Perimenopause and Mental Health

My daugther's first communion, looking like I had it together when in reality my anxiety was extreme.

When I was in my early 40s, my anxiety went through the roof. I had no idea what was happening but suddenly driving with my kids in the car seemed scary. My hands would go numb in particularly stressful situations. I was also having a hard time concentrating and finding words. I thought something was wrong with my brain, which didn't exactly decrease my anxiety.

Though I consulted many doctors, noone mentioned that perimenopause might be causing my symptoms. After a year of running the gamut, I was finally prescribed an SSRI, which helped with the anxiety, though my congnitive symptoms actually got worse...including brain fog and memory lapses. I had to wait another 5 years for HRT.

Thankfully, ten years later, perimenopause is increasingly understood as a critical window for mental health, with around 70% of women experiencing some level of emotional or psychological change.

Yet many, if not most, women still don’t realise that their feelings of anxiety, panic, and general unhappiness may be connected to perimenopause. Often when they seek medical attention, doctors don't recognise these as perimenopause symptoms. Alot of times women just keep these feelings to themselves, hoping it will pass and they will feel like themselves again.

That may be dangerous, as research shows definite link between perimenopause and mental health conditions:

• A higher risk of depression. Women in perimenopause are two to four times more likely to experience a major depressive episode than they were before this transition. Even those who’ve never struggled with depression before can develop symptoms for the first time.

• Anxiety and panic symptoms. Anxiety is extremely common during perimenopause. Research suggests that more than half of women experience significant anxiety, which may include panic attacks, irritability, or a constant sense of being on edge.

• “Brain fog” and emotional volatility. Many women describe forgetfulness, difficulty concentrating, and sudden emotional shifts, such as unexpected tearfulness or irritability, that feel unfamiliar and unsettling.

• An increased risk of suicide. Studies show that suicide risk peaks for women between the ages of 45 and 55, highlighting how serious and under-recognised perimenopausal mental health challenges can be.

I know that this is all pretty scary. The good news is that there are effective, research-backed options to support mental wellbeing during this transition:

• Hormone Replacement Therapy (HRT). For many women, HRT can be highly effective in stabilising mood and easing depression related to hormonal fluctuations.

• Cognitive Behavioural Therapy (CBT). CBT is widely recommended for perimenopausal depression and anxiety. It can help women navigate mood swings, irritability, and brain fog by building emotional regulation skills, reframing unhelpful thought patterns, and developing healthier ways to cope with stress.

• Lifestyle approaches.

  • Movement: Regular exercise supports emotional balance, reduces anxiety, and improves overall quality of life.

  • Yoga: Research shows yoga can significantly ease both physical and emotional menopausal symptoms, including anxiety and low mood.

  • Sleep support: Addressing insomnia and disrupted sleep is essential, as poor sleep can dramatically affect mood and resilience.

  • Nutrition: A Mediterranean-style diet has been linked to fewer menopausal symptoms and better mental health.

• Connection and emotional support. Feeling understood makes a real difference. Peer support, strong social connections, and validation from healthcare professionals all play a protective role during perimenopause.

• Medication options when needed. If hormone therapy isn’t suitable, or symptoms are severe, certain antidepressants such as SSRIs can help manage both mood symptoms and physical experiences like hot flushes.

Perimenopause shouldn't be about sucking it up and merely surviving. Understand that what you are feeling is real. You aren't going crazy.

Get compassionate support from women who understand, be that from friends, a support group or a coach like me. Find medical providers that know about perimenopause and will offer treatments that help.

Not getting help can have severe consequences to your well-being, your relationships and your career. There are many things that can help you start feeling better. Just remember: You don't need to go this alone!

Citations

• Brown et al., Promoting good mental health over the menopause transition,.The Lancet, Volume 403, Issue 10430, 2024, Pages 969-983

• Clayton AH, Ninan PT. Depression or menopause? Presentation and management of major depressive disorder in perimenopausal and postmenopausal women. Prim Care Companion J Clin Psychiatry. 2010;12(1)

• Freeman, E. W., et al. (2006). "Depression and depressive symptoms in the menopausal transition." Menopause

• Kuck MJ, Hogervorst E. Stress, depression, and anxiety: psychological complaints across menopausal stages. Front Psychiatry. 2024 Feb 22;15: