Psychiatric Conditions During Peripartum and Perimenopause

Growing interest in women’s mental health has paralleled the expanding clinical and research focus on women’s health issues over the past two decades. Research has shown that prior to puberty, both genders are equally at risk for developing mood disorders; however, with the onset of menstruation, women begin to show an increased risk for unipolar depression compared with men. Although studies have not yet revealed a consistent association between female reproductive hormones and psychiatric illness, there appears to be a subgroup of women at increased risk for psychiatric symptoms during times of hormonal fluctuation, such as premenstrually, postpartum, and perimenopause. Further, the management of mood disorders during pregnancy must take into account not only the risks of medication exposure to the unborn child but also the risks associated with untreated psychiatric illness, given the high relapse rate in women who stop their psychiatric medications for pregnancy. Psychosocial risk factors and intervening life events are also key factors in increasing women’s risk for psychiatric illness. This chapter focuses on psychiatric conditions during important reproductive transitions in women, including pregnancy, postpartum, and perimenopause; premenstrual syndrome and premenstrual dysphoric disorder are thoroughly discussed in a separate chapter.