Gaslit by the System: How Perimenopausal & Menopausal Women With Mental Health Changes Are Dismissed by Doctors and Therapists

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.

Kim Seelbrede is a licensed psychotherapist and former model based in New York City, offering boutique, concierge-style mental health care through her private practice, Holistic Therapy & Wellness New York. With advanced training in trauma, EMDR, somatic psychotherapy, and mind-body medicine, she provides a deeply personalized, integrative approach for high-functioning women navigating complex transitions—like perimenopause, identity shifts, and nervous system dysregulation. Drawing on decades of experience, Kim blends evidence-based psychotherapy with holistic wellness to support profound healing and self-reclamation.

this is how my psychotherapy patient describes herself in session…

She wakes up in a body she barely recognizes, trapped in a life that once felt like her own. The rage comes out of nowhere—sharp and terrifying. Everyone is afraid of her at times. Sometimes, she thinks she hates everyone. Her brain feels scrambled, words vanish mid-sentence, and the simplest decisions leave her frozen. She has an anxiety she’s never experienced before. She cries in grocery store parking lots. She clenches her jaw through meetings. Her body feels tense. She wonders, almost daily, if she’s losing her mind. Her family still sees the woman who keeps everything going—who mostly remembers the schedule. But inside, she’s unraveling. Perimenopause has hijacked her mind, her sleep, her desire, and her identity. No one warned her it would feel like this, and her mother certainly never talked about it. Was it shame that kept her silent? She loves her people, truly. But sometimes, she dreams about walking away from it all—just to remember what it feels like to be her old self.

What’s happening to her is real—and it’s not in her head. She’s in the thick of perimenopause, a wildly misunderstood and under-acknowledged neurohormonal metamorphosis that affects not just her body, but her mind, identity, and entire sense of self.

Here’s what’s likely going on beneath the surface:

Her Brain Chemistry Is Shifting

• Estrogen, progesterone, and testosterone—the trio that once kept her mood, focus, sleep, and sense of connection stable—are fluctuating wildly.

• Estrogen is a key player in serotonin, dopamine, and oxytocin regulation, meaning that as it drops, so does her capacity for calm, pleasure, bonding, and joy.

• Her prefrontal cortex (decision-making, focus, organization) and limbic system (emotion regulation) are under hormonal siege—no wonder she feels scattered, reactive, and emotionally raw.

She’s Dealing with Cortisol and Adrenal Dysregulation

• Years of “pushing through” and performing have caught up with her nervous system. Now, with less hormonal buffer, stress hits harder and lingers longer.

• Even tiny triggers feel enormous because her system is overloaded—and there's no hormonal scaffolding to soften the edges.

She’s Sleep-Deprived and Sensory-Overloaded

• Night sweats, insomnia, and disrupted circadian rhythms mean she’s running on fumes.

• Without deep restorative sleep, her resilience tanks, anxiety spikes, and executive function goes offline. She’s exhausted, overstimulated, and under-supported.

She’s Experiencing a Soul-Level Identity Crisis

• Perimenopause isn’t just biological—it’s existential. The roles she’s played (mother, partner, achiever, caretaker) may no longer feel sustainable or aligned.

• The false self she’s worn to survive now feels suffocating. Her inner world is demanding truth, freedom, and authenticity—even if it costs her the life she’s built.

She Feels Invisible and Gaslit

• Doctors brush her off. Friends don’t get it. She’s told she’s “too young” for menopause or “just stressed.”

• She begins to question her sanity. But she’s not crazy—she’s hormonally, neurologically, spiritually reorganizing.

In short: her mind, body, and spirit are undergoing a total rewiring. She is not broken. She is becoming. But without the right support, it feels like falling apart.

The Medical Ping-Pong: Women Going Doctor to Doctor Without Answers

For many women, the journey through perimenopause becomes a revolving door of appointments—bouncing from primary care doctors to OB/GYNs, endocrinologists, psychiatrists, and even urgent care providers—only to walk away feeling more confused and invalidated. They're often prescribed antidepressants for mood swings, sleep aids for insomnia, or anti-anxiety medications for panic attacks, but never told that these symptoms could be hormonally driven. Some are told their labs look "normal," that it’s just stress, or worse, that it’s all in their head. The disconnect between women's lived experiences and the fragmented medical response creates a chronic cycle of frustration, self-doubt, and emotional exhaustion. Many women blame themselves for not coping better, when in reality, they are navigating a poorly understood neurological and hormonal storm without a map. This cycle of medical gaslighting can delay meaningful treatment, deepen mental health struggles, and erode trust in the healthcare system. Women deserve better—and therapy that honors both the science and the soul of this life stage can help reclaim clarity and control.

