Emotional Wellness During Peri/Menopause
Authored by Dr. Jessica Gaulton, CEO/Founder
We don’t talk enough about how perimenopause & menopause affect our emotional wellness—at FamilyWell, we’re changing that. We often 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 in our lives.
Let’s first align on terminology. According to The Menopause Society, perimenopause begins when you start experiencing changes in your menstrual cycle or other menopause-related symptoms (described below). Perimenopause can begin as early as your 30s or 40s and typically lasts between four to seven years (or longer!).
Menopause refers to your last menstrual cycle, which is confirmed after 12 consecutive months without a period – marking the end of your fertility window. Most women reach menopause in their early 50s, with the average age being 51.
During this phase in life, many women experience 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 emotional changes that emerge during perimenopause and menopause and share some evidence-based, compassionate strategies to help you feel your best. This is not a list of things to “fix”—you are not broken. Rather, this is about meeting yourself with kindness and finding tools that help you build coping skills and resilience, so you feel confident as you navigate this transition.
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
Studies suggest that 40-60% of women experience increased anxiety symptoms during perimenopause & menopause. 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. Mood Swings
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, irritability, or even rage.
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.
3. Sleep Disturbances
Sleep disturbances affect nearly 40% of women age 40-55, with insomnia being the most common sleep disorder. Hot flashes, anxiety & other mood changes can contribute to sleep problems. Sleep deprivation, on its own, can also be a risk factor for depression and anxiety.
4. 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.
5. 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 weight gain can stir unresolved grief or identity challenges.
How to Support Your Emotional Wellness in Perimenopause & Menopause
Hormonal replacement therapy (HRT) can be beneficial for treating peri/menopausal symptoms for some women, but unfortunately, there’s not a magic pill. HRT paired with counseling, nutrition, exercise and other lifestyle changes and sometimes other medications for depression and anxiety, can work together to help you feel your best. Some emotional wellness strategies that can complement your medical treatment include:
1. Counseling
Working with a coach or a therapist who specializes in midlife transitions or offers trauma-informed support can be life-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 women, antidepressant or anti-anxiety medication can be an important part of feeling better. 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 primary care provider, psychiatrist or OB-GYN provider who is familiar with medication management specifically for menopause-related symptoms.
3. Nutrition That Supports Brain and Hormone Health
According to the British Menopause Society, a balanced diet plays a key role in supporting brain, heart, and hormone health during peri/menopause. Choosing more unsaturated fats like olive oil, avocados, and nuts—and ensuring you get enough calcium, iron, omega-3s, vitamin B12, and vitamin D—can help maintain energy, mood, and bone strength. Experts recommend a daily vitamin D supplement (10 mcg or 400 IU) alongside a foundation of whole, nutrient-rich foods.
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. With the pelvic floor and vaginal health changes that happen in this phase of life, it’s important to focus on strengthening your pelvic floor.
5. Mindfulness, Breathwork, and Nervous System Regulation
Mindfulness-based practices like breathwork, meditation, or yoga help soothe the nervous system and foster emotional resilience. Even just 5 minutes a day of deep belly breathing can make a difference.
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
Poor sleep quality is linked to increased risk of cardiovascular disease, obesity, diabetes, psychiatric disorders, and even higher mortality rates.
If hot flashes are interrupting your sleep, talk to your doctor about the benefits and risks of hormonal therapy or other medications. Also, Cognitive Behavioral Therapy for insomnia (CBT-I) is an extremely effective technique that can help with sleep disturbances whether you’re taking medications or not.
7. Sexual & pelvic floor health
It's very common for your libido to shift during perimenopause and menopause. Many women find this a meaningful time to expand what intimacy means to them and explore new ways to be intimate with their partner that deepen their relationships in unexpected ways.
Declining estrogen during perimenopause and menopause can weaken pelvic floor muscles and tissues, contributing to issues like urinary incontinence, pelvic organ prolapse, or pain during intercourse—all of which can significantly impact sexual wellness and quality of life. Pelvic floor physical therapy is a highly effective, evidence-based treatment that can strengthen these muscles, improve bladder control, and reduce discomfort during sex.
8. Build a Support Network
Navigating perimenopause and menopause can feel surprisingly lonely, especially when you're balancing caregiving responsibilities, career transitions, or shifts in relationships. Ask your healthcare provider about local support groups, counseling resources, or online communities where you can meet people who understand what you’re going through and remind you that you're not alone.
Mental Health During Peri/Menopause Matters
If you're struggling emotionally during perimenopause or menopause, it doesn't mean something is wrong with you or that you’re weak. Navigating one of life's major transitions is challenging - just like with puberty, pregnancy, and postpartum, the hormonal shifts bring real psychological changes that deserve recognition and support, not dismissal or shame.
This isn't only a physical transition. Your sense of self, your relationships, your identity—all of it is evolving. With compassionate, holistic care, this chapter of your life can be a time of profound self-discovery, healing, and renewal.
You deserve support that sees all of you, not just your symptoms.