What Therapists Working With Mid-Life Women Often Hear During Midlife and Menopause

We talk a lot about Melani and her “We Do Not Care Anymore” Movement—and yes, we love her! She truly gets it. But this doesn’t necessarily have to mean “letting yourself go.” Sometimes, it’s simply about expressing yourself authentically and reserving your energy for what truly matters to you—by choice, not by default.

For decades, the struggles of perimenopause and menopause—insomnia, hot flashes, brain fog, and mood swings—were often endured quietly, with women suffering in isolation. Today, thanks to Melani Sanders, founder of the We Do Not Care Club (WDNC) on social media, millions of women have a vibrant space to voice their experiences, share relatable challenges, and celebrate the humor and honesty of midlife transitions.

If you spend any time on Instagram, and your algorithm allows, you’ve met Melani. Melani has created a movement that resonates deeply with women navigating midlife, capturing the humor, courage, and liberation that come with embracing authenticity. Known for her distinctive style—often spotted with multiple pairs of readers dangling from her body—she embodies playfulness alongside wisdom, reminding women that self-expression and confidence can coexist at any stage of life. Her work celebrates emotional honesty, boundary-setting, and self-alignment, offering a voice that many women feel mirrors their own inner experience. Beyond trendiness, Melani provides a supportive, validating framework for women to reclaim energy, make intentional choices, and approach life with clarity and confidence.

At first glance, this movement can feel bold—or even a little rebellious—but in the therapy room, it often reflects something deeper: a desire for authenticity, self-alignment, and emotional truth. After decades of prioritizing others and meeting external expectations, this is a turning point signaling readiness to honor personal boundaries and make choices that feel meaningful.

For many women, this “We Do Not Care Anymore” moment can feel like a slippery slope at first—a sudden awareness of all the areas in life that no longer feel aligned, creating uncertainty or even guilt. Yet it can also be reframed as a powerful opportunity: a chance to consciously choose what truly matters, set meaningful boundaries, and prioritize energy toward relationships, work, and activities that nourish rather than deplete. This doesn’t have to mean “letting yourself go”—sometimes it’s as simple as expressing yourself in ways that feel authentic, and reserving your energy for the things that now matter to you most! In therapy, this transition becomes less about losing control and more about reclaiming agency—learning to say yes to what resonates and no to what no longer serves.

I’m a psychotherapist in New York, and this is What Often Emerges in Therapy sessions with Midlife women struggling with perimenopause and Menopause

Many women describe this period as though their internal operating system has shifted, leaving them unsure how to work with a version of themselves that feels unfamiliar.

In the therapy room, many women in midlife describe a quiet but unsettling sense that something fundamental has shifted. Researchers, clinicians, and depth psychologists have long noted that menopause is not merely a hormonal event, but a profound psychological reorganization. Neurobiological processes, once operating seamlessly, including neurotransmitter activity, cognition, attention, and executive functioning, may begin to feel less stable, unavailable. Beyond cognition and executive functioning, women often notice changes across multiple areas of psychological and physiological functioning that were previously reliable or effortless.

Many women begin to experience a quiet but persistent questioning of their lives as they have been structured. Relationships, careers, caregiving roles, and long-held compromises are often reexamined—not impulsively, but with a new internal honesty. What once felt tolerable may no longer feel sustainable. For some, this creates tension between emerging self-trust and very real concerns about financial security, stability, or social consequence.

There is also frequently a renewed encounter with the body—not as an object to manage, but as a messenger. Changes in skin, weight distribution, sleep, libido, or energy can stir grief, ambivalence, and vulnerability, even among women who consciously reject youth-centric ideals. Clinically, this reflects not vanity but the deeper psychological task of integrating change and mourning previous versions of the self while forming a new, embodied identity.

Do any of these changes resonate for you?

Emotional regulation may feel less stable, with heightened reactivity, tearfulness, irritability, or sudden emotional intensity that feels unfamiliar or disproportionate.

Stress tolerance often narrows. Once manageable situations may now feel overwhelming, reflecting changes in nervous system capacity rather than personal weakness.

Sleep architecture frequently shifts, with difficulty falling asleep, early waking, or non-restorative rest—further impacting mood, concentration, and resilience.

Memory and word retrieval can feel less accessible, particularly under stress, contributing to self-doubt or fear of cognitive decline despite no underlying pathology.

Sensory sensitivity may increase. Women report heightened responses to noise, light, temperature, or physical discomfort, signaling changes in nervous system threshold.

Motivation and drive often recalibrate. Rather than constant forward momentum, there may be a desire for simplicity, meaning, or rest—sometimes misinterpreted as loss of ambition.

Emotional boundaries may shift. Many women feel less able or willing to override their internal signals, leading to clearer limits in relationships and work, even when this creates external tension.

Relational tolerance can decrease. Patterns of over-functioning, people-pleasing, or emotional caretaking that once felt manageable may become untenable.

Embodiment and physical confidence may change, as fluctuations in energy, libido, or comfort in the body affect self-perception and identity.

Existential awareness often deepens. Questions of purpose, time, legacy, and authenticity may arise naturally during this stage.

historical themes resurface, giving women an opportunity for deeper integration!

From a psychodynamic and attachment-informed perspective, midlife often reactivates early emotional themes. Core beliefs shaped by childhood relationships—around worth, safety, autonomy, or visibility—may resurface with unexpected clarity. This is not regression, but what many theorists describe as a second developmental window: a time when unresolved material returns, asking not to be suppressed, but to be metabolized at a deeper level.

Hormonal changes often amplify attunement to emotional truth, making authentic consent and personal boundaries central in decision-making.

Neuroscience and hormonal research further illuminate why this period can feel so destabilizing. Fluctuations in estrogen affect neurotransmitters involved in mood regulation, threat detection, and emotional memory. As a result, women may feel more emotionally permeable—less armored, more sensitive, more attuned. Some describe this as losing their edge; others eventually recognize it as a shift toward intuition, discernment, and internal authority.

Therapists also hear women describe a change in orientation—from outward striving to inward listening. The nervous system may no longer tolerate chronic overextension, emotional caretaking, or self-abandonment. This can feel like a loss of capacity in a culture that rewards productivity, but clinically, it often marks the emergence of a more authentic rhythm.

Midlife and menopause are not psychological detours; they are thresholds. When supported thoughtfully, this stage can become a time of integration rather than fragmentation—where insight, embodiment, and emotional truth align.

Why This Matters Clinically

When these experiences are misunderstood or minimized, women are often misdiagnosed, overmedicated, or encouraged to “push through.” An integrative therapeutic approach recognizes that emotional distress during menopause is rarely just situational—and rarely just biological. It exists at the intersection of hormones, nervous system function, identity, relational history, and meaning.

Psychotherapy during this stage offers not only symptom relief, but orientation—helping women contextualize what is happening, regulate their nervous systems, and make choices rooted in clarity rather than fear.