The Gaslighting Effect of Perimenopause

One of the most devastating aspects of the perimenopausal journey for many women is the experience of gaslighting—not just from the medical system, but from the culture at large. Women are often told that their symptoms are "just aging," "normal stress," or even worse, that they're overreacting or being dramatic. They're handed prescriptions instead of validation, or advised to meditate when what they truly need is a comprehensive hormonal workup and emotional support. The subtle (and not so subtle) message is that they are imagining things, being too emotional, or failing to handle life like they used to. This compounds the internal sense of confusion, making women feel like they are going crazy—when in fact, they are simply under-supported. Being repeatedly dismissed, invalidated, or misdiagnosed by doctors chips away at self-trust and delays access to appropriate care. True healing begins when women are believed, respected, and offered care that reflects the full spectrum of their physiological and psychological experience.

Research continues to neglect women

After childbirth, many women find themselves abandoned by a healthcare system that treats the postpartum period as a brief medical episode rather than a profound, ongoing transformation. While research often focuses on the immediate weeks after birth—screening for baby blues or postpartum depression—it largely ignores the complex psychological, hormonal, and identity shifts that unfold over months and even years. At just six weeks postpartum, most women are discharged from care, left to navigate sleepless nights, identity loss, relationship strain, and crushing societal expectations without continued support. Medical research rarely explores the slow unraveling that can occur in the shadow of motherhood, especially for women with histories of trauma, high-functioning anxiety, or perfectionism. There is little understanding of how postpartum hormonal upheaval can intersect with thyroid disruption, adrenal fatigue, or even accelerate perimenopause. Women are expected to feel grateful, not grieving; energized, not depleted. Their rage, grief, and identity confusion go unnamed and unstudied. The result? A vast, aching research gap—and a generation of mothers who feel unseen, gaslit, and deeply alone in their suffering.

Doctors, what’s their problem? Why aren’t they more curious? why can’t they think outside the Box? What can’t they connect the dots?

Here’s the honest truth: most doctors, including OB-GYNs and even some psychiatrists, receive shockingly little training in the nuanced mental health and hormonal changes that occur during perimenopause. And the system isn’t set up to encourage thinking outside the box—it’s built around protocols, lab ranges, and symptom checklists that don’t always match the real, messy, nonlinear experience women are having.

1. Medical education is still deeply outdated.
Hormones, especially those related to perimenopause and menopause, are often taught as a “late-stage” or postmenopausal issue. Many doctors are trained to look for hot flashes and missed periods—not crushing anxiety, memory fog, rage episodes, or existential dread in a 39-year-old woman still getting her period.

2. There’s a bias toward pathology, not pattern.
Doctors are trained to rule out diseases, not necessarily to recognize complex transitional phases. So when a woman comes in with fatigue, panic, or brain fog, she might get referred to a psychiatrist or told it’s just “stress.” They often miss the perimenopausal thread connecting it all.

3. Hormone therapy is still controversial.
Thanks to lingering confusion from the early 2000s WHI study, many providers were taught that hormone replacement therapy is risky—even dangerous. The result? Many women are told hormone replacement is dangerous, and that they’re “too young” or “not yet eligible,” and dismissals or lifestyle suggestions are handed out instead of meaningful support.

4. Psychiatry and endocrinology rarely collaborate.
Mental health providers often don’t look at hormones, and hormone specialists rarely understand the emotional rollercoaster they can trigger. So a woman might see three specialists and still be left in the dark, gaslit, or told it’s all in her head.

5. They’re rushed and overwhelmed.
Most primary care docs have 10–15 minutes per visit. There’s no time to sit with the whole story, let alone question the system that trained them. Even well-meaning doctors often don’t have the resources, curiosity, or training to explore integrative, lifestyle, and hormonal factors deeply.

6. Postpartum care ends at 6 weeks—but the transformation lasts years.
The medical model treats childbirth as an event rather than a process. Most women are seen once at six weeks postpartum—and that's it. No long-term follow-up. No mental health screening after the "danger window." No check-in on how their identity, body, hormones, or relationship with the world has changed.

7. Women’s mental health research drops off dramatically after the ‘baby blues.’
Research on perinatal mental health is heavily frontloaded. Studies tend to focus on immediate postpartum depression or anxiety—but not the slow-burn unraveling that can occur over the next 1–3 years. Many women report that their deepest psychological shifts happen after the first year—when they're most invisible to the healthcare system.

8. The body-mind-hormone interplay is underfunded and under-researched.
We still don’t fully understand how estrogen, progesterone, cortisol, thyroid function, and trauma history interact postnatally. What happens when a woman with a perfectionistic personality, a history of childhood emotional neglect, and a traumatic birth experience is flooded with hormones and deprived of sleep? This should be foundational research. It's barely touched.

