When Everything Shifts: Therapy for Women in Perimenopause and Menopause in New York City
Midlife therapy isn’t about symptom management—it’s about reintegration. At my Holistic Psychotherapy & Wellness practice, I combine psychotherapy, EMDR, somatic, and attachment-based work, and mind-body coaching to help women reinhabit themselves—body, mind, and spirit.
“It feels like I’m running on a different operating system than I used to.”
If you’re a woman somewhere in your forties, fifties—or even sixties—you may have noticed that the ground beneath your life has started to tremble in subtle, disorienting ways. Your mind doesn’t feel as sharp. Your skin feels dry and thin, your sleep unsteady. You love your partner, but your libido has disappeared. You find yourself looking at your reflection, wondering where the old “you” has gone. And perhaps, for the first time in a long time, you feel… fragile. Not in the weak sense of the word, but in the way that things feel closer to the surface. The emotions. The memories. The longing. The grief for what used to feel easy.
As a psychotherapist in New York City and midlife coach supporting women through perimenopause and menopause, I see this every day. Women who are strong, intuitive, successful—and utterly bewildered by how unfamiliar their inner world feels. This time of life is not just hormonal. It’s existential. It’s spiritual. It’s about identity, power, and the question that begins to echo through everything:
"Who am I now, and how can i rewrite the script for myself?
When the Old Playbook Stops Working
Many women describe midlife as if their internal operating system suddenly got an unannounced software update. The old codes—discipline, multitasking, people-pleasing, pushing through—start glitching.
“I can’t remember anything good about myself, my successes, my strength, my worth.”
“I quite literally don’t want to have sex anymore, at all. And I love my partner.”
“I feel scattered and overwhelmed. My ADHD feels off the charts.”
“It’s like my body and brain are speaking a new language—and I didn’t get the dictionary.”
You may notice new symptoms that feel foreign: hot flashes, insomnia, brain fog, anxiety, emotional sensitivity, a sudden loss of motivation or confidence. These aren’t character flaws. They’re signals from your body that a profound shift is underway. Estrogen and progesterone, the hormones that once quietly influenced mood, cognition, and desire, begin to fluctuate and decline. These hormonal shifts affect the brain, skin, libido, metabolism, and mood regulation—literally changing how you think, feel, and relate. But beyond biology lies something even deeper: a psychological and spiritual reckoning with selfhood.
Common Mental Health Changes in Perimenopause and Menopause
As hormones shift, many women experience unexpected changes in mood, energy, and cognition. These are not “all in your head” — they’re rooted in real neurochemical transitions happening in the brain and body.
Anxiety
Heightened sense of worry or unease.
Racing thoughts, irritability, or muscle tension.
Feeling “on edge” or hypersensitive to stress, noise, or conflict.
Panic Attacks
Sudden waves of fear, chest tightness, or heart palpitations.
Feeling trapped, shaky, or detached from your surroundings.
Often linked to fluctuating estrogen, cortisol, or disrupted sleep.
Depression
Persistent sadness or emptiness.
Loss of motivation, confidence, or joy.
Emotional flatness or tearfulness without clear reason.
Irritability & Mood Swings
Emotional volatility that feels unpredictable.
Sudden anger, tears, or frustration.
Hormonal surges can heighten sensitivity and reactivity.
Cognitive Fog & Memory Changes
Forgetting names, appointments, or words.
Difficulty focusing or following through.
Linked to estrogen’s role in memory, attention, and brain speed.
ADHD & Executive Function Challenges
Worsening distractibility, procrastination, or impulsivity.
Feeling scattered, disorganized, or “mentally overloaded.”
Some women are newly diagnosed in midlife as estrogen loss amplifies dopamine-related ADHD symptoms.
Tasks that once felt effortless now feel overwhelming — not from lack of willpower, but from changing brain chemistry.
Sleep Disturbances
Difficulty falling or staying asleep.
Night sweats, restless nights, or early waking.
Sleep deprivation worsens mood, concentration, and coping.
Obsessive or Intrusive Thoughts
Increased rumination or looping thoughts.
Heightened worry about safety, relationships, or control.
Common when serotonin and stress hormones are out of sync.
Social Withdrawal & Apathy
Pulling back from friends or family.
Feeling disconnected or emotionally flat.
Sometimes mistaken for indifference, but often rooted in exhaustion or depression.
Loss of Confidence & Self-Esteem
Harsh self-talk, body image struggles, or imposter feelings.
Feeling invisible, irrelevant, or like a stranger in your own life.
Deeply tied to both hormonal shifts and identity transitions.
