The Emotional Rollercoaster: Perimenopause and Mental Health

Menopause has been portrayed as the time in life when women lose both their fertility and their minds. Portrayals of hormonal, hysterical women who can turn on you in an instant are common – when menopause is even mentioned at all. But what about the period before menopause? What do we know about perimenopause and mental health – and why is no one talking about it?

How Perimenopause Affects Mental Health

The hormonal changes of menopause actually start in the time before your period ends. Many women will experience menopause sometime in their 50s but the period before (perimenopause) can start as early as your 30s and is most common in women in their 40s. And it can go on for years. Hormonal shifts start in this pre-menopause stage and women sensitive to hormonal changes, or who have struggled with mental health previously, may experience increased anxiety and depression.

This season of life is complex, as many women are starting to have children later and may be ramping up their careers, and caring for aging parents, all at a time when their hormones start to fluctuate. And it’s common to shrug it off, and point to all the other life stressors, when you start to experience increased feelings of sadness and dread. Or maybe you are concerned and reach out to your medical provider. And they just tell you it’s “normal” or to “do more self care.” But they rarely mention, or provide education on, the effects of perimenopause. Women start to feel invisible as we age, no longer useful to society. And the lack of understanding and support around this change in life only serves to increase the feeling that we should keep ourselves quiet and small. 

Feeling Crazy During Perimenopause

If you Google perimenopause and mental health, you will find a couple of articles about perimenopause on the front page and then the information shifts to menopause - with maybe a passing mention of the years before menopause is official. One of the reasons perimenopause can feel so crazy making is the lack of support and acknowledgement from the medical community and popular culture. Women report going to their primary care physicians and getting little to no guidance on how to deal with the effects of shifting hormones and they are certainly not being warned that this is a common occurrence. The medical community is typically more focused on physical symptoms and takes a more reactive stance, rather than preparing and educating women on the changes they may experience physically AND mentally in the period before menopause.

Emotional Effects of Perimenopause

If you experienced PMS, or the wide range of emotions that is pregnancy, then you have an idea of what perimenopause feels like. Except it’s considered “cute” when a pregnant woman is crying one minute and laughing while she eats a pint of ice cream the next minute. Not so much with perimenopausal women. Many women report mood fluctuations - being so anxious it’s hard to sleep at night and feeling so depressed during the day that it’s hard to function. The hormone swings in perimenopause can lead to symptomatic extremes. The increase in anxiety may lead to increased irritability and having a hard time just dealing with everything. And the depressive symptoms may lead to lowered self esteem and dread.

Can I Control My Emotions During Perimenopause?

Many women come to therapy to learn how to feel better. Their goal is to get rid of the uncomfortable feelings or learn to control them better. It is not possible (or preferable) to get rid of feelings. We have them for a reason and they serve us well. Learning to “control” emotions sounds like a slippery slope to wanting to just make them go away. What if we learned instead how to allow, accept and regulate our emotions? Instead of pushing them away, or becoming fused with what we are feeling, we can learn to acknowledge and accept what we are feeling. Only then can we do something about it. If you are sad but want to go out with friends, you can learn how to be sad AND keep your plans (and there is a high probability that the social connection will help relieve your sadness). If you are angry but want to lessen the intensity of your rage, you can learn how to breathe deeply and reduce your flight/fight/freeze response. 

Tools You Can Use:

• We recommend Tara Brach’s RAIN meditation practice to learn how to sit with uncomfortable feelings and to bring compassion to yourself and what you are experiencing.
• Our blog on “letting it be,” has good tools to use when you are stuck in ruminating or your anxiety is ramping up. And Claire offers helpful tips to manage anxiety in her blog on treating anxiety without medication.
• If you are feeling down, distraction can be a helpful tool to shift your mood enough to energize you. Try watching funny videos on YouTube or playing with a pet. 

How to Improve Mood During Perimenopause

As we learned previously, the hormone shifts of perimenopause can cause rapid changes in mood. The first step towards improving your mood is accepting the rollercoaster. Struggling with accepting the inevitable almost always leads to more pain. Making an effort to establish a consistent morning and evening routine can go a long way towards setting the tone for the day and helping you get a better night’s sleep (which is essential for physical and mental health). 

Morning Routine Suggestions:

• Gratitude practice 
• Yoga
• Reading or journaling for a few minutes
• Mindfulness as you drink your morning coffee

Evening Routine Suggestions:

• Body scan meditation
• Reading or journaling
• Skincare routine
• Nightly wind down

Finally, there are prescription and over the counter methods of improving your mood as well. You should always talk to your medical provider first before taking any new medication. Perimenopause is a significant change in life, and can take you by surprise.

But don’t stay quiet and small. Roar until someone takes notice. And educate your friends and loved ones. Advocate for yourself. 

Sometimes you need the support of someone else. A therapist can help you manage your feelings and thoughts around perimenopause and the changes it brings. If you are struggling with changes related to perimenopause, contact us today to schedule a free consultation. We also provide support for women struggling with anxiety, trauma, and attachment issues. 

Disclaimer for Blog: The content of this blog is meant solely for educational and informational purposes only, and does not constitute mental health or medical advice. It also specifies that the use of the blog content does not establish any therapist-client relationships.

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