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. Plus, we share some evidence-based, compassionate strategies to 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. 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
Sleep disturbances affect nearly 40% of women aged 40-55, with insomnia being the most common sleep disorder—and women are 1.5 times more likely to experience it than men. 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.
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 weight gain can stir unresolved grief or identity challenges.
How to Support Your Emotional Wellness in Perimenopause & Menopause
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 develop the coping strategies, resilience, and confidence to navigate the stressors that may arise during this major life transition.
1. Counseling
Working with a coach or a therapist who specializes in 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 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 psychiatrist or OB-GYN provider familiar with menopause-related care.
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.
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. 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.