Perimenopause is a profound biological transition that marks the beginning of the end of a woman’s reproductive years. While many associate this phase with hot flashes and irregular periods, far less attention is given to the complex emotional and mental health changes that can arise as the many body-wide systems are impacted by hormone depletion. Typically high-functioning, already overwhelmed New York City women are caught off guard. For many, perimenopause is not just a hormonal shift but a neurological and psychological one, capable of reshaping how they think, feel, and relate to themselves and others.

My mental health is tanking—what’s happening to me?

So many women have no idea what is happening to them during perimenopause. They feel emotionally off-balance, disconnected, or unlike themselves—and often, they’re met with confusion or dismissal. Their doctors may be undereducated about the emotional and neurological dimensions of hormonal changes, or tell them they’re "too young" for hormone therapy. Many are left feeling brushed aside or undersupported. Compounding this is the reality that most mental health professionals receive little to no formal training on how hormonal transitions impact emotional well-being. This lack of awareness can leave women misdiagnosed, misunderstood, and unsure where to turn. In my Manhattan-based boutique psychotherapy practice, I regularly hear from high-functioning, high-achieving women who have been struggling in silence, unaware that their mental health challenges are rooted in hormonal change. Therapy that integrates an understanding of these transitions can be a game-changer—offering validation, regulation, and real tools for relief.