Perimenopause and Mental Health

By: Allison Ronda, Student Therapist

Allison has spent the past ten years working as a Naturopathic Doctor, supporting people with care, empathy, and a holistic focus on mind, body, and spirit. Now, as a Master of Counselling student at City University, she’s continuing that work in a new way—offering counselling at reduced rates under the supervision of a registered psychologist. Allison is passionate about creating a warm, non-judgmental space where clients can feel supported, explore their experiences, and build on their own strengths along the way.

The Mental Health Impact of Perimenopause

Perimenopause is the transitional phase leading up to menopause which is often characterized by hot flashes, night sweats, and irregular periods. While these physical symptoms are real and disruptive, they can overshadow another significant and equally challenging aspect of this stage of life: the profound impact on mental health.

For many women in their forties and early fifties, perimenopause can feel like an emotional rollercoaster. If you have been feeling anxious, irritable, or simply “not yourself,” know that you are not alone, and your feelings are valid. This is not just “stress” or “getting older” it is biology.

The Hormonal Rollercoaster

The significant influencer of perimenopause mental health challenges is the turbulent and eventual decrease of hormones, specifically estrogen and progesterone.

Estrogen plays a role in regulating neurotransmitters like serotonin, which is the “feel-good” hormone. In perimenopause estrogen is in a rollercoaster ride which affects the stability of your mood leaving you vulnerable to anxiety and depression.

Progesterone naturally has a calming effect. During perimenopause, this hormone starts to decrease which can remove your emotional buffer, leading to heightened stress, irritability, and anxiety.

Mental Health Symptoms

The mental health symptoms of perimenopause can be varied and imitate other conditions, making them hard to diagnose.

Anxiety and Panic Attacks - A pervasive sense of worry, nervousness, or dread that can become a daily companion. For some, this can escalate into experiencing racing heart and sweating which can be exacerbated or mistaken for hot flashes.

Mood Swings and Irritability – Mood swings can be rapid and unpredictable including feeling disproportionately angry or frustrated by what you used to consider minor annoyances. These mood changes can lead to tension and challenges in personal and professional relationships.

Depression – A persistent low mood along with a loss of interest in activities, fatigue, and a feeling of hopelessness. Perimenopause is a time of increased vulnerability to depression, especially if you previously experienced mood disorders or severe PMS.

Cognitive Issues – “Brain Fog” in perimenopause can consist of memory lapses, difficulty in concentrating, and mental fatigue. This can lead to significant difficulty and frustration at a personal and professional level.

Self-Esteem – Other changes that can occur during perimenopause include weight gain and loss of sleep which can lead to emotional instability and a loss of self-worth.

The Compounding Factors

Our lives are always in flux and perimenopause often coincides with other major life stressors that compound our mental health.

Sleep Deprivation – As progesterone levels decline and we lose its calming effect we can experience more anxiety, irritability, and sleep disturbance. Night sweats and hot flashes can also disrupt sleep leading to an increase in fatigue and worsening of mental health outcomes.

Life Pressures – Women are often juggling demanding careers, caring for aging parents, and managing their own families and relationships which can lead to increased stress and impact both mental and physical health.

Stigma of Aging and Perimenopause – This is a period of life transition which can bring up feelings of loss, grief, shame, and identity shifts. Talking about perimenopause can be difficult because of the stigma and stereotypes that still exist.

Strategies for Mental Wellness

Exercise – Regular physical activity can lift the mood, relieve stress, and improve sleep. This can be a mix of aerobic, stretching, and strength training.

Mindfulness and Meditation – Techniques like meditation, yoga, and breathing exercises can help us practice slowing down and being present which can improve emotional regulation.

Improve Sleep Hygiene – Create a sleep routine by maintaining a sleep schedule and limit screen time before bed.

Support Networks – Connection with other women going through perimenopause and sharing your experience can provide a sense of comfort and feeling understood. A lack of knowledge and support can exacerbate the challenges of going through perimenopause.

Counselling – Psychotherapy can be highly effective for managing anxiety, depression, and life transitions. Therapists can provide a safe space to process emotional changes, develop coping strategies, and manage symptoms of perimenopause.

If perimenopause is impacting your mental health, please know that you do not have to “tough it out.” You can seek out professional support through consulting your healthcare provider and through reaching out to a mental health professional.

The mental health impact of perimenopause is real, common, and can be supported. Be kind to yourself, listen to your body, and do not hesitate to reach out for the support you deserve.

Click here to learn more about Allison and her work as a student therapist at Collective Healing Centre.

References

Cleveland Clinic. (2024). Perimenopause. https://my.clevelandclinic.org/health/diseases/21608-perimenopause#management-and-treatment

McElhany, K., Aggarwal, S., Wood, G., & Beauchamp, J. (2024). Protective and harmful social and psychological factors associated with mood and anxiety disorders in perimenopausal women: A narrative review, Maturitas, 190, 108118. https://doi.org/10.1016/j.maturitas.2024.108118.

UPMC. (2024). Perimenopause. https://www.upmc.com/services/womens-health/conditions/perimenopause