Emotional Turbulence At Perimenopause: Coping with Mental Health Changes & Hormonal Transitions
When Perimenopause Disrupts Your Mind: Mental Health Support for Women in New York
One day you’re handling it all—your career, your calendar, your people—with grace and precision. The next, you’re snapping at a colleague, forgetting simple things, weeping in the bathroom between meetings... and sweating through your blouse in a boardroom that’s 68 degrees. It’s not “just stress.” It’s not that you’re “falling apart.”
For many women in New York City and across New York State, this is perimenopause—and it often arrives without warning, unraveling your emotional stability and sense of self.
Hormonal Shifts, Emotional Whiplash
Perimenopause can feel like a mysterious, destabilizing storm. And while its physical symptoms—hot flashes, night sweats, fatigue—are well-known, the emotional and psychological toll is often misunderstood or overlooked entirely.
Women navigating this hormonal transition frequently experience:
Sudden irritability and mood swings
Anxiety and panic-like symptoms
Depression or emotional numbness
Cognitive fog and memory issues
Disrupted sleep and chronic exhaustion
Loss of motivation and emotional volatility
What makes this even harder? These symptoms rarely come with a label. Many of the women I work with in therapy for perimenopause in NYC initially assume they’re “just stressed” or “not handling things well.” They're told by doctors that it's normal aging—or worse, offered a prescription and sent on their way.
But as a licensed psychotherapist specializing in midlife women’s mental health, I want you to know:
This is real. You’re not imagining it. And you don’t have to suffer in silence.
Do Most Therapists Understand Perimenopause?
Unfortunately, no. Most therapists, psychologists, and even psychiatrists aren’t trained to recognize or treat the emotional and psychological effects of hormonal shifts. That means perimenopausal women—especially high-functioning, high-achieving women—are often misdiagnosed or dismissed.
I regularly see women who’ve been given antidepressants or anti-anxiety meds without anyone ever mentioning the word perimenopause. They’re treated for symptoms but never offered the education, validation, or integrative care they need.
In reality, up to 70% of women experience significant mental health changes during the perimenopausal transition. This can begin as early as the late 30s and persist into the early 50s. And yet, comprehensive support remains elusive.
A Boutique, Holistic Approach to Therapy for Perimenopause in New York
At Holistic Therapy and Wellness New York, I provide a specialized, boutique psychotherapy experience for women navigating the hormonal and emotional terrain of midlife. My work is rooted in:
Advanced trauma-informed care for anxiety, mood shifts, and identity disruptions
EMDR therapy for processing emotional overwhelm or long-standing trauma activated by hormonal instability
Somatic and mind-body interventions to support nervous system regulation during hormonal fluctuations
Referrals to integrative or functional hormone specialists for a coordinated approach to care
Psychoeducation to help you understand what’s happening biologically and emotionally—and regain a sense of agency
I understand how disruptive, confusing, and even shame-inducing perimenopause can feel—especially for driven, successful women who’ve always “handled” everything. Therapy offers a space where you don’t have to hold it all together. A space where you can fall apart, be seen, be supported, and slowly come back to yourself—wiser, more grounded, more whole.
You Deserve Informed Support
If you’re in New York City or anywhere in New York State and you’re struggling with mental health changes that feel inexplicable, unpredictable, or just “not like you”—you’re not alone, and it’s not your fault.
You deserve a therapist who understands the emotional realities of perimenopause and menopause, who won’t pathologize your experience, and who can walk with you through this transition with skill, empathy, and collaboration.
Perimenopause is a pivotal life stage that often brings a complex mix of emotional and physical challenges. Mental health symptoms such as mood swings, depression, irritability, and even exacerbated ADHD can arise, and they are often compounded by physical changes like hot flashes, body shifts, sexual difficulties, and sleep disruptions. These symptoms can feel overwhelming, but it's important to remember that you don't have to face this transition alone. There are numerous effective treatment options available that can help manage both the mental and emotional aspects of perimenopause. From holistic approaches like essential oils to therapy, mindfulness techniques, and medical treatments, support is accessible and can be tailored to your unique needs. Understanding the connection between perimenopause and mental health empowers you to take proactive steps to restore balance and well-being, ensuring you approach this transformative phase with the tools and resources you need to thrive.
