Perimenopausal Anhedonia and Anxiety
As cancer fighters, we have a lot of reasons to experience anxiety and depression simply because of our situation. Chemo and radiation sap our energies, leaving us feeling drained and less-than. Aromatase inhibitors are well known to dampen our libido, which can also add to our frustrations and strain relationships. Well, guess what! It's not just our situations that are causing us to feel anxiety or malaise. AIs can affect our mental health a lot more than we previously thought.
New research released in 2025 is showing that ovarian hormones play a key role in dopamine regulation.[1] When estrogen levels fluctuate during perimenopause, it contributes to bouts of depression, anxiety, and anhedonia (the inability to feel joy fully or at all). When we are put into chemical menopause, it starves cancer cells - which is a very good thing. But it is now believed to also interrupt our ability to process dopamine. This makes it harder for us cope with the mental and emotional challenges a cancer diagnosis brings on its own, and exacerbates existing depression and anxiety.
The recommended treatment being investigated currently is estradiol administration. Obviously, that treatment may not be available to ER+ cases. But knowing more about the mental health risks of AIs can help women and their partners better prepare for those changes if they happen and make more fully informed decisions.
[1] https://www.biologicalpsychiatryjournal.com/article/S0006-3223(25)00608-0/abstract
[2] https://www.sciencedirect.com/science/article/abs/pii/S016503272500045X