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 histor y of inconsistent training performance, mood lability, tearfulness, anxiety , insomnia, fatigue, and decreased concentration. Symptoms persisted despit e stress management training and resolution of family stressors, and furthe r evaluation revealed other symptoms consistent with early menopause. Sympt oms responded to estrogen/progesterone therapy, and patient returned to fli ght training. The clinical presentation, differential diagnosis, treatment, and aeromedical disposition of perimenopause and menopause are discussed.