What Helps
Therapy helps you track these patterns, regulate your nervous system, and rebuild trust in your body’s wisdom. Mind-body psychotherapy, EMDR, somatic and mindfulness-based approaches, and gentle lifestyle adjustments often restore clarity and calm far more quickly than you might expect. You don’t have to “push through.” Once you understand the biology behind these shifts, compassion replaces shame — and healing can begin.
The Invisible Patient: How Midlife Women Are Being Ignored by Their Doctors
One of the most painful refrains I hear from women in my practice is this: “My doctor told me everything looks fine — but I don’t feel fine.”
For decades, women’s health — especially around menopause — has been treated like a footnote in medicine. Despite the fact that half the population will experience it, most physicians receive little to no formal training in menopause care. Many were taught to view this transition as an inevitable decline rather than a complex biopsychological transformation. So when a woman in her forties or fifties walks into her doctor’s office saying she feels anxious, sleepless, foggy, irritable, or disconnected from her own body, she’s often met with one of three responses:
“You’re probably just stressed.”
“You might be depressed — here’s an antidepressant.”
“This is just part of getting older. You’ll adjust.”
The result? Women walk out feeling dismissed, confused, and ashamed — believing their suffering must be imaginary, or that they should simply “push through.” But you know your body. You know when something’s off. And you deserve more than a five-minute visit and a shrug.
“Why do i feel crazy at this time?
My Friend Is Fine — Why Am I Falling Apart?”
One of the most painful—and least talked about—aspects of midlife is the quiet comparison game.
You look around and see friends who seem fine. They’re still sleeping, still glowing, still in love with their partners, still running marathons or companies. And meanwhile, you can barely get through the day without crying, forgetting something, or wanting to crawl back into bed. You might think, What’s wrong with me? Why can she handle this and I can’t?
Here’s the truth: no two bodies experience perimenopause or menopause in the same way.
Hormones fluctuate differently in every woman, depending on genetics, stress, trauma history, sleep quality, lifestyle, medications, and even gut health. Some women’s transitions are smooth; others experience intense turbulence. The differences can be dramatic—and yet both are completely normal.
Maybe, but just maybe they aren’t so fine?
There’s also an invisible layer to this: the woman who looks “fine” may be struggling quietly, just as you are. She might be holding it together externally while falling apart inside. Midlife women are experts at masking pain—especially high-functioning women who have spent years taking care of everyone else. So when you catch yourself thinking, “My friend isn’t having panic attacks” or “She still wants sex—why don’t I?”—pause.
Your body and your life story are uniquely yours. How you respond to this transition says nothing about your strength, your character, or your worth. In therapy, we unpack the hidden layers beneath comparison—the guilt, shame, and self-blame—and replace them with understanding. You begin to see that your symptoms are not personal failures but biological and emotional messages calling for care, rest, and re-alignment.
The Medical Knowledge Gap: Your doctor doesn’t have a clue…
and shame on them for not having the curiosity to dig deeper for their patients!
Medical research has historically centered on men’s bodies, leaving women understudied and underserved. The hormonal transitions of menopause are incredibly complex — affecting the brain, cardiovascular system, bones, metabolism, and mood. Yet many clinicians still treat it as if it’s only about hot flashes or periods stopping. Even when lab results are “normal,” hormones can be fluctuating wildly beneath the surface. You can be fully functional — running companies, raising kids, caring for others — and still be suffering from hormonal chaos that profoundly impacts your mind, sleep, libido, and energy. It’s not “in your head.” It’s in your chemistry. And ignoring it can have real consequences — physically, emotionally, and relationally.
When we override negligent medical care and learn to advocate for ourselves, we gain knowledge and empowerment to take back our lives and our health. It takes some fortitude to do the research, but it’s well worth the effort..
The Hormones Behind the Storm: How Biology Shapes the Emotional Landscape of Midlife
Many women come to therapy believing their struggles are purely emotional — that their anxiety, brain fog, or loss of libido are signs of weakness or stress. But the truth is, what’s happening is not just in your head. It’s also in your chemistry. Your body, once regulated by a delicate hormonal rhythm, is rewriting its entire script.
Estrogen, progesterone, testosterone, thyroid hormones, and stress hormones like cortisol all shift in complex, cascading ways — influencing mood, energy, memory, and desire. It’s not psychological or physical. It’s both, intertwined.
Estrogen: The Great Stabilizer
Estrogen has always done more than regulate your cycle. It plays a profound role in brain function, enhancing serotonin and dopamine — the very neurotransmitters that help you feel balanced, motivated, and alive.
