Perimenopause, Menopause, and Mental Health: How Hormonal Changes Bring Emotions and Life Challenges to the Surface
Are you a woman in NYC navigating the challenges of perimenopause and menopause? Hormonal changes during this transitional stage can bring mood swings, anxiety, fatigue, and heightened stress to the surface. At Holistic Therapy, EMDR & Wellness NYC, I specialize in supporting women through perimenopause with talk therapy support, education, somatic therapy, mindfulness, and other supportive holistic approaches that help manage emotional shifts, release tension, and regain balance.
Perimenopause and menopause can bring major emotional and cognitive shifts that may leave you wondering, “What’s happening to me?” If you’re experiencing mood swings, anxiety, or brain fog, you’re not alone. These symptoms are common and are linked to natural hormonal changes that affect the brain and the body. Mental health challenges during menopause are often overlooked, even though this transitional period can bring increased symptoms of anxiety, depression, mood swings, and struggles with alcohol or substance use. Women with pre-existing conditions such as schizophrenia or bipolar disorder may find their symptoms intensifying during perimenopause and menopause.
Isobel, a 48-year-old professional living in NYC, came to therapy feeling unusually anxious and fatigued. She initially thought it was just the stress of her job and life transitions, but over time, she realized her mood swings and irritability were intensified by hormonal changes associated with perimenopause. In therapy, Isobel explored both the external pressures in her life—career changes and family responsibilities—and the internal shifts brought on by hormones. Through a combination of somatic therapy and mindfulness practices, she learned to notice how tension and stress showed up in her body, release stored trauma, and develop strategies to manage her emotions.
Over time, Isobel also recognized growing dissatisfaction in her marriage. Therapy helped her examine her feelings honestly, set boundaries, and explore what changes might be necessary to cultivate greater fulfillment and alignment in her personal life, alongside managing her emotional and hormonal shifts. She also noticed that her ability to tolerate situations, compromises, or patterns that no longer served her had lessened, allowing her to prioritize her well-being and make clearer decisions about her relationships.
Many women also notice changes in self-esteem, focus, motivation, sexual health, and sleep, along with cognitive difficulties such as word-finding problems or short-term memory lapses. These cognitive shifts can understandably cause concern about dementia or Alzheimer’s. At the same time, midlife often brings additional pressures, caring for aging parents, navigating relationship changes, and managing health issues, which can make it harder to prioritize self-care. Simple practices that might help, like exercising, eating well, and maintaining social connections, can feel exhausting or overwhelming during this stage of life. While these changes can feel challenging, understanding them is empowering, and with the right support, lifestyle strategies, and self-care, women can continue to thrive and enjoy fulfilling, balanced lives after menopause.
Women and Therapy at Midlife: Why They Come in Droves
Many midlife women in NYC come to therapy during a period of profound change, noticing shifts in mood, energy, or emotional resilience and wondering whether these changes are driven by hormones, life circumstances, or both. Hormonal fluctuations during perimenopause and menopause, including changes in estrogen and progesterone, can heighten stress, anxiety, irritability, or sadness. These physiological changes don’t create problems in isolation, but they often bring underlying emotional patterns or life stressors to the surface, making them more noticeable and impactful.
As a therapist working with midlife women, I often see clients navigating a complex mix of life transitions and hormonal changes. Many arrive feeling heightened anxiety, irritability, or sadness and are unsure whether it’s their circumstances or perimenopause and menopause driving these shifts. What I notice is that hormonal fluctuations often bring underlying patterns, unresolved emotions, or long-standing dissatisfaction to the surface. Women may begin to recognize that their tolerance for unfulfilling relationships, jobs, or life situations has decreased, prompting a desire for meaningful change. Therapy becomes a space to explore both internal shifts and external pressures, helping clients process emotions, reconnect with their bodies, and make choices that support their well-being, clarity, and personal growth.
At the same time, midlife is often a time of transitions—career shifts, relationship changes, children leaving home, caregiving responsibilities, or a reevaluation of personal goals. Therapy provides a supportive space to explore how both internal hormonal shifts and external life circumstances intersect to influence mood, relationships, and overall well-being.
A Few Encouraging Things to Keep in Mind as You Navigate This Transition
Mental health challenges can develop or become more pronounced during perimenopause and menopause, even for women with no prior history of psychiatric concerns, and can significantly affect mood, cognition, and emotional regulation.
It’s important to seek support from professionals who are specifically trained to understand and treat menopause-related changes in mood, cognition, and overall well-being.
Integrating mental health support with medical care leads to better overall outcomes.
Because every woman’s experience is unique, there’s no single approach that works for everyone.
Stress, poor sleep, and life transitions can compound emotional symptoms.
Antidepressants alone may not address hormone-related mood changes; comprehensive treatment works best.
Empowering yourself with knowledge and support normalizes this stage, reduces stigma, and helps you feel less alone.