What’s happening to my estrogen, progesterone and testosterone?
Estrogen (estradiol e2)
Your hormones are coming and going and not in the same rhythm as when you were younger. The symptoms experienced during perimenopause are primarily caused by fluctuating hormone levels, particularly the decline in estrogen and progesterone. As these hormones decrease, they impact various systems in the body, leading to emotional and physical challenges. Estrogen plays a key role in regulating mood and brain chemistry, so its decline can result in irritability, anxiety, depression, and even exacerbate symptoms of ADHD. Additionally, hormonal changes affect the hypothalamus, leading to hot flashes, night sweats, and disrupted sleep, which can further contribute to mood swings and fatigue. At perimenopause, estradiol peaks and drops, causing the challenging symptoms.
Progesterone
The drop in progesterone, which normally has a calming effect, can increase emotional sensitivity, while shifts in neurotransmitters like serotonin and dopamine may intensify feelings of anxiety and depression. Cognitive changes, such as forgetfulness and brain fog, are also common, making it difficult to concentrate. Hormonal fluctuations can even impact sexual health, causing vaginal dryness and a decrease in libido, which can affect self-esteem and contribute to emotional stress. Progesterone helps balance the stimulating effects of estrogen in the body, promoting a sense of calm and relaxation. It does more than maintain a healthy uterine lining, it also plays a role in maintaining a healthy mood, supporting sleep, and promoting overall reproductive health.
Testosterone
As women enter perimenopause, testosterone levels gradually decline, which can contribute to a variety of physical and emotional changes. Testosterone is a key player as well and is regularly overlooked. This is interesting because women actually have more testosterone than estrogen, but few doctors know this and it gets measured differently. Testosterone levels in women are typically about 10% of men's testosterone levels but it’s still a key component of our health. Testosterone important for maintaining energy levels, muscle mass, bone density, libido, and overall sense of well-being. Its decline can lead to feelings of fatigue, decreased motivation, and a diminished interest in sex. Women may also experience mood fluctuations, including irritability or depression, as testosterone helps regulate mood and cognitive function. Additionally, the reduction in testosterone can contribute to a decrease in muscle strength and bone density, which can impact physical health and overall confidence. The interplay between declining estrogen, progesterone, and testosterone during perimenopause can therefore create a complex set of symptoms that affect both physical health and mental well-being.
what symptoms do many women experience at this time?
Physical Symptoms:
Hot Flashes – Sudden feelings of heat, often accompanied by sweating.
Night Sweats – Hot flashes occur during sleep, leading to disturbed rest.
Irregular Periods – Changes in menstrual cycle length and flow.
Vaginal Dryness – Decreased lubrication, leading to discomfort during intercourse.
Sleep Disturbances – Insomnia, trouble falling asleep, or frequent waking during the night.
Weight Gain – Changes in metabolism can lead to weight accumulation, especially around the abdomen.
Decreased Libido – Reduced sexual desire due to hormonal shifts.
Fatigue – Chronic tiredness, often exacerbated by poor sleep and fluctuating hormones.
Joint and Muscle Pain – Aching muscles and stiff joints, often due to hormonal changes affecting bone density and fluid balance.
Memory Problems (Brain Fog) – Difficulty concentrating, forgetfulness, or feeling mentally foggy.
Mental Health Symptoms:
Mood Swings – Sudden shifts in mood, from irritability to feelings of sadness or euphoria.
Anxiety – Increased feelings of worry, nervousness, or unease.
Depression – Persistent feelings of sadness, hopelessness, or lack of interest in activities once enjoyed.
Irritability – Heightened sensitivity, feeling easily annoyed or angered.