As estrogen levels fluctuate and decline during perimenopause, those neurotransmitters become less stable.
That’s why you might notice:
Sudden mood swings or irritability.
Tearfulness or anxiety that seems to appear out of nowhere.
Feeling flat, joyless, or disconnected from your usual self.
A loss of focus or confidence that you can’t quite explain.
These changes don’t mean you’re “losing it.” They mean your brain is adjusting to a new hormonal reality.
Progesterone: The Soothing Counterbalance
Progesterone, often called the “calming hormone,” acts like nature’s anti-anxiety agent. It promotes relaxation and quality sleep. As progesterone levels drop, women may notice more insomnia, agitation, and restless nights—leaving the mind less resilient and emotions more raw. When you wake up already tired, everything feels harder to regulate — thoughts, moods, and relationships alike.
Testosterone: The Drive and Desire Hormone
Though we think of testosterone as a “male” hormone, it’s essential for women’s energy, confidence, and libido.
During menopause, testosterone also declines, which can affect motivation, assertiveness, and sexual desire.
It’s not uncommon for women to say, “I love my partner, but I literally don’t want sex anymore.”
This is not a moral or relational failing — it’s biology speaking. With time and therapeutic exploration, desire can often be redefined and reborn in more soulful ways. Desire is not just sexual; it generalizes to life.
Cortisol and Thyroid: The Stress–Energy Axis
Chronic stress can amplify hormonal symptoms, creating a feedback loop: as estrogen dips, cortisol rises, and the nervous system becomes more reactive. The thyroid, sensitive to these shifts, can slow down — contributing to fatigue, low mood, and weight changes. In therapy, learning to calm your stress response through mindfulness, somatic awareness, and nervous-system regulation is crucial for restoring emotional balance.
Your Hormones Are Not the Enemy — They’re the Messengers
When women understand that hormones are influencing how they think and feel, shame dissolves.
The narrative shifts from “I’m falling apart” to “My body is asking for care.” Therapy helps you listen to those messages rather than fight them — so you can respond with compassion instead of criticism, rest instead of resistance, and curiosity instead of fear. The truth is: this hormonal transition is not the end of vitality. It’s the body’s invitation to recalibrate, renew, and reclaim a wiser, more attuned way of living.
The Return of Old Wounds that you thought you had processed
Many women say, “It feels like all my core wounds are coming back.” Memories, insecurities, unfinished grief—all rise to the surface as if time folded in on itself.
“I’ve never been so insecure in my life. I can’t remember anything good about myself.”
“I feel worthless in so many parts of my life.”
“I’m staying in my relationship because I can’t afford to leave and I don’t know how I’d survive.”
When estrogen declines, so does our natural buffer against stress. Emotional resilience can dip, and long-silenced pain finds its way to consciousness again. If you grew up being the caretaker, the achiever, the peacemaker—this stage can feel like those survival roles are dissolving. You might suddenly realize how much of your life has been lived for others. Therapy helps you slow down and remember what’s yours.
Do you find yourself saying…
“I can’t integrate the old me with this current me.”
“My needs keep changing, I don’t know what to expect from day to day.”
“I just want to be alone, more than I should, away from my family, friends, partner, even children.”
Your psyche is inviting you to heal what’s unfinished, to reclaim the exiled parts of yourself that have been silenced under obligation, motherhood, marriage, or perfectionism.
It’s Not Just identity and Existential — It’s Hormonal
For many women, midlife feels like an identity crisis, a spiritual unraveling, or a deep reckoning with purpose and meaning. And it is all those things. But it’s also biochemical. The emotional weather of perimenopause and menopause doesn’t arise out of nowhere — it’s shaped, moment by moment, by what’s happening inside your body.
The Hormonal Symphony Is Changing
From puberty onward, your hormones have worked in exquisite synchrony. Estrogen, progesterone, testosterone, cortisol, thyroid hormones, and neurotransmitters like serotonin and dopamine — all dancing in rhythm, influencing how you think, feel, desire, sleep, and connect. During perimenopause, that rhythm begins to stutter.
Estrogen fluctuates wildly — one day soaring, the next plummeting. Progesterone levels drop, removing the calming counterbalance that once soothed your system. The result? Emotional volatility. Brain fog. Irritability. Anxiety. Sleep disturbance. Loss of libido. Fatigue that feels bone-deep.
Estrogen supports serotonin and dopamine, two neurotransmitters that regulate mood, focus, motivation, and pleasure. When estrogen levels fall, these neurochemicals dip too — which is why many women feel uncharacteristically flat or anxious. This is not weakness or “moodiness.” It’s neuroendocrinology in motion — a real, measurable shift that affects your nervous system, brain chemistry, and emotional regulation.
