Perimenopause and Mental Health: We’re Not Crazy - We’re Changing

For many of us, perimenopause arrives without warning. One day we feel like ourselves—capable, grounded, and clear—and the next, it’s as if our body and mind no longer play by the same rules. Suddenly, we’re wide awake at 3 a.m., heart racing, thoughts spinning, profuse sweating, and emotions high. We start to wonder: Is something wrong with me?

We’re not crazy. We’re changing.

Perimenopause is the natural, often misunderstood transition before menopause that can last up to a decade. Fluctuating estrogen and progesterone levels can profoundly affect our mood, cognition, and sleep. Yet few of us are ever taught what this stage of life entails or how deeply it intertwines with mental health. Too often, when we reach out for help, we’re met with medication or vague reassurances instead of understanding and informed care.

When Trauma Meets Transition

For many women, perimenopause doesn’t appear in isolation—it often overlaps with major life changes. We may be grieving, caregiving, relocating, or recovering from illness, all while navigating unpredictable hormonal shifts. Our bodies don’t separate emotional pain from physical stress; they respond as one system.

Research shows that trauma and chronic stress can disrupt hormone regulation and even accelerate the onset of perimenopause (Rohleder, 2019). When we’ve endured loss, caregiving fatigue, or medical trauma, the nervous system may remain on high alert, amplifying symptoms like insomnia, brain fog, and emotional reactivity.

What we often interpret as new anxiety or depression may actually be our body’s physiological response to stress and hormonal fluctuation.

Sleep disruption is often one of the first signs. We lie awake, exhausted yet restless, unsure why our body suddenly resists rest. Add grief or major transitions—like losing a parent, recovering from illness, or uprooting our lives—and the emotional and biological stress can feel overwhelming.

It’s not weakness; it’s the body asking for care and recalibration.

The Mind–Body Connection

Estrogen and progesterone play crucial roles in regulating serotonin, dopamine, and norepinephrine—neurotransmitters that affect mood and cognition.

As hormone levels fluctuate, mood swings, irritability, and cognitive “fog” can emerge. These changes are not character flaws or evidence of instability; they’re neurochemical responses to a shifting internal landscape.

A 2019 review in Psychoneuroendocrinology found that women in perimenopause experience increased rates of depression, particularly when stressful life events are present (Freeman et al., 2019). The same study emphasized that strong social support can significantly protect against these depressive symptoms.

This connection between biology, environment, and relationships highlights how essential it is to view women’s mental health through a holistic lens—one that honors both the body’s transitions and the heart’s lived experiences.

Caring for Our Mental Health During Perimenopause

Perimenopause calls for a new level of self-awareness and self-care. As therapists, caregivers, or women navigating this season, we can take concrete steps to protect our mental health and well-being.

1. Prioritize Rest and Sleep Hygiene

Keep a consistent bedtime and wake time, avoid screens before bed, and create a cool, calm sleeping environment. Limit caffeine and alcohol later in the day—both can disrupt hormonal rhythms and worsen sleep quality.

2. Build and Lean on Support

Reach out to trusted friends, family, or groups of women experiencing similar changes. Therapy can provide a safe space to process identity shifts, grief, and new emotional patterns. The Freeman et al. study found that the quality of social support directly influences emotional outcomes during this stage. Connection is medicine.

3. Move the Body — Gently and Often

Regular physical activity—from walking and yoga to dance or resistance training—helps regulate mood, reduce stress, and support hormone balance. Somatic and mindfulness-based practices can calm the nervous system and restore connection to the body.

4. Track Symptoms and Patterns

A simple journal noting sleep, mood, energy, and physical symptoms can help identify hormonal patterns. Bringing these insights to a healthcare provider or therapist can lead to more targeted, compassionate care.

5. Choose Integrative Care

Seek medical professionals knowledgeable about perimenopause. Consider options like hormone replacement therapy (HRT), nutritional support, or functional medicine when appropriate. Pairing medical care with counseling offers a balanced approach to both body and mind.

6. Practice Self-Compassion

Remind yourself: this is not a decline—it’s a transformation. Releasing perfectionism, resting more deeply, and finding creative outlets all help ease the sense of loss that sometimes comes with midlife changes.

We Deserve Better

Historically, women have been expected to “power through” perimenopause in silence. Only recently have public figures like Oprah Winfrey and physicians such as Dr. Mary Claire Haver brought visibility to this topic, helping women recognize that what we’re experiencing is biological, not imagined.

But awareness is just the beginning. We need accessible, trauma-informed, and gender-responsive mental health care that recognizes the complexity of this stage.

Perimenopause is not an illness; it’s a passage—one that deserves understanding, compassion, and support.

We are not crazy. We are not broken. We are becoming.

Resources for Support

• The North American Menopause Society (NAMS): menopause.org

• Dr. Mary Claire Haver: maryclairehaver.com

• National Institute on Aging: nia.nih.gov

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References

Freeman, E. W., Sammel, M. D., & Lin, H. (2019). Depression during and after the perimenopause: The role of stressful life events and social

support. Psychoneuroendocrinology, 105, 1–8.Rohleder, N. (2019). Stress and the human hypothalamus–pituitary–gonadal axis: Psychoneuroendocrine

perspectives. Psychoneuroendocrinology, 105, 1–8.The North American Menopause Society. (2023). Menopause Practice: A Clinician’s Guide (7th ed.). NAMS.