The Gap in Support and Education (No, We didn’t learn about this in graduate school)

Despite how common and impactful perimenopause is, there remains a glaring gap in awareness, support, and education around this life stage. Many women are left navigating profound changes to their mood, energy, cognition, and identity without adequate guidance from their medical providers or mental health professionals. Too often, they are told they are "too young" to be in perimenopause or dismissed with a prescription that doesn't address the root hormonal shifts at play. Meanwhile, most mental health providers are not trained to recognize how fluctuations in estrogen, progesterone, and cortisol influence brain function and emotional stability. As a result, women are often misdiagnosed or offered treatments that overlook the full picture. This lack of interdisciplinary understanding leaves women feeling gaslit by the very systems meant to support them. Therapy that accounts for these hormonal and life stage realities is essential—not only for relief but for empowerment, validation, and informed care.

What Happens in the Brain During Perimenopause?

Perimenopause is characterized by fluctuating levels of estrogen and progesterone—two hormones that deeply influence brain chemistry. Estrogen, in particular, plays a vital role in regulating serotonin, dopamine, and GABA—neurotransmitters responsible for mood, motivation, sleep, and emotional resilience. As estrogen levels rise and fall unpredictably, so too does the stability of these neurotransmitter systems.

These hormonal fluctuations can:

• Disrupt the brain's stress response system (HPA axis), leading to heightened anxiety

• Alter the brain's plasticity and emotional regulation capacity

• Interfere with REM sleep and deep sleep cycles

• Amplify pre-existing mood disorders or emotional trauma

Many women report feeling like a different version of themselves—less confident, more emotionally reactive, and often disconnected from their previous mental clarity or resilience.

Common Mental Health Symptoms During Perimenopause

Emotional and psychological changes can appear gradually or feel abrupt. Women often describe feeling blindsided by symptoms that mimic or worsen existing mental health conditions.

Common symptoms include:

• Mood swings and increased emotional sensitivity

• Anxiety, often without clear cause

• Panic disorder symptoms

• Depressive episodes or low-grade, persistent sadness

• Brain fog, difficulty concentrating, and memory lapses

• Sleep disturbances or insomnia

• Irritability or rage that feels disproportionate to the situation

• Loss of motivation or pleasure in previously enjoyable activities

• Heightened sensitivity to stress

Less Common or Misunderstood Symptoms of Perimenopause

• Electric shock sensations (tingling or zapping feelings under the skin)

• Burning tongue or metallic taste in the mouth

• Heightened health anxiety or sudden fear of dying

• Skin crawling or formication (sensation of bugs under the skin)

• Sudden allergies or increased sensitivity to foods, scents, or medications

• Increased tinnitus (ringing in the ears)

• Episodes of vertigo or feeling “off balance”

• Heart palpitations or racing heart not related to anxiety

• Exaggerated startle response

• Chronic dry eyes or sudden changes in vision

• Joint pain or stiffness without clear cause

• Unexplained fatigue that feels like burnout or flu-like exhaustion

• Increased urinary urgency or bladder irritation

• Feelings of detachment or depersonalization (like watching your life from outside yourself)

There are more symptoms; trust the women when they tell you what’s happening. It’s not in their head, and they aren’t crazy.

Mental Health & Psychiatric Diagnoses Commonly Associated with Perimenopause

Mental health conditions may first emerge or re-emerge during this hormonal transition. While not caused by perimenopause alone, the hormonal changes can act as a catalyst or amplifier.

Mental health conditions often diagnosed or exacerbated during perimenopause:

• ADHD

• Major Depressive Disorder (MDD)

• Generalized Anxiety Disorder (GAD)

• Panic Disorder

• Insomnia Disorder

• Adjustment Disorder

• Bipolar Spectrum Disorders

• Post-Traumatic Stress Disorder (PTSD), especially if there is unresolved trauma

• Substance Use Disorders (as a form of self-medication)

Treatment Options: A Holistic, Integrative Approach for NYC Women

Managing mental health during perimenopause requires a nuanced, multi-dimensional strategy that honors both the biological and emotional aspects of this life stage. For women navigating this transition in the fast-paced environment of New York City, finding the right therapeutic support is essential.

1. Natural Hormone Replacement Therapy (HRT)

Bioidentical hormones, typically estrogen and progesterone derived from plant sources, can help stabilize mood, improve sleep, and reduce cognitive fog. Transdermal applications (patches, creams) are often preferred for their consistent absorption and lower risk profile.

It's essential to work with a hormone-literate provider who can test your levels and tailor treatment to your unique needs.

2. Trauma-Informed Psychotherapy

Perimenopause can bring unresolved emotional wounds to the surface. Therapy modalities such as:

• EMDR (Eye Movement Desensitization and Reprocessing)

• Somatic Experiencing

• Attachment-focused therapy

...can help process underlying trauma and regulate the nervous system.