Your Brain Is Literally Rewiring
Recent neuroscience shows that menopause is not decline — it’s reorganization.
Functional MRI studies reveal that the female brain undergoes remodeling during menopause, pruning certain neural pathways while strengthening others. It’s as if the brain is decluttering — shedding what’s no longer needed to prepare for a more streamlined, efficient future.
But that rewiring can feel turbulent in real time:
Forgetting names mid-sentence.
Losing focus halfway through an email.
Feeling emotionally fragile for no clear reason.
Sensing that your “spark” has dimmed.
This stage is both biological and symbolic. The body is recalibrating its chemistry, and the psyche is recalibrating its sense of self. One informs the other. Hormonal shifts don’t just trigger symptoms — they open emotional floodgates, allowing old stories, grief, and truth to surface.
You’re Not Imagining It — And You’re Not Alone
When women understand that hormones are partly driving their emotional experience, compassion replaces self-blame. You start to see your moods not as moral failures, but as messages — cues that your body is asking for care, balance, and re-attunement. Therapy at this stage helps you translate those messages:
to make sense of what’s biochemical, what’s historical, and what’s emerging as your next chapter of becoming. This is why mind-body psychotherapy and coaching are so powerful in menopause — because they honor both realities: the physiological and the existential, the hormonal and the soulful.
When the Body Becomes a Messenger
One of the most painful aspects of menopause is the betrayal of the body—or what feels like it. Your skin is thinner, more delicate. Your energy wanes. Desire dims. Women tell me their reflection feels like a stranger. They mourn the loss of ease—the glow, the fullness, the sense of vibrancy that felt natural for so long. These are not just aesthetic concerns; they are profoundly existential. Because when your body changes, your sense of identity shifts too. When we soften into curiosity rather than judgment, we can begin to partner with the body again—learning to nourish it differently, move differently, and listen for its new language. The goal isn’t to reclaim your 30-year-old self—it’s to honor your evolving womanhood, your needs and desires.
The Relationship Reckoning and changing needs, or more correctly, newly identified needs:
Many women in midlife therapy describe new tension in relationships: a pull toward solitude, irritability, a loss of desire, or the painful realization that they’ve outgrown relational patterns.
“I don’t want to be with my partner. I don’t even want to be with my family, friends, or children.”
One of the most surprising parts of this transition is how many women begin to question the relationships they once felt sure about. It’s not uncommon for women in midlife to sit across from me and whisper, “I don’t recognize myself in my marriage anymore.” What used to feel comfortable can suddenly feel constricting. What once brought warmth now feels heavy. And yet, for many, it’s not a lack of love that creates distance—it’s a shifting sense of self.
During perimenopause and menopause, your hormones, nervous system, and emotional wiring are all changing at once. The estrogen fluctuations that affect your mood and desire also impact how you bond, how you tolerate conflict, and how much closeness or solitude your body can handle. For some women, this relational withdrawal is physiological—a nervous system asking for rest, quiet, and space to recalibrate. When your stress response is overactivated, even a loving connection can feel overstimulating. For others, it’s psychological—a truth rising to the surface after years or even decades of compromise, overfunctioning, or emotional caretaking.
In therapy, we take time to discern the why:
Is your exhaustion hormonal, or the result of years of carrying too much emotional labor?
Is your lack of desire a side effect of hormonal shifts—or a symptom of unmet needs and unspoken resentment?
Is your longing for space a temporary need for stillness—or an inner call to redefine the terms of intimacy?
Couples often enter individual or couple therapy during this season not because love is gone, but because the rules of the relationship no longer fit who they are becoming. A woman who once prioritized harmony begins to crave honesty. A man who thought he knew his partner now faces a woman whose needs have evolved. The dynamic that once “worked” may start to feel hollow or performative.
Through a blend of Emotionally Focused Therapy (EFT), Internal Family Systems (IFS), and somatic awareness, we explore these shifts together—slowing down to listen to the parts of you that feel disconnected, angry, or unseen. We trace how hormonal changes can amplify sensitivity and vulnerability, making it easier to react than to relate. The goal is not to force closeness, but to rebuild authenticity—to help each partner express what’s real rather than what’s expected. Sometimes that leads to a deeper, more conscious form of love. Other times, it opens space for honest re-evaluation and compassionate uncoupling.
