08/18/2025
August 18, 2025
By Dr. Rachael Berg-Martinez | Safe Haven Psychology Center | Orange County, CA
For many women, perimenopause arrives quietly. It can begin as early as your late 30s or 40s, and often the first signs aren’t hot flashes or night sweats, but something more subtle: a change in mood, sleep, or energy. You might find yourself feeling more irritable, anxious, or down and wonder if it’s stress, depression, or something else entirely.
The truth is, perimenopause has a profound impact on mental health. Hormonal changes during this transition affect not only your body, but also your brain, emotions, and sense of self. Understanding these changes can help you feel less alone and more empowered to seek the right kind of support.
What Is Perimenopause?
Perimenopause is the time leading up to menopause, when the ovaries gradually produce less estrogen and progesterone. It can last anywhere from a few years to a decade, and symptoms can come and go unpredictably (Haver, 2024). While every woman’s journey is different, common experiences include:
-Irregular periods
-Hot flashes or night sweats
-Sleep disturbances and daytime fatigue
-Brain fog or forgetfulness
-Changes in libido
-Mood swings, anxiety, or depression
-Decreased frustration tolerance and irritability
-Frozen shoulder, digestive issues, weight gain, and heart palpitations
Research also shows that perimenopause can increase vulnerability to depression, especially for women who are already at higher risk (Antai-Otong, 2007; Soares, 2019).
How Hormones Impact Mental Health
Estrogen and progesterone influence brain chemistry, including serotonin, dopamine, and GABA — neurotransmitters that regulate mood and anxiety. As hormone levels fluctuate, you may notice:
-Increased anxiety or irritability, even when circumstances are stable
-Depression or low mood, particularly if you’ve experienced mood disorders before
-Sleep problems, which worsen stress and mood regulation (Baker et al., 2018)
-Cognitive changes, such as brain fog or trouble concentrating
Research shows estradiol levels directly influence how the brain processes stress, with lower levels associated with stronger negative responses (Albert, Pruessner, & Newhouse, 2015).
In addition, perimenopause represents a window of vulnerability for stress-related mood disorders. Fluctuating hormones interact with the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress response system, making women more sensitive to stress and mood dysregulation (Hantsoo et al., 2023).
Mental Health Risks During Perimenopause
While many women navigate perimenopause without major psychiatric difficulties, research shows this stage can be a critical period for mental health:
Women with pre-existing mental illness may experience changes in symptom severity or treatment response during perimenopause (Behrman & Crockett, 2023).
Qualitative research describes women feeling like “a shell” of themselves, reporting increased anxiety, depression, and diminished self-worth (O’Reilly et al., 2024).
Another study highlighted that some women reported suicidal thoughts or attempts during perimenopause, often linked to feelings of entrapment and hopelessness — especially when misdiagnosed or delayed in accessing appropriate hormone therapy (Hendriks et al., 2025).
These findings highlight the importance of proactive, compassionate care and the need for providers to integrate both psychological and hormonal perspectives.
The Emotional Side of Perimenopause
Beyond physical and hormonal shifts, perimenopause often stirs up deeper emotional themes. Many women reflect on:
Identity — Who am I now that my body and roles are changing?
Relationships — Shifts in intimacy, parenting, and caregiving roles
Losses — Fertility changes, aging parents, or children leaving home
Resilience — The chance to heal old wounds and embrace new growth
This combination of biological and psychological changes means perimenopause is not only a medical transition, but also a life stage of meaning, reflection, and potential healing (Soares, 2019).
Therapy and Support During Perimenopause
Medical care (such as hormone replacement therapy or sleep interventions) can be crucial, but therapy also plays an important role. Therapy can help you:
-Understand and normalize your experiences
-Manage anxiety, depression, or mood swings
-Learn tools for grounding, sleep, and emotional regulation
-Process grief, identity shifts, and relationship changes
-Build resilience and self-compassion during this new stage of life
At Safe Haven Psychology Center, we specialize in supporting women through transitions like perimenopause. Our approach integrates trauma-informed therapy, attachment-focused work, and depth-oriented exploration to help you not just cope, but also grow during this season.
You Don’t Have to Go Through This Alone
If you’re experiencing mood changes, anxiety, or emotional upheaval during perimenopause, you’re not failing — you’re human. This stage can feel disorienting, but it also carries an opportunity to deepen self-understanding and create a new, empowered chapter of life.
Therapy can help you find balance, clarity, and compassion for yourself in the midst of change. Reach out for a free 15-minute consultation to discuss how we can help.
References
Albert K, Pruessner J, Newhouse P. Estradiol levels modulate brain activity and negative responses to psychosocial stress across the menstrual cycle. Psychoneuroendocrinology. 2015 Sep;59:14-24. doi: 10.1016/j.psyneuen.2015.04.022. Epub 2015 May 7. PMID: 26123902; PMCID: PMC4492530.
Antai-Otong D. Transition to depression? Perimenopause, menopause and mental health. Adv Nurse Pract. 2007 Oct;15(10):45-6, 48-50. PMID: 19998879.
Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018 Feb 9;10:73-95. doi: 10.2147/NSS.S125807. PMID: 29445307; PMCID: PMC5810528.
Behrman S, Crockett C. Severe mental illness and the perimenopause. BJPsych Bull. 2023 Nov 13;48(6):1-7. doi: 10.1192/bjb.2023.89. Epub ahead of print. PMID: 37955045; PMCID: PMC11669460.
Hantsoo L, Jagodnik KM, Novick AM, Baweja R, di Scalea TL, Ozerdem A, McGlade EC, Simeonova DI, Dekel S, Kornfield SL, Nazareth M, Weiss SJ. The role of the hypothalamic-pituitary-adrenal axis in depression across the female reproductive lifecycle: current knowledge and future directions. Front Endocrinol (Lausanne). 2023 Dec 12;14:1295261. doi: 10.3389/fendo.2023.1295261. PMID: 38149098; PMCID: PMC10750128.
Haver, M. C. (2024). The new menopause: Navigating your path through hormonal shifts with clarity and confidence. New York, NY: Rodale Books.
Hendriks O, McIntyre JC, Rose AK, Crockett C, Newson L, Saini P. The mental health challenges, especially suicidality, experienced by women during perimenopause and menopause: A qualitative study. Womens Health (Lond). 2025 Jan-Dec;21:17455057251338941. doi: 10.1177/17455057251338941. Epub 2025 Jul 8. PMID: 40626330; PMCID: PMC12246672.
O'Reilly K, McDermid F, McInnes S, Peters K. "I was just a shell": Mental health concerns for women in perimenopause and menopause. Int J Ment Health Nurs. 2024 Jun;33(3):693-702. doi: 10.1111/inm.13271. Epub 2023 Dec 11. PMID: 38082463.
Soares CN. Depression and Menopause: An Update on Current Knowledge and Clinical Management for this Critical Window. Med Clin North Am. 2019 Jul;103(4):651-667. doi: 10.1016/j.mcna.2019.03.001. PMID: 31078198.
