What we treat
Psychiatric care for women at every life stage
Women's mental health is shaped by biological, hormonal, and psychosocial factors that deserve attention in psychiatric care. From puberty through menopause, hormonal shifts influence mood, anxiety, and sleep. Women experience depression and anxiety at roughly twice the rate of men, yet much of the research behind standard treatment was historically done on men. So it matters that treatment accounts for how estrogen and progesterone fluctuations affect medication response, how hormonal contraceptives affect mood, and how reproductive milestones shape psychiatric symptoms.
At MindMED, Dr. Laura Fredes has a clinical interest in women's mental health, with attention to how reproductive transitions and hormonal changes intersect with psychiatric conditions. Whether your mood tracks your menstrual cycle, you are anxious during pregnancy, you are struggling after childbirth, or perimenopause has changed how you feel, you deserve care that accounts for the whole picture.
Estrogen and progesterone influence the neurotransmitter systems central to mood regulation, particularly serotonin, dopamine, and GABA. Shifts in these hormones across the menstrual cycle, during pregnancy, after childbirth, and through perimenopause can trigger or worsen mood and anxiety symptoms.
The pattern is clearest at the transitions. The luteal phase (the two weeks before a period) brings lower estrogen and, in susceptible women, more depressive and anxiety symptoms. Pregnancy raises estrogen and progesterone sharply, which helps some women and worsens symptoms in others. The postpartum period brings a sudden drop that contributes to postpartum mood disorders. Perimenopause, often in the 40s and early 50s, means years of fluctuating hormones that can cause new anxiety or depression. These dynamics shape how we choose medications, set doses, time them within the cycle, and plan for each life stage.
Premenstrual Dysphoric Disorder goes far beyond typical PMS. Women with PMDD experience marked mood symptoms (depression, anxiety, irritability, anger, or emotional emptiness) during the luteal phase, the 1-2 weeks before menstruation, that lift once the period begins. The symptoms are severe enough to disrupt work, school, relationships, and daily functioning.
Many women with PMDD have been told for years that their symptoms are "just PMS" or that they need to "cope better." That is not accurate. PMDD is a medical condition with a biological basis: an unusual sensitivity to the normal hormonal shifts of the menstrual cycle. Women with PMDD often have normal hormone levels. The difference is in how the brain responds to them.
Treatment includes medication options with evidence specific to this condition. Certain SSRIs (selective serotonin reuptake inhibitors), taken only during the luteal phase or continuously, can improve PMDD symptoms substantially. Hormonal contraceptives that suppress ovulation may also help. Sleep, stress, exercise, and nutrition matter as well. PMDD is a focus of Dr. Fredes' practice, and she works with each patient on an approach that fits.
Perimenopause, the transition into menopause that typically spans 4-10 years in a woman's 40s and early 50s, is a time of major hormonal change. As estrogen fluctuates and eventually declines, many women experience new or worsening anxiety, depression, mood instability, sleep disruption, and cognitive symptoms. Some describe it as the hardest stretch of their mental health.
The relationship runs both ways. Hormonal changes can trigger psychiatric symptoms, and pre-existing mood disorders can worsen. A woman who has never had depression or anxiety may suddenly have panic attacks, persistent worry, or low mood. A woman with a history of depression may find that a medication that worked for years no longer holds. Sleep disruption, from hot flashes and from the mood symptoms themselves, compounds all of it.
Care during this stage has to account for the hormonal drivers. Treatment may involve adjusting psychiatric medications, coordinating with your OB/GYN on hormone therapy, and addressing sleep. These changes are common, medical, and treatable.
Dr. Fredes takes an integrative, evidence-based approach that starts with your full picture: medical history, hormonal and menstrual history, past medications, lifestyle, and personal goals.
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PMDD is a real medical condition recognized by the DSM-5 and the ICD-11, the diagnostic manuals used by mental health professionals. The difference between PMS and PMDD is severity and impact: PMDD causes marked mood symptoms that significantly interfere with work, school, or relationships. Treatment is available.
Some psychiatric medications have little effect on fertility or the menstrual cycle; others can. Most SSRIs and SNRIs are not significantly associated with reduced fertility, but antipsychotics can raise prolactin, which may disrupt the cycle. If you are planning to conceive, raise this with your psychiatrist. Dr. Fredes can help you weigh the risks and benefits of your specific medication.
Untreated mental illness during pregnancy carries real risks to both mother and baby, and for many women the risks of medication are lower than the risks of untreated depression or anxiety. Some medications are considered safer than others in pregnancy. Dr. Fredes works through this decision with each patient, weighing individual risks and benefits.
Many psychiatric medications are considered safe during breastfeeding, meaning very little passes into breast milk. Not all are equally safe, though. The choice depends on the specific drug, the dose, and your baby's age and health. Dr. Fredes can go over the options with you if you are breastfeeding.
Perimenopause can change pre-existing conditions. A woman whose depression has been stable on medication for years may find it becomes less effective. Another may see her anxiety worsen. That is frustrating, but it is also a reason to reassess and adjust treatment with perimenopause in view.
It depends on your symptom pattern. For some women with PMDD, taking an SSRI only during the luteal phase (the two weeks before menstruation) works well and limits side effects. For others, daily medication works better. Dr. Fredes will help you decide based on your symptoms, past medication trials, and preferences.
Yes, in some women. For some, hormonal birth control improves mood; for others it triggers or worsens depression or anxiety. The response is individual. If you suspect your birth control is affecting your mood, discuss it with both your psychiatrist and your OB/GYN.
The "baby blues" occur in the first 1-2 weeks after delivery: mood swings, crying, anxiety, and sleep disruption. They affect 50-80% of new mothers and resolve on their own. Postpartum depression persists beyond the first 2 weeks and involves persistent sadness, hopelessness, difficulty bonding with the baby, or difficulty functioning. It is a medical condition that needs treatment, and earlier is better.
Schedule a consultation with Dr. Fredes to discuss your care.