The connection
Later, I threw myself into bipolar research. I wanted to understand why I developed this disorder at the age of 48. I learned that the risk of bipolar disorder significantly increases during perimenopause.
One study in the UK, published in 2024, examined the rates of bipolar disorder and depression in more than 128,000 women. The study focused on the 4 years around the last menstrual period. Women in the study were twice as likely to experience mania during perimenopause compared to premenopause (the 6-10 years before menopause). There was a 112% increase in mania among study participants during this time period. Researchers believe that this is due to changes in estradiol levels and genetic factors.
What I want others to know
I am sharing this to help others who might be going through something similar. Here’s what I think is important to understand.
Take mental health symptoms very seriously
There’s an increased vulnerability to certain mental health conditions around the time of perimenopause. Additionally, the symptoms may overlap with perimenopause symptoms. Some overlapping symptoms between bipolar disorder and perimenopause include:
- Brain fog
- Sleep issues
- Irritability
- Mood swings
- Sleep disruptions
It’s important to seek help from a mental health professional if you’re experiencing severe psychiatric symptoms like the above. Even if you think they might be due to hormonal fluctuations during perimenopause or menopause, it’s best to be evaluated.
There are many effective treatments for mental health issues. It’s essential to get the right support.
My life now
Menopause
For me, perimenopause has been a long transition. It’s been almost 3 years since I started having symptoms. Menopause is official when you haven’t had a period for 12 months. My periods are very close to — but not quite — 1 year apart. So, I am nearing the end of perimenopause, but not quite there yet.
For the symptoms, I use topical estrogen cream, which helps. Unfortunately, due to my medical history, systemic hormone replacement therapy (HRT) is not an option for me. So, I’ve found other ways to manage perimenopause symptoms.
I frequently do stress-relieving activities, like pickleball, dance, or yoga, nearly every day. And I’ve started traveling again. These things all help improve my mood and reduce anxiety.
Struggling with sleep
Before perimenopause, I slept effortlessly. However, now I struggle with sleep. I frequently wake up in the middle of the night. Sometimes, I’m unable to fall asleep.
I’m not sure if the sleep problems are due to perimenopause or bipolar disorder. Either way, sleep is incredibly important to well-being. So, I talked to my psychiatrist about my sleep issues, and he prescribed medication to help me fall asleep. It works very well for me.
Mental health
I’ve made peace with the fact that I will be living with bipolar disorder for the rest of my life. Now, I prioritize my mental health more than ever before. To stay well, I rely on:
- Medication. Finding the right medications has been the key to stability for me.
- A great mental health support team. A caring and competent mental health team makes all the difference. Thankfully, I have a wonderful psychiatrist and therapist whom I can trust. My psychiatrist is empathetic and collaborative. He listens to my concerns and works with me to find solutions to my problems.
- Support from loved ones. I have very supportive family members. My sister and daughter check in on me daily to make sure I am doing okay.
Final thoughts
It’s evident that hormones remarkably affect our brains. For me, the impact was significant. It helped me enormously to talk about my experience. I think it’s important to be open and talk about these issues and the connection they may have with menopause.
