Wait… Is This Perimenopause? When Hormones and Mental Health Collide
A Four-Part Series on Perimenopause, Mental Health and Therapy
“I just don’t feel like myself.”
For many women, that might be one of the first clues that something is changing.
Maybe you're suddenly more anxious. Maybe you're waking up at 3:00 a.m. with your brain enthusiastically reviewing every questionable decision you've made since 1997.
Maybe your patience has disappeared. Maybe you walk into a room and have absolutely no idea why you're there.
Or maybe your periods have become what one presenter rather memorably described as “crime scene periods.”
Kristy and I have started a training on perimenopause and mental health through Better BRIA, and it reinforced something we both think we need to talk about much more openly:
Perimenopause isn't just about hot flashes.
It can be physical, cognitive and emotional, and sometimes it can make you wonder what on earth is happening to you.
What Is Perimenopause and what is Menopause? Understanding the Changes Women Experience in Midlife
One of the simplest things we learned was also one of the most helpful:
Menopause is actually one day!
It is the point (the actual day AFTER) you've gone 12 consecutive months without a menstrual period. After that, you're considered postmenopausal.
The years leading up to that point are perimenopause. For many women, perimenopause begins sometime in their mid-40s often around age 45, and the transition can last for years. While everyone's experience is different, four to ten years isn't unusual. In other words, this isn't necessarily a short little hormonal blip!
Periods may change. Sleep can become disrupted. There may be hot flashes, night sweats, heart palpitations, joint discomfort, sexual or urinary changes, and the infamous brain fog.
And then there are the psychological changes.
Perimenopause and Anxiety: Mental Health Support in Airdrie, Calgary and Cochrane
This was another big takeaway from the training. Anxiety during perimenopause doesn't always feel like worrying. It can be incredibly physical.
A racing heart. A pit in your stomach. Restlessness. Feeling nervous for no obvious reason. Or even a panic attack. And then we become anxious about the anxiety!
Why is my heart racing? Why can't I calm down? What is wrong with me?
This is where looking at the bigger picture becomes important.
When did this start? What's happening with your menstrual cycle? How are you sleeping? Have you experienced significant PMS or PMDD in the past? Let’s look at your history and what happened with your mood during pregnancy, postpartum, fertility treatment or hormonal contraception?
Our hormonal history can sometimes provide clues about how we respond during other hormonal transitions.
Perimenopause, Irritability and “Rage”: What's Underneath the Anger?
“Perimenopause rage” has become a popular term online. In therapy, we'd want to get curious about what rage means for that particular person.
Is it irritability? Overstimulation? Anger? Resentment? Exhaustion? Anxiety?
Because anger is often carrying something underneath it.
Maybe you've spent years taking care of children, parents, partners, clients or even everyone at once. Maybe you're sleeping terribly. Maybe your body suddenly feels unfamiliar.
Hormones may be part of the picture. But so is everything else.
Why Psychology Matters During Perimenopause and Menopause
One thing we particularly appreciated about the Better BRIA training was the emphasis
on the biopsychosocial model.
We can't separate what's happening hormonally from what's happening psychologically and socially.Midlife can bring enormous change. Children grow up. Parents age. Relationships shift. Careers evolve. Losses accumulate.
And sometimes we find ourselves asking:
Who am I now?
What do I actually want?
Previous experiences can also become louder during this transition: a pregnancy loss, difficult postpartum experience, fertility struggles, grief, trauma, depression or anxiety.
Something you thought you'd already dealt with may suddenly feel surprisingly close again.
That doesn't necessarily mean you've gone backwards. It may mean there's something worth revisiting with the person you are now.
Perimenopause and Brain Fog: Memory, Sleep and ADHD in Midlife
And then there's brain fog. You can't find the word. You forget someone's name. You open your laptop and forget what you were going to do. But before assuming the worst, there's another important question:
How are you sleeping?
Sleep, mood, stress and cognition are deeply connected.
For some women, this stage can also raise questions about ADHD. Especially when a child has recently been diagnosed and you're reading their assessment thinking, Wait a minute…
What did your report cards say?
Sometimes midlife doesn't create an entirely new problem. Sometimes it makes an old one harder to compensate for.
Therapy for Perimenopause: Looking at the Whole Picture
You don't have to be told “It's just hormones.”
But you also don't need to assume every change means something terrible is happening. Maybe there's a better question.
Instead of:
What's wrong with me?
Try:
What's changing for me?
Hormones. Sleep. Stress. Relationships. Identity. Physical health. Past experiences. Current demands.
Treatment isn't one-size-fits-all either. For some women, menopause hormone therapy (MHT) may be appropriate and can be discussed with a medical provider. Sleep treatment such as CBT-I (Cognitive Behaviour Therapy-Insomnia), pelvic-floor physiotherapy, medication, lifestyle changes and other medical treatments may also be helpful depending on the symptoms.
And therapy can be another piece of the puzzle, particularly when perimenopause intersects with anxiety, depression, anger, grief, relationships, trauma or identity.
Perimenopause Therapy in Airdrie, Calgary and Cochrane: Maybe We Don't Need to Get the “Old Me” Back
Perhaps one of the more interesting psychological opportunities of this stage is recognizing that we don't necessarily have to become exactly who we were before.
Midlife can be disruptive, but it can also make us curious.
Who am I now?
What matters to me?
What have I outgrown?
What do I want the next part of my life to look like?
Those aren't purely menopause questions. They're human ones.
At Off the Beaten Path Psychology and Wellness, we support clients in Airdrie, Calgary and Cochrane, and we're interested in the whole story, not simply whether something is “hormonal” or “psychological.”
Because usually, we're a little more complicated than that.
This post was inspired by professional training through Better BRIA, whose work focuses on women's mental health and hormone health. We gratefully acknowledge Better BRIA for the education and clinical insights that informed this discussion.
This blog is intended for general educational purposes and is not medical advice. New, severe, persistent or concerning physical or mental health symptoms should be discussed with an appropriate healthcare provider.
This blog was written by Jolene Siemens, R. Psych. | Off the Beaten Path Psychology and Wellness | Airdrie, Calgary, and Cochrane, Alberta
At Off the Beaten Path Psychology, we provide counselling and therapy services to individuals, couples, and families in Airdrie, Calgary, and Cochrane, Alberta. Our team supports anxiety, burnout, relationship challenges, and trauma recovery. Contact us today to learn more about how we can support your mental health journey.