Mental Health During Peri/Menopause:
How to Manage Symptoms
Mental health and perimenopause and menopause aren’t often talked about in the same sentence. We hear about this season of life framed through the lens of hot flashes and hormone replacement—but what often goes unspoken is the emotional and mental turbulence that can accompany this time.
For many women, this phase is marked by unfamiliar mood shifts, increased anxiety, trouble sleeping, and even a return of symptoms that resemble depression or past trauma.
In this blog post, we explore the most common mental health symptoms that emerge during perimenopause and menopause. Plus, we share some evidence-based, compassionate strategies to help you navigate them with care.
What Happens to the Brain During Peri/Menopause?
First, it helps to understand the why. During perimenopause, the transition period leading up to menopause, estrogen and progesterone levels begin to fluctuate significantly. These hormones don’t just affect your reproductive system; they also have a profound influence on brain chemistry, particularly serotonin, dopamine, and GABA, all of which are critical to mood regulation, emotional resilience, and sleep.
Common Mental Health Symptoms in Perimenopause and Menopause
Let’s take a closer look at what might show up. Keep in mind that this season of life and the symptoms experienced are different for everyone.
1. Increased Anxiety
Anxiety and menopause often show up hand in hand. Even women with no prior history of anxiety may notice racing thoughts, a sense of dread, or physical symptoms like heart palpitations. Those with past trauma or generalized anxiety may find it resurfaces with new intensity.
2. Depression or Low Mood
Women are two to four times more likely to experience depression during the menopause transition compared to premenopausal years. This can look like persistent sadness, hopelessness, or lack of interest in daily activities.
3. Irritability and Mood Swings
Fluctuating hormones can cause mood to shift rapidly, leaving some women feeling like they’re on an emotional rollercoaster—tearing up at a commercial one moment and snapping at a loved one the next.
4. Sleep Disturbances
Insomnia, night sweats, or early morning waking can wreak havoc on emotional stability. Sleep deprivation on its own is a risk factor for depression and anxiety.
5. Brain Fog and Memory Issues
Many women report cognitive changes: difficulty focusing, forgetfulness, or feeling like they’re mentally in a haze. While not a direct mental health issue, these changes can fuel frustration, anxiety, and fear about aging.
6. Resurfacing of Trauma and Body Image Struggles
Menopause can be a triggering time for those with a history of trauma, body image struggles, disordered eating, eating disorders, or body-based shame. For some, the loss of fertility or changes in body image can stir unresolved grief or identity challenges.
How to Support Your Mental Health Through the Transition
This is not a list of things to “fix”—you are not broken. Rather, this is about meeting yourself with gentleness and finding tools that help you feel more grounded, supported, and emotionally well.
1. Talk Therapy and Trauma-Informed Care
Working with a therapist who understands midlife transitions or offers trauma-informed support can be game-changing. Cognitive Behavioral Therapy (CBT) has been shown to reduce perimenopausal symptoms like anxiety, depression, and insomnia. Somatic or EMDR therapy may also help if past trauma is resurfacing.
2. Medication When Needed
For some, antidepressants or anti-anxiety medications can be a lifeline. SSRIs and SNRIs not only treat mood symptoms but may also help with hot flashes. If you're unsure whether medication is right for you, speak with a psychiatrist or OB-GYN familiar with menopause-related care.
3. Nutrition That Supports Brain and Hormone Health
Omega-3s, magnesium, and B vitamins have all been shown to support mood regulation. Eating consistent, nourishing meals that balance blood sugar is also crucial because unstable glucose levels can exacerbate mood swings and anxiety.
Functional nutrition practitioners may also recommend adaptogens like ashwagandha or rhodiola (with medical guidance), which have been studied for their role in stress response and mental clarity.
4. Movement for Emotional Resilience
Exercise can be powerful for mental health, but this doesn’t have to mean high-intensity workouts. Walking, dancing, yoga, or gentle strength training can regulate cortisol, support sleep, and improve mood.
The key during peri/menopause is intuitive movement and listening to your body’s cues rather than punishing it into a rigid routine.
5. Mindfulness, Breathwork, and Nervous System Regulation
Mindfulness-based practices like breathwork, meditation, or yoga nidra help soothe the nervous system and foster emotional resilience. Even just 5 minutes a day of deep belly breathing can make a difference.
Polyvagal-informed strategies, like vagus nerve stimulation or grounding techniques, can also help regulate the body’s response to anxiety or overwhelm.
Try this simple grounding prompt: “Notice five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste.”
6. Prioritize Sleep Hygiene
Sleep disruption is both a symptom and a cause of poor mental health in menopause. Try:
Establishing a consistent bedtime and wake time
Reducing screen time before bed
Using cooling bedding or a fan if night sweats are an issue
Avoiding caffeine late in the day
Exploring natural supports like magnesium glycinate or CBT for insomnia
If sleep troubles persist, a sleep specialist can rule out issues like sleep apnea, which becomes more common post-menopause.
7. Build a Support Network
Midlife can be isolating, especially if you’re juggling caregiving, career shifts, or changing relationships. Having a trusted friend, support group, or therapist to reflect your experience back to you with compassion can be profoundly grounding.
Organizations like Let’s Talk Menopause offer virtual and in-person spaces to connect with others navigating similar experiences.
Mental Health During Peri/Menopause Matters
Mental health challenges during perimenopause and menopause aren’t signs of weakness. They’re signs of transition. Just as puberty, pregnancy, and postpartum come with their own emotional landscapes, so too does this chapter.
It’s not just your hormones—it’s your whole self being asked to adapt, adjust, and evolve. And with the right support, this can also be a powerful time of self-discovery, healing, and renewal.
You deserve support that sees all of you, not just your symptoms.