Case study · Women's HealthSample
Seeking inputPerimenopause with vasomotor symptoms, poor sleep and new anxiety
Age 40–49Sex: FemaleWomen's Health
Women's Health NP · Menopause care
Looking for peer input. Perimenopausal patient with new-onset anxiety alongside vasomotor symptoms and poor sleep. Hot flashes are much better on HT; the anxiety only partly. When do you add an SSRI/SNRI versus give it more time?
- Presenting issue
- Eight months of hot flashes and night sweats, fragmented sleep, and new-onset anxiety. No prior psychiatric history. Thyroid function and CBC normal.
- Approach
- Transdermal estradiol with oral micronized progesterone at bedtime; CBT-I referral; sleep plan.
- Outcome Seeking input
- Vasomotor symptoms down roughly 70% at week 10. Sleep improving; anxiety partly improved.
The author asks
Add an SSRI/SNRI now, or reassess at 16 weeks?
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De-identified · reviewed by a moderator on October 25, 2026
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