Your Body Is Changing. Your Mind Might Be, Too.
If you're in your 40s or 50s and something feels different — more anxious, more tired, less like yourself — you're not imagining it. Perimenopause and menopause involve real hormonal shifts that affect not just your body, but your mood, your sleep, your focus, and your sense of who you are.
You don't have to figure this out alone. This page offers trusted information and practical resources to help you understand what's happening and take steps that feel right for you.
Mental Health During Perimenopause and Menopause
The physical symptoms of menopause — hot flashes, night sweats, irregular periods — tend to get the most attention. But the emotional and psychological changes are just as real, and they often catch women off guard.
During perimenopause, fluctuating hormones can contribute to:
- Increased anxiety or worry that feels new or unfamiliar
- Mood swings or irritability that seem out of proportion
- Feelings of sadness or low motivation
- Difficulty concentrating or feeling mentally foggy
- Sleep disruption that makes everything harder to manage
Research confirms that perimenopause is a window of increased vulnerability for mood changes. A major long-term study, the Study of Women's Health Across the Nation (SWAN), found that women in perimenopause face a significantly higher risk of depressive symptoms compared to their premenopausal years. This risk appears to be highest during the transition itself and often improves after menopause.
A 2025 review published in Advances in Therapy notes that key neurotransmitter systems — including serotonin and GABA — are directly affected by fluctuating estrogen, progesterone, and testosterone levels. This helps explain why mood, sleep, and cognitive function can all shift at the same time.
If you're feeling more anxious, more emotional, or less like yourself, it's not a personal failure. There's a biological reason. And there are real options for support.
Signs It May Be Time to Talk to Someone
Some degree of emotional change during perimenopause is common. But it's worth reaching out to a healthcare provider or therapist if you notice:
- Sadness, worry, or irritability that lasts for more than two weeks
- Difficulty functioning at work, at home, or in relationships
- Loss of interest in things you used to enjoy
- Sleep problems that aren't improving on their own
- A sense that something is "off" that you can't quite explain
You don't have to wait until things feel like a crisis. Early support is often more effective, and simply having someone help you understand what's happening can bring real relief.
Call 988 — Suicide and Crisis Lifeline, available 24/7
Text HELLO to 741741 — Crisis Text Line
Or go to your nearest emergency room.
Practical Steps You Can Take
There is no one-size-fits-all approach to managing perimenopause or menopause. But research consistently supports several strategies that can make a meaningful difference.
Move your body regularly
Physical activity is one of the most well-supported interventions for both mood and physical symptoms during the menopause transition. A 2025 systematic review and meta-analysis found that regular exercise significantly reduces symptoms of depression and anxiety in perimenopausal and menopausal women. This doesn't require a gym membership — walking, dancing, yoga, or any movement you enjoy counts.
Prioritize sleep
Sleep disruption during perimenopause is extremely common and has a direct effect on mood, energy, and coping. Small changes can help: keeping your bedroom cool, creating a calming bedtime routine, limiting caffeine in the afternoon, and talking to your doctor if hot flashes are waking you at night.
Stay connected
Isolation tends to make emotional symptoms worse. Reaching out to trusted friends, joining a support group, or simply talking to someone who understands can reduce the sense that you're going through this alone.
Consider therapy
Therapy can help you process the identity shifts, grief, anxiety, and emotional overload that often accompany midlife transitions. Cognitive behavioral therapy (CBT) has specific research support for managing mood symptoms and sleep problems during menopause. Relational and somatic approaches can also help you reconnect with yourself during a time of change.
Talk to your healthcare provider
A conversation with your doctor about both physical and emotional symptoms is an important step. Options may include hormone therapy, non-hormonal treatments, or referrals to specialists who understand menopause care. When possible, look for providers who have specific training in menopause — The Menopause Society maintains a directory of certified practitioners.
Resources We Recommend
These organizations provide reliable, evidence-based information about perimenopause and menopause. We've chosen resources that are accessible, science-based, and respectful of women's experiences.
You Don't Have to Navigate This Alone
Midlife transitions are real, and the emotional weight of perimenopause and menopause deserves attention — not dismissal. Whether you're looking for information, considering therapy, or just want to feel understood, support is available.
If you'd like to explore how therapy might help during this time, I'd welcome the chance to talk.
Schedule a Free ConsultationClarity Within Therapy offers therapy for women 40+ navigating anxiety, emotional overwhelm, and midlife transitions.
In-person in Bethesda, Maryland. Virtual across Maryland.