When desire disappears, it doesn’t necessarily mean the relationship is over. Often, it means you are being invited home to yourself first—to rediscover what pleasure, connection, and safety feel like in this new season of your body and your life. Because the truth is, love in midlife requires a new language—one built not on performance or obligation, but on presence, curiosity, and emotional truth.
The Mental Fog, the Scattered Mind, and other new mental health problems:
Many midlife women say, “My brain just doesn’t work the way it used to.”
You forget words mid-sentence. You lose your train of thought in meetings. You reread the same paragraph three times and still can’t absorb it. The multitasking superpower that once defined you feels like it’s vanished overnight. You feel scattered, foggy, and frustrated. And for some women, it’s not just forgetfulness or mental clutter—it’s a growing sense of panic, anxiety, or despairthat seems to arrive out of nowhere.
The Hormonal Connection to Mood and Mind
As estrogen levels fluctuate and fall, your brain’s chemistry shifts too. Estrogen supports serotonin and dopamine, which influence mood, motivation, and focus. When these neurotransmitters dip, it’s common to experience:
Sudden or worsening anxiety and irritability.
Panic attacks that seem to appear from nowhere.
New or recurring depressive symptoms—sadness, hopelessness, loss of pleasure.
Emotional swings that feel disproportionate to what’s happening around you.
Increased sensitivity to stress, noise, or conflict.
You may find yourself reacting in ways that feel foreign, or worrying constantly about things that never used to rattle you. It can feel like your emotional resilience is thinning—because, biologically, it is.
The ADHD Amplifier
For women with ADHD or executive-function challenges, hormonal changes can amplify every symptom. Estrogen fluctuations affect dopamine regulation, the very neurotransmitter responsible for motivation, organization, and focus. Tasks that once felt doable suddenly feel impossible. You can’t start. You can’t finish. You can’t rest. This decline in cognitive ease often leads to self-criticism, guilt, or shame—especially for high-functioning women who’ve built identities around competence and control.
But these changes are neurobiological, not moral.
Your brain is adapting to a new chemical landscape.
Therapy as a Grounding Force
Therapy during this stage is not about “fixing” your brain—it’s about understanding it. Together, we identify the intersection between hormones, mood, and nervous system regulation. We slow things down. We learn to read your body’s cues before anxiety spikes or depression deepens.
Through mindfulness, body-based awareness, EMDR resourcing, and somatic grounding, you learn how to:
Soothe your nervous system before it spirals.
Recognize hormonal mood shifts without self-blame.
Develop daily systems for focus, clarity, and rest.
Reconnect to a sense of internal stability even when everything feels uncertain.
These symptoms do not mean you’re “losing it.” They mean your body and mind are asking for gentler rhythms, better boundaries, and deeper care. With the right support, this season can become less about losing control—and more about rewriting your relationship with your own mind.
Remembering and integrating Your Worth
Perimenopause and menopause can dismantle identity in painful but ultimately liberating ways.
Everything that isn’t authentic begins to fall away. The perfectionism. The comparison. The “good girl” patterns.
What remains is the truth of who you are when the noise quiets down. Therapy becomes a place to remember your own voice. To rebuild your sense of self-worth from the inside out—not through achievement or beauty, but through authenticity and meaning.
You may find yourself exploring:
What does purpose mean now?
How to find beauty in softness, in presence, in truth.
How to connect with others from a place of choice rather than obligation.
How to live this next season of life on your own terms.
Why Therapy (or Coaching) Helps
Midlife therapy isn’t about symptom management—it’s about reintegration. At my practice, I combine psychotherapy, EMDR, somatic, and attachment-based work, and mind-body coaching to help women reinhabit themselves—body, mind, and spirit.
Therapy can help you:
Gain education about hormonal support and other lifestyle interventions
Reconnect to your body and its new rhythms.
Heal core wounds and outdated self-beliefs.
Rebuild self-worth and emotional resilience.
Navigate relationship changes with clarity and compassion.
Rekindle pleasure and desire in authentic ways.
Move through fear of aging into self-acceptance and empowerment.
Learn to better care for yourself
For the Women of New York City (and Beyond)
New York women are known for their drive, stamina, and self-sufficiency. But when perimenopause or menopause arrives, even the most resilient women are surprised by how undone they feel. You’ve been in command your whole life—at work, at home, in love. And now your body, your emotions, your focus—they’re calling for something different.
If you live in New York City or anywhere in New York State, I offer virtual therapy for women navigating perimenopause and menopause. For women outside of New York, I offer coaching and consultation—personalized support blending psychological insight, somatic wisdom, and lifestyle guidance.
you can schedule a virtual therapy consultation or explore coaching for midlife transformation.