Mental Health and Perimenopause: What Every Woman Should Know

Let’s talk about what’s really going on, and how to take care of your mental health through this significant life stage.

Perimenopause is a natural phase in a woman’s life, but it doesn’t always feel natural or at all easy. It can stir up changes that leave you feeling confused, exhausted, and not quite like yourself. Often starting in the early 40s for many women, though for some women it can begin in their late 30s even, Perimenopause marks the transition toward menopause and can last anywhere from a few years up to a decade.

While physical symptoms like hot flashes and irregular periods are more commonly talked about, the emotional and psychological shifts during Perimenopause can be just as impactful, and in many cases more so.

So what is Perimenopause?

Perimenopause is the time leading up to menopause and the point when a woman hasn’t had a menstrual period for 12 months. During this transition, hormone levels, especially estrogen and progesterone, fluctuate. These hormonal changes can affect everything from your sleep and energy to your emotions and sense of identity and belonging.

It typically begins between the ages of 40 and 45, though as I previously mentioned some women may experience early Perimenopause in their late 30s, especially due to genetics, medical conditions, or lifestyle factors. The average length of Perimenopause is about 4 to 8 years, but the emotional impact can feel like a rollercoaster that few are prepared for.

Common Mental Health Challenges During Perimenopause

1. Mood Swings

   • Sudden irritability, anger, or sadness can take you (and your loved ones) by surprise. These mood swings aren’t “just in your head” they are linked to real hormonal fluctuations.

2. Increased Anxiety

   • You may notice a spike in generalised anxiety or even panic attacks, especially if you have never experienced them before. The physical symptoms of Perimenopause, for example, heart palpitations or disrupted sleep, can also worsen anxiety.

3. Depression or Low Mood

   • Some women experience a resurgence of depression during Perimenopause, particularly if they have had it in the past. Others may feel a dull, persistent sense of sadness or disconnection without any clear reason.

4. Brain Fog and Memory Issues

   • Forgetfulness, trouble focusing, and a fuzzy-headed feeling can be unsettling, especially if you're used to being sharp and organised. This “brain fog” can mimic symptoms of ADHD or early cognitive decline, but it’s often hormone related.

5. Sleep Disruption

   • Insomnia or fragmented sleep can wreak havoc on mental wellbeing, fueling irritability, low mood, and poor concentration during the day.

6. Loss of Confidence or Identity

   • As hormones shift and your body changes, it’s common to feel a loss of self, questioning your worth, your attractiveness, or even your purpose. This is a psychological adjustment as much as a physical one.

Too often, women going through Perimenopause are told they are just “too emotional” or “overreacting.” But what’s really happening is a profound physiological change that deserves understanding and compassion.

This period of life can stir up old wounds or identity shifts, especially if you are navigating children leaving home, ageing parents, or career transitions at the same time.

You are not weak. You are not broken. You are evolving.

How to Support Your Mental Health During Perimenopause

• Consider Medical Support
  In some cases, hormone therapy, antidepressants, or natural supplements might be helpful. Always speak with a qualified medical professional about what’s right for you.

• Track Your Symptoms
  Keeping a journal of mood changes, sleep patterns, and menstrual cycles can help you and your healthcare provider better understand what’s happening.

• Move Your Body
  Regular, gentle exercise helps regulate mood and reduce anxiety. Even a walk in nature or dancing to your favourite song counts.

• Prioritise Sleep and Rest
  Give yourself permission to rest more. If you have good sleep routines and this may include taking short naps when needed, this can make a big difference.

• Connect with Others
  Talk to friends going through the same stage of life. There’s power in knowing you’re not the only one.

• Talk to a Trusted Professional
  Therapy or counselling can help you process emotional changes and build coping strategies. It can also be a safe space to reconnect with your sense of self.

A New Chapter, Not the End

Perimenopause is not just an ending, it really is a transition into a new and potentially empowering chapter. Yes, it can bring emotional upheaval. But it can also be an invitation: to slow down, listen inward, and begin living with more intention and honesty.

If you're finding it hard right now, please know that you don’t have to navigate this alone. As a therapist, I support women through life transitions like this every day. Whether you are grieving parts of yourself that no longer feel present or feeling unsure about what’s next, your experience is valid. You deserve a space where you can be seen, heard, and supported exactly as you are.

This isn’t something to simply push through, it’s a meaningful life change. And within it lies the potential for deep self-discovery. With the right support, this season of change can become a turning point: not the end of something, but the beginning of a more grounded, powerful, and authentic you.

You’re still you. You’re just becoming a deeper, wiser version.