Increased ADHD Symptoms – Difficulty focusing, impulsivity, and distractibility may be worsened.
Emotional Sensitivity – Feeling overwhelmed or more easily upset by everyday stressors.
Feelings of Loss of Identity – Struggles with self-esteem or a sense of purpose during this life transition.
Panic Attacks – Sudden feelings of intense fear or dread, often accompanied by physical symptoms like a racing heart or shortness of breath.
Social Withdrawal – A tendency to isolate oneself from others due to emotional overwhelm or lack of energy.
Other Symptoms:
Thinning Hair – Hair loss or thinning, particularly on the scalp, due to hormonal imbalances.
Skin Changes – Dry, thinning skin and changes in texture as collagen production decreases.
Breast Tenderness – Swelling or soreness in the breasts, similar to premenstrual symptoms.
What are my treatment options at perimenopause?
During perimenopause, a combination of hormone therapy and lifestyle support can be highly effective in managing symptoms and promoting overall well-being. Hormone Replacement Therapy (HRT) can help balance fluctuating estrogen and progesterone levels, alleviating symptoms such as hot flashes, mood swings, and sleep disturbances. For those who prefer non-hormonal options, lifestyle changes play a crucial role. Regular exercise, a balanced diet rich in nutrients, stress management techniques like mindfulness or yoga, and sufficient sleep can significantly reduce symptoms and improve mood. By integrating both hormone support and healthy lifestyle practices, women can better navigate perimenopause with enhanced physical and emotional health.
Hormone Options, HRT & BHRT
Hormone Replacement Therapy (HRT) – HRT involves taking estrogen and sometimes progesterone to balance hormonal levels, alleviating symptoms like hot flashes, mood swings, and vaginal dryness. It can be administered through pills, patches, gels, or creams.
Estrogen Therapy – For women who have had a hysterectomy, estrogen therapy alone can help manage menopausal symptoms.
Progesterone – Often used alongside estrogen to protect the uterus from the risks of unopposed estrogen, especially for women who still have their uterus, and for women without a uterus, it still offers many benefits, such as balancing estrogen.
Non-Hormonal Options should you choose to skip hRT support:
Antidepressants (SSRIs/SNRIs) – These can help manage mood swings, depression, and anxiety associated with perimenopause. Some also alleviate hot flashes.
Gabapentin – Typically used for nerve pain, it has been shown to reduce hot flashes.
Cognitive Behavioral Therapy (CBT) – A therapeutic approach that helps manage anxiety, depression, and stress through practical coping strategies.
Herbal Supplements – Plant-based remedies like black cohosh, evening primrose oil, and red clover may help alleviate symptoms, though their effectiveness varies.
Lifestyle Changes – Exercise, a balanced diet, adequate sleep, and stress-reducing practices like yoga or meditation can significantly reduce perimenopausal symptoms.
Acupuncture – A traditional method that may help with hot flashes, mood swings, and overall well-being.
Both hormone and non-hormone options have their benefits, and the best choice depends on individual symptoms, health history, and preferences. It's important to consult a healthcare provider to determine the most suitable treatment plan.
is hormone therapy natural?
Even hormones that exactly match your body's natural levels are synthesized in a lab from natural plants, and they are preferable. Choosing natural over synthetic hormone replacement therapy (HRT) is an option many women consider during perimenopause due to concerns about the potential side effects and risks associated with synthetic hormones. Natural HRT, typically derived from plants such as yams and soy, is believed to be more similar to the body’s own hormones. This may lower adverse effects, such as blood clots and breast cancer, compared to synthetic progestins, which have a small increase. The Women’s Health Initiative (WHI) study, launched in the early 2000s, produced data that led to widespread fear and confusion about hormone replacement therapy (HRT). The study suggested that synthetic HRT, particularly combined estrogen and progestin, increased the risks of heart disease, stroke, blood clots, and breast cancer in postmenopausal women. As a result, many women and healthcare providers became hesitant to use HRT, leading to a dramatic decline in its use. However, later analyses of the data revealed that the risks were more significant for older women in the trial starting HRT many years after menopause with significant disease progression, while younger women entering perimenopause or early menopause may experience fewer risks. These findings have since prompted a reassessment of HRT's benefits and risks, underscoring the importance of individualized treatment plans based on age, health status, and symptom severity.