You have options, such as hormone replacement to support you now and throughout your lifespan
How Hormones Affect Mental Health During Menopause
During perimenopause, estrogen and progesterone levels fluctuate dramatically. These hormones play a key role in regulating neurotransmitters such as serotonin and dopamine, which influence mood, motivation, memory, and sleep. This is a time when many women may notice increased emotional instability—feeling more irritable, anxious, or tearful than usual—and a sense that they cannot fully rely on themselves to manage everyday challenges. Even simple tasks can feel overwhelming, and decisions that once felt routine may now require extra effort or mental energy. These shifts can be frustrating and unsettling, but understanding that they are linked to hormonal and neurochemical changes can help normalize the experience and guide women toward strategies and support that restore a sense of balance and confidence.
Post menopause, when estrogen and progesterone levels remain consistently low, these hormonal changes continue to affect the brain’s chemistry. Estrogen in particular helps regulate key neurotransmitters such as serotonin, dopamine, norepinephrine, and acetylcholine—all of which influence mood, motivation, focus, and memory. When estrogen declines, serotonin production and receptor sensitivity can decrease, leading to mood instability or depressive symptoms. Dopamine levels may also drop, contributing to lower motivation and pleasure, while changes in acetylcholine are linked to forgetfulness and cognitive slowing. These neurochemical shifts help explain why some women notice lingering emotional or cognitive changes even after the transition to menopause is complete.
As a result, many women experience new or intensified emotional symptoms such as:
Anxiety or panic feelings
Irritability and mood swings
Low motivation or loss of joy
Difficulty focusing or remembering
Insomnia or disrupted sleep patterns
For women managing pre-existing conditions like depression, bipolar disorder, or schizophrenia, these hormonal changes can make symptoms more severe or harder to manage.
changes in Sexual Health and your Relationships
Menopause often brings changes that can affect sexual health and intimacy. Fluctuating or declining estrogen levels can cause vaginal dryness, thinning of vaginal tissue, and decreased elasticity, making sexual activity uncomfortable for some women. Hormonal changes can also impact libido, arousal, and orgasm, while sleep disturbances, mood changes, and stress may further influence sexual desire. Many women experience shame or embarrassment around the changes menopause brings, but it’s important to remember that these experiences are natural and nothing to feel ashamed of.
It’s important to recognize that these changes are normal and do not mean the end of a satisfying sex life. Open communication with your partner is key—sharing your experiences, concerns, and preferences can foster understanding and intimacy. Exploring options such as lubricants, vaginal moisturizers, or hormone therapy under the guidance of a qualified healthcare provider can alleviate physical discomfort and support sexual well-being. Emotional connection is just as vital as physical intimacy. Taking time to nurture closeness, engage in shared activities, and express affection can help maintain a strong bond. For women experiencing distress, consulting a sexual health therapist, couples counselor, or mental health professional trained in menopause-related changes can provide guidance and support.
Couples Therapy & Marriage Counseling in NYC for Midlife Transitions: Men have no idea what’s happening with their partners
Midlife brings significant changes for both partners, including career shifts, family responsibilities, and, for women, hormonal changes associated with perimenopause and menopause. These shifts can bring long-standing relational patterns, communication challenges, or unmet needs to the surface. At Holistic Therapy, EMDR & Wellness NYC, couples and marriage counseling helps partners navigate these transitions with understanding and empathy. We focus on improving communication, rebuilding emotional connection, and fostering mutual support. Education for men is a key component, helping partners understand hormonal changes, mood shifts, and physical symptoms, so they can respond with patience and validation. Through therapy, couples develop practical strategies for conflict resolution, emotional attunement, and shared growth. Whether addressing marital dissatisfaction, communication breakdowns, or the impact of midlife transitions, counseling provides tools to strengthen relationships and support individual well-being.
Do all women suffer during the perimenopause and menopause transition?
No, not all women experience the same symptoms during perimenopause and post-menopause. While hormonal fluctuations affect everyone to some degree, the intensity, type, and duration of emotional and cognitive changes can vary widely. Some women may notice only mild mood swings or occasional forgetfulness, while others experience more pronounced challenges with anxiety, depression, or memory lapses. Genetics, lifestyle, overall health, stress levels, and prior mental health history all play a role in how these changes present. The key takeaway is that there is no “one-size-fits-all” experience—what matters most is recognizing your own patterns, seeking support when needed, and using strategies that help you feel your best.
The Mind-Body Connection: More Than Just Hormones
Dr. Louise Newson’s research identified over 80 potential perimenopausal and menopausal symptoms, including those affecting mood, cognition, energy, skin, digestion, and sexual health. This highlights how interconnected the mind and body truly are during this life stage.
The Harvard Study of Moods and Cycles revealed that women entering menopause earlier face higher risks for first-time depression, particularly when experiencing hot flashes and night sweats. Poor sleep and chronic stress can further increase vulnerability, even in women with no prior history of mental health concerns.
