This topic is about a woman in her early 40s who has had an ileostomy since she was a baby. Recently, she has been experiencing severe mood swings, depression, and anxiety attacks, which are affecting her personal life and work. She suspects these symptoms might be related to perimenopause. Her doctor initially prescribed Yaz birth-control pills, but they only helped a little. She is now seeking advice from other women with ostomies who might have faced similar menopause-related challenges.

Here are some insights and advice shared by others:

1. Short-term anti-anxiety and antidepressant medication:
- It's recommended to take prescribed medications, like lorazepam at night, to help stop panic attacks, clear the mind, and improve sleep.
- Melatonin is suggested as a natural sleep aid.

2. Check for other medical causes and monitor triggers:
- It's important to have a full gynecological check-up to rule out other conditions.
- Keeping a food diary can help identify if certain foods, like cheese and chocolate, trigger headaches or mood changes.
- Since a lifelong ileostomy can lead to dehydration, it's crucial to drink plenty of fluids to prevent dry skin, eyes, and cramping.

3. Hormone therapy options:
- Avoid synthetic hormones like standard birth-control pills. Consider bio-identical hormone replacement therapy under professional guidance after checking hormone levels.
- Joining online support groups and reading books like "Ageless" by Suzanne Somers and "What Your Doctor May Not Tell You About Menopause" by Dr. John R. Lee can be helpful.
- Routine blood tests might not be very useful due to fluctuating hormone levels, but a rising FSH level can indicate menopause transition.

4. Natural and lifestyle approaches:
- Incorporate plant estrogens into your diet by eating more soy foods, such as tofu, soy milk, and yams.
- Some find herbal supplements like Red Clover helpful, though others see little benefit from Black Cohosh or Agnus Castus.
- Engaging in activities like exercise, hypnosis, relaxation tapes, Tai Chi, Ai Chi, and Feldenkrais movement classes can reduce anxiety and improve balance.
- Regular physical activity helps burn excess adrenaline and can ease mood swings.

5. Reassurance and outlook:
- Experiencing menopause in the early 40s is normal, and intense symptoms often decrease over time.
- Many women, including those with ostomies, face similar challenges. With balanced hormones, proper hydration, medication when necessary, and lifestyle changes, significant relief is possible.