What about therapy at perimenopause?
Talk therapy can be especially helpful during perimenopause, as it provides a safe and supportive space to address not only the hormonal changes but also the increased life demands many women face at this stage. In addition to managing mood swings, anxiety, and depression, women often juggle significant responsibilities such as caretaking for aging parents, balancing work and family obligations, and navigating shifting personal identities. Therapy offers valuable tools to manage these stressors, helping women build coping strategies for emotional regulation, time management, resilience, and self-care. Cognitive-behavioral therapy (CBT) can help challenge negative thought patterns, while mindfulness techniques promote relaxation and stress relief. Therapy also supports women in exploring how perimenopause impacts their relationships, self-esteem, and overall well-being, empowering them to regain a sense of balance and control amidst the pressures of daily life.
Processing unresolved negative experiences and trauma at perimenopause…
It seems that what doesn’t get repaired comes roaring back at this time of life. During perimenopause, unresolved trauma can often resurface, with hormonal fluctuations intensifying emotional sensitivity and making past experiences feel more immediate and overwhelming. This period of life can trigger old memories or unprocessed emotions, leading to heightened anxiety, stress, or depressive symptoms. If you're struggling with the emotional impact of unresolved trauma during perimenopause, EMDR therapy (Eye Movement Desensitization and Reprocessing) can offer effective relief. EMDR helps process and reframe traumatic memories by using bilateral stimulation to aid the brain in integrating and healing emotional wounds. This therapy can significantly reduce the emotional charge of past trauma, enabling you to regain control and emotional balance. If you're navigating perimenopause and the resurfacing of unresolved trauma, EMDR therapy could be a valuable tool to support your emotional well-being and help you move forward with clarity and peace. Reach out today to learn how EMDR can help you heal during this transformative life stage.
How can essential oils support your mental health during perimenopause?
Essential oils can be a great natural remedy for supporting mental health and managing symptoms of perimenopause. Here are some essential oils that may be helpful for each:
For Mental Health:
Lavender – Known for its calming and soothing properties, lavender can help reduce anxiety, stress, and promote relaxation.
Frankincense – Helps improve mood, reduce feelings of stress, and enhance mental clarity and focus.
Bergamot – A citrus oil that is often used to reduce stress and anxiety while promoting a positive mood.
Chamomile – Known for its calming effects, chamomile essential oil can be beneficial for reducing anxiety and promoting emotional balance.
Rose – A comforting and uplifting oil, rose essential oil helps ease emotional stress and promote feelings of love and compassion.
Ylang Ylang – This sweet, floral oil helps reduce stress, anxiety, and depression by promoting relaxation and emotional well-being.
Sandalwood – Sandalwood is often used to promote mental clarity and relaxation, helping with feelings of anxiety or mental fatigue.
For Perimenopause:
Clary Sage – Known for its hormone-balancing properties, clary sage can help alleviate mood swings, hot flashes, and other perimenopausal symptoms.
Lavender – Widely recognized for its calming and relaxing effects, lavender essential oil helps reduce stress and anxiety, promoting a sense of tranquility, peace and calm.
Lemon – A refreshing citrus oil that can improve mood, boost energy levels, and reduce feelings of irritability.
Peppermint – Often used to reduce hot flashes and boost energy levels, peppermint also helps with mental clarity and focus during perimenopause.
Sandalwood – Known for its grounding properties, sandalwood essential oil can help promote calmness and reduce mood swings by stabilizing emotional fluctuations.
Geranium – Helps balance hormones, reduce irritability, and improve mood during perimenopause.
