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Fig. 1

Steps for addressing sleep problems. CBTi, CBT for insomnia; OSA, obstructive sleep apnea; RLS, restless leg syndrome.

Fig. 2

Steps for addressing cognitive complaints. ADHD, attention-deficit/hyperactivity disorder; CBC, complete blood cell count; HBA1c, glycated haemoglobin A1c; MoCA, Montreal Cognitive Assessment; TSH, thyrotropin.

First page of article

Perimenopause is a 4- to 9-year window of risk before menopause in which women may experience new onset or worsening of psychiatric symptoms, particularly depression. Therefore, primary care assessment of women at midlife should include routine depression screening. In addition, psychiatric evaluations of midlife women should also screen for symptoms of perimenopause, including hot flashes and night sweats; sleep disturbance; cognitive complaints; sexual, vaginal, and urinary problems; and joint pain, with concerning symptoms receiving further workup or appropriate referral. Treatment of perimenopausal depression should include treatment of contributing perimenopausal symptoms and consideration of agents with efficacy for vasomotor symptoms.

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