Mosaic Mental Healthand WellnessBook an appointmentPerimenopause is a psychiatric event as well as a hormonal one.
The sleep that breaks at 3 a.m., the fuse that got shorter, the worry that arrived out of nowhere, the word you cannot find mid-sentence. Hormone change can bring all of it, and it can sit on top of a mood history that was already there. Mosaic MoodHaus™ treats both sides in one plan.
Book the initial evaluation
Sixty minutes, in person in Katy or by secure video. Tell us it is about perimenopause when you book, or send a message first and we will route you to the right visit.
Book an appointmentCall or text (713) 987-7828Read the articleBilled like any psychiatric visit. Labs and medication are separate.
It is not in your head. It is also not only hormones.
Perimenopause is the stretch of years before your final period, when estrogen and progesterone swing rather than simply fall. Those swings can change sleep, mood and focus, and they land on whatever you were already carrying.
Sleep that breaks
Waking at 3 or 4 a.m., night sweats, or lying awake with a busy mind. Poor sleep makes every other symptom louder, so we treat it as its own problem.
Anxiety that is new, or louder
Worry with no clear reason, a racing heart, or a first panic attack in your 40s. Women with little anxiety before the transition can develop it during the transition.
Low mood and a shorter fuse
Irritability, tears that come easily, losing interest, or the sense that you are not yourself. The risk of depression rises in these years, most of all after past depression, PMDD or postpartum depression.
Brain fog
Losing words, losing the thread, walking into a room and forgetting why. Memory and focus do dip in perimenopause and tend to recover afterward, and we check what else may be adding to it.
Focus and ADHD
If you have ADHD, the systems that worked for years may start slipping. The research is still early, so we look at sleep, mood, hormones and attention together.
Mood that follows your cycle
Mood that dips before your period, now for longer, as cycles become irregular. A history of PMDD or strong premenstrual changes raises the risk of mood symptoms in perimenopause.
Both sides, one plan.
Before we credit hormones with everything, we check what else could be adding to it: thyroid, iron, sleep apnea, medications, alcohol and the load itself.
A 60-minute evaluation
Your mood and anxiety history, sleep, cycles and hot flashes, any history of PMDD or postpartum depression, your medications, and your medical and family history, in one visit.
Labs, when they change the plan
A thyroid panel, and the labs your history points to. Perimenopause itself is diagnosed from your cycles and symptoms, not a single hormone level, because levels swing from day to day.
A plan you agree with
Therapy skills, medication, hormone therapy when it is clinically appropriate, sleep care, or a mix. You decide what you are willing to try.
Follow-ups that adjust
Thirty-minute visits, as often as the plan needs. Hormonal changes and medication both take tuning, and tuning takes more than one visit.
Options, not a script.
Every option here is decided with you after an evaluation, never before it.
Therapy skills in every visit
Cognitive behavioral and acceptance-based skills for anxiety, low mood and the stress of these years, with insomnia treated first with the skills of CBT-I. When a full course of therapy is the right next step, we refer and stay involved.
Antidepressant medicine
A first-line treatment for depression and anxiety in perimenopause. Some of these medicines also reduce hot flashes.
Hormone therapy, when it is appropriate
Estrogen is the most effective treatment for hot flashes and night sweats, and it may ease depressive symptoms during perimenopause. It is not a treatment for depression after menopause. With a uterus, estrogen is paired with a progestogen. Prescribed for uncomplicated perimenopause after an evaluation, with your personal risks reviewed first.
Non-hormone options
Prescription treatments for hot flashes that do not involve hormones, when hormones are not right for you.
Thyroid care
Thyroid problems become more common with age and share many symptoms with perimenopause. Treatment when labs show it is needed.
Coordination
We work with your gynecologist or primary care clinician, and refer back to them for gynecologic care.
What this is
Psychiatric evaluation and treatment for mood, anxiety, sleep and focus during perimenopause and early menopause
Medication management, including antidepressant medicines that may also ease hot flashes
Hormone therapy for uncomplicated perimenopause, when it is clinically appropriate
Thyroid evaluation and treatment
Therapy skills in every visit, and coordination with your gynecologist or primary care clinician
What this is not
Gynecologic care. We refer back to your gynecologist for abnormal bleeding, contraception, pelvic exams, Pap tests and mammograms.
Hormone therapy when your history makes it complicated, for example after breast cancer, a blood clot or a stroke. We coordinate with your specialists instead.
A single test or a single prescription. Care here is a plan that adjusts as you do.
Emergency care. If you are thinking about harming yourself or do not feel safe, call or text 988, or call 911.
Before you book.
Am I too young for perimenopause?
For many women it begins in the mid-40s, and for some in the late 30s. Cycles that change in length are often the first sign. If your mood or sleep changed along with your cycles, it is worth an evaluation at any age.
Can a blood test tell me if I am in perimenopause?
Usually not on its own. Hormone levels swing from day to day, so after 45 perimenopause is diagnosed from your cycles and symptoms. Labs are used to rule out other causes, such as thyroid problems or low iron.
Is hormone therapy safe?
It depends on your age, how long it has been since your last period, and your personal and family history. For many healthy women under 60, or within 10 years of their last period, the benefits outweigh the risks when symptoms are bothersome. In late 2025 the FDA began removing the boxed warnings about heart disease, breast cancer and dementia from hormone therapy labels, keeping the boxed warning about uterine cancer for estrogen taken on its own. We review your own risks before anything is prescribed.
Will hormone therapy fix my mood?
It may help, especially during perimenopause and when hot flashes are part of the picture. It is not approved as a treatment for depression, and it does not treat depression after menopause. Therapy skills and antidepressant medicine remain first-line treatments for depression.
Can I do this by video?
Yes, in Texas, Colorado, Iowa, Michigan, New Mexico, Utah and Washington, or in person at our Katy office.
Does insurance cover it?
It is billed as a psychiatric visit, the same as any other visit here. Self-pay rates are $250 for the initial evaluation and $155 for each follow-up. Labs and medication are separate costs.
Bromberger and colleagues, Psychological Medicine, 2011, and Menopause, 2013 (SWAN: depression and anxiety across the transition)
Freeman and colleagues, and Cohen and colleagues, Archives of General Psychiatry, 2006 (new depression during the transition)
Maki and colleagues, Guidelines for the evaluation and treatment of perimenopausal depression, Menopause, 2018
Kravitz and colleagues, Menopause, 2003 (sleep), and Greendale and colleagues, Neurology, 2009 (memory and processing speed)
The Menopause Society (formerly NAMS): the 2022 hormone therapy and 2023 nonhormone therapy position statements
American College of Physicians insomnia guideline, Annals of Internal Medicine, 2016
U.S. Food and Drug Administration, labeling changes for menopausal hormone therapy, November 10, 2025
NICE guideline NG23, Menopause: identification and management
This page is general information, not medical advice. Treatment decisions belong in a visit with your own provider.