Lavender – In addition to its calming effects on the mind, lavender can help with sleep disturbances, which are common during perimenopause.
Rosemary – Rosemary can help with mental fatigue and memory issues often associated with hormonal changes during perimenopause.
Frankincense – This grounding oil can help improve focus and calm the mind, aiding in emotional regulation and clarity.
Fennel – Known for its hormone-balancing properties, fennel oil can help alleviate bloating, cramps, and mood swings.
Bergamot – This citrus oil has mood-boosting and anxiety-reducing qualities, helping to elevate mood and alleviate nervousness.
Tea Tree – While mainly known for its antibacterial properties, tea tree oil can also help with the skin issues that sometimes arise during perimenopause due to hormonal fluctuations.
These essential oils can be used in various ways, such as through aromatherapy, topical application (when diluted with a carrier oil), or added to a warm bath, to help support both mental health and ease symptoms of perimenopause. Always consult with a healthcare provider before using essential oils, especially during significant hormonal changes.
If you are seeking non-hormonal remedies for perimenopausal balance, some favorites…
Several non-hormonal natural herbs can help alleviate symptoms of perimenopause, providing relief from hot flashes, mood swings, and other discomforts without the use of hormones. Here are some popular herbal options:
Black Cohosh – Known for its ability to reduce hot flashes, night sweats, and mood swings, black cohosh is one of the most widely used herbs for perimenopausal symptoms.
Red Clover – Rich in phytoestrogens, red clover can help balance estrogen levels and alleviate hot flashes and vaginal dryness.
Chaste Tree Berry (Vitex) – Often used to regulate menstrual cycles and reduce symptoms such as irritability and mood swings, chaste tree berry can support hormonal balance during perimenopause.
Evening Primrose Oil – High in essential fatty acids, evening primrose oil can help reduce hot flashes, improve mood, and support skin health during perimenopause.
Dong Quai – A traditional Chinese herb, dong quai is often used to help balance hormones, improve mood, and alleviate symptoms like hot flashes and irregular periods.
Ashwagandha – Known for its adaptogenic properties, ashwagandha can help reduce stress, improve sleep quality, and promote overall emotional well-being during perimenopause.
Motherwort – This herb is known for its calming properties, helping to reduce anxiety, irritability, and stress during perimenopause.
Ginseng – Ginseng can help with fatigue, mood swings, and cognitive function, boosting energy levels and mental clarity during perimenopause.
These herbs are often available in various forms, including teas, tinctures, capsules, or oils. As always, it’s important to consult with a healthcare provider before adding any new herbs to your routine.
About Holistic Psychotherapy, EMDR & Wellness Manhattan
Kimberly Seelbrede, LCSW is a New York State licensed Psychotherapist, EMDR Practitioner and Couple Therapist with a private practice in New York City, Montana and virtually. As a wellness psychotherapist and holistic consultant, she has received advanced, extensive training in Psychoanalytic Psychotherapy, Internal Family Systems (IFS), Eye Movement Desensitization Reprocessing (EMDR), Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Somatic Experiencing (SE), and Nutrition & Integrative Medicine For Mental Health. She is passionate about honoring the exquisite interplay of the mind-body connection. Kim Seelbrede specializes in anxiety, depression, trauma and women’s mental health. She brings over 20 years of counseling, coaching, and healing experience to her holistic practice and transformational work.
In addition to online therapy for anxiety, depression, trauma and relationship struggles, Holistic Psychotherapy & Wellness offers a wide variety of online services to fit the needs of busy professionals. New Yorkers often lead fast-paced and complex lives, which makes work-life balance and managing career, family and social obligations a challenge. Psychotherapy and wellness practices provide the support to help clients cultivate resources, resilience and enhanced emotional health, as well as uncover conflicts and obstacles that may interfere with having the life they desire.
Curated Lifestyle Interventions & Protocols
Women’s Mental Health Therapy & Coaching for Perimenopause & Menopause
Integrative Medicine & Mental Health