Coping Strategies for Emotional Instability During Perimenopause
Prioritize Sleep: Aim for consistent sleep routines; consider relaxation techniques like deep breathing, meditation, or gentle stretching before bed.
Move Your Body: Regular exercise, even light activity like walking or yoga, supports mood, energy, and cognitive function.
Balanced Nutrition: Eat nutrient-rich meals with protein, healthy fats, and complex carbs to stabilize blood sugar and support brain health.
Mindfulness & Stress Management: Journaling, mindfulness meditation, or guided breathing exercises can reduce anxiety and improve emotional regulation.
Social Support: Stay connected with friends, family, or support groups—talking openly about experiences can normalize feelings and reduce isolation.
Professional Guidance: Work with healthcare providers trained in menopause care and mental health professionals who understand the hormonal and emotional changes during this transition.
Track Your Symptoms: Keeping a journal of mood, sleep, and energy patterns can help identify triggers and inform discussions with your healthcare provider.
Living Longer and Living Well…
Women in the U.S. now have an average life expectancy of 81.1 years (CDC, 2023). But longevity means little without quality of life. Many women in their later years experience fatigue, cognitive decline, and bone density loss, issues that can often be mitigated through early attention to hormonal and lifestyle health.
Recent studies from The Menopause Society (2025) show that the timing of hormone replacement therapy (HRT)matters. Women who begin estrogen therapy during perimenopause show no increased risk of breast cancer, heart attack, or stroke compared to those who begin later or not at all.
According to some data, early HRT has also been linked to:
Improved bone density
Healthier cardiovascular markers
Lower Alzheimer’s risk
Reduced genitourinary symptoms
Taking a proactive approach to hormonal health can greatly influence both emotional balance and long-term vitality.
Getting started and Finding the Right Support
It’s important to work with healthcare providers who are specifically trained to assess and address perimenopause and menopause concerns. For decades, most medical studies focused on male subjects, often generalizing the findings to women. Thankfully, research is now increasingly centered on women, providing more insight into perimenopause, menopause, and hormone therapy than ever before.
However, not all professionals have received specialized training in this area. Trusted resources such as Dr. Louise Newson and Dr. Kelly Casperson are a great place to begin gaining knowledge, as they offer guidance on finding qualified clinicians who understand the complexities of menopause.
Helpful Resources for Navigating Menopause
The Good News About Estrogen – Explores the benefits of estrogen therapy, dispels myths, and empowers women to make informed decisions about hormone replacement.
Hormone Repair Manual – Offers practical guidance on managing hormonal changes, with tips on nutrition, lifestyle, and symptom management for perimenopause and menopause.
The Menopause Moment by Dr. Kelly Casperson – A comprehensive guide helping women understand the emotional, cognitive, and physical changes of menopause while providing strategies for improved quality of life.
You Are Not Broken by Dr. Kelly Casperson – Focuses on mental health and self-compassion during menopause, encouraging women to seek support and normalize their experiences.
The Great Menopause Myth: The Truth About Perimenopause and Menopause – Debunks common misconceptions, offering science-based insights to help women navigate this stage with confidence.
Dr. Rachel Rubin’s Resources – Provides expert insights on mental health, cognitive changes, and emotional support for women during perimenopause and menopause.
Screaming to Be Heard – Highlights women’s personal experiences with perimenopause and menopause, fostering understanding and validation of emotional and physical symptoms.
Happy Healthy Hormones – How to Thrive Through Perimenopause & Menopause – Provides actionable steps to balance hormones naturally and improve overall health during midlife transitions.
The Definitive Guide to Perimenopause and Menopause – A clear, structured resource covering symptoms, treatments, and lifestyle strategies for navigating hormonal changes.
Estrogen Matters – Offers evidence-based insights into the benefits and risks of estrogen therapy, empowering women to make informed decisions with their healthcare providers.
The Menopause Brain – Explores the impact of hormonal changes on cognition, memory, and mood, helping women understand and manage brain health during perimenopause and menopause.
There’s No One-Size-Fits-All Treatment
Your experience is unique — and so is your treatment plan. Together with your provider, consider:
Personal and family health history
Mental health background
Sleep, exercise, and nutrition patterns
Stress management strategies
Hormone levels and transition stage
Life goals and desired quality of life
While some physicians prescribe antidepressants for perimenopausal mood symptoms, studies show these medications may not always work for hormone-related depression or anxiety. A provider trained in menopause care can help evaluate whether HRT or alternative therapies may better suit your needs.
You Deserve Balance, Energy, and Joy
Perimenopause and menopause are natural — but struggling through them doesn’t have to be. With the right knowledge, professional guidance, and lifestyle support, you can thrive through this transition and beyond.
If you’re noticing changes in your mood, focus, or motivation, don’t wait to reach out. The sooner you seek support, the sooner you can feel like yourself again. Therapy Services or Counseling for Women, Couple Therapy, Trauma Counseling