Early menopause presenting with mood symptoms in a student aviator

The clinical presentation of menopause can resemble the symptoms of a mood disorder. We describe the case of a 31-yr-old student helicopter pilot who presented to the Aviation Psychiatry Department with a several-month history of inconsistent training performance, mood lability, tearfulness, anxiety, insomnia, fatigue, and decreased concentration. Symptoms persisted despite stress management training and resolution of family stressors, and further evaluation revealed other symptoms consistent with early menopause. Symptoms responded to estrogen/progesterone therapy, and patient returned to flight training. The clinical presentation, differential diagnosis, treatment, and aeromedical disposition of perimenopause and menopause are discussed.