3. Lifestyle Modifications

Supportive daily habits can dramatically reduce the intensity of perimenopausal symptoms:

• Nutrition: Anti-inflammatory diets rich in whole foods, omega-3s, and phytoestrogens

• Movement: Gentle, regular exercise like yoga, strength training, and walking

• Sleep hygiene: Consistent sleep routines, reducing screen time, and environmental support

• Mindfulness and breathwork: To reduce cortisol levels and increase nervous system resilience

• Limiting alcohol and caffeine: To stabilize mood and sleep

4. Nervous System Support

Because estrogen supports vagal tone and parasympathetic regulation, its decline can heighten anxiety and dysregulation. Integrative therapies such as:

• Acupuncture

• Craniosacral therapy

• Vagal toning exercises

• Urban Zen Integrative Therapy

...can be incredibly helpful in restoring balance.

5. Peer Support and Psychoeducation

Understanding that you're not alone in this experience is profoundly healing. Women's groups, support circles, and curated psychoeducation can offer both community and clarity.

Advocate for yourself, and here’s what to do if you are dismissed or undertreated

If your doctor ignores you—or dismisses your symptoms—you’re not out of options. In fact, this could be the very moment you reclaim your agency. Here’s where to turn when you know something’s wrong, but no one’s listening:

Find a Trauma-Informed or Hormone-Literate Therapist

Mental health professionals trained in perimenopause, trauma, or integrative care can be game-changers. Look for someone who understands the body-mind connection, can validate your experience, and help you explore emotional, hormonal, and lifestyle factors. If you’re in NYC or anywhere in New York State, I offer this kind of care—personalized, holistic, and trauma-informed. Often, you need a saavy clinician who has done the work for herself and “been there.”

Seek Out a Functional or Integrative Medicine Doctor

Unlike conventional medicine, functional and integrative practitioners look at the whole picture—hormones, gut health, thyroid, stress, sleep, and emotional well-being. They’re more likely to run comprehensive panels and believe your lived experience, even if your labs are “normal.”

You can find these providers through:

• IFM.org (Institute for Functional Medicine)

• AIHM.org (Academy of Integrative Health & Medicine)

• Local naturopathic or holistic women’s health clinics

Find a Menopause/Perimenopause Specialist, they aren’t all good, but some are

Many OB-GYNs are not trained in the nuances of perimenopause. A Menopause Practitioner will have more targeted expertise and may be more open to discussing HRT and non-traditional treatment paths. Even though they say they are treained, many are sub-par so you’ll need to do your own research.

Connect with Peer Support & Advocacy Groups

Sometimes, hearing “me too” can be the most powerful medicine.
Explore:

• Facebook support groups

• Instagram

• Local or virtual support groups, often hosted by therapists or wellness coaches

Don’t give up, become your best advocate. Get a Second (or Third) Opinion—And Bring Notes

If your gut says something is off, trust it. Bring a journal of symptoms, cycle tracking, mood shifts, and sleep patterns. Be clear, firm, and unapologetic. If they won’t listen, walk out and don’t look back. You are not difficult. You are discerning.

Neglected by in-person doctors? Use Telemedicine for Perimenopause & Menopause treatment. Top Online Hormone Therapy Services for Women…

1. Midi Health

Midi Health is a virtual clinic specializing in perimenopause and menopause care. They offer insurance-covered services, including HRT, bloodwork, and screenings. Their new AgeWell program focuses on preventive health services for women across the U.S.

2. Evernow

Evernow provides online menopause treatment with licensed medical experts. They offer personalized care plans, symptom tracking, and prescriptions delivered to your door. Their platform is designed to address symptoms like night sweats, hot flashes, and brain fog.

4. Alloy

Alloy specializes in online menopause treatment and relief. They offer doctor-prescribed medications delivered to your door, including estradiol pills, patches, and gels. Their services also encompass weight care, sexual health, and skin & hair treatments.

6. Defy Medical

Defy Medical specializes in online hormone replacement therapy for women. They offer individualized care plans, comprehensive blood testing, and various HRT options, including injectable, topical, and pellet therapies. Their services aim to address symptoms like low libido, mood swings, and weight gain. Defy Medical

7. MyMenopauseRx

MyMenopauseRx is an online doctor's office devoted to menopause healthcare, covered by health insurance. They provide certified menopause specialists, personalized treatment plans, and a focus on holistic wellness.

You Are Not Losing Yourself—You Are Reintegrating

Perimenopause is a threshold. Yes, it is marked by physical and emotional complexity, but it also invites a deeper integration of self. In my Manhattan-based boutique psychotherapy practice, I offer trauma-informed, holistic care specifically designed for overwhelmed, high-functioning women in NYC who are navigating the mental and emotional layers of hormonal transitions. You are not broken—you are evolving. And with the right support, this phase can become a catalyst for powerful renewal.