How to Take Care of Your Mental Health During Perimenopause
A guide for navigating hormonal changes, emotional shifts and being taken seriously.
What was commonly called “the change”.
Perimenopause, a phase many women begin to experience in their 40s, though it can start as early as the late 30s or not until the 50s. It marks the transitional time leading up to menopause, when hormone levels—especially estrogen and progesterone—start to fluctuate. And while hot flashes and night sweats often get the spotlight, what’s rarely talked about is how dramatically perimenopause can affect your mental health.
Many women report feeling unlike themselves during perimenopause.
Mood swings, anxiety, irritability, insomnia, brain fog, extreme fatigue and lack of motivation, and even somatic or depressive symptoms can become more frequent and intense. This isn’t just anecdotal—these experiences are well-documented in research.
Fluctuating estrogen levels during perimenopause impact neurotransmitters like serotonin and GABA, which help regulate mood and sleep. If you've ever felt like you’re “going crazy” during this phase—you’re not. You’re going through a neurological and hormonal storm that deserves real support, not dismissal.
Unfortunately, support can be hard to find. In Canada, wait times to see a perimenopause or menopause specialist can be months or even years. Many women never get access to a specialist at all, and are left to suffer through this transition without adequate medical help.
Suicide rates peak during midlife—and we’re not talking about it
One of the most alarming facts is that the highest suicide rates among women occur between the ages of 45 and 64 in Canada and the U.S. In England and Wales, the highest rates are seen in women aged 45–49 (1), and in Australia, women aged 45–54 are at greatest risk (2). This is not a coincidence. It’s a stark reminder of how urgent this conversation is.
Mood disorders during perimenopause are real, and untreated distress can escalate into crisis. Yet too often, women in this life stage are met with medical gaslighting or told they’re “just stressed.” Mental health is still not treated as a routine part of reproductive health care—and women’s mental health in particular remains deeply underfunded and misunderstood.
The invisible load of midlife
Perimenopause rarely happens in isolation. It tends to show up right in the middle of everything else:
Caring for aging or ill parents
Supporting teens or young adult children
Managing careers, relationships, and financial pressures
Grieving losses or navigating major life transitions
Add hormonal instability to the mix, and it can feel like you’re constantly walking a tightrope. Many women say they’ve felt dismissed by doctors, unsupported by loved ones, and unsure of where to turn. When specialized care is out of reach, even getting basic validation can feel like a battle.
Therapy can help—and there are options
While hormonal shifts play a significant role, therapy can be a crucial lifeline for managing perimenopause-related mood changes. It offers a space to be heard, validated, and supported.
Some evidence-based therapies that may help include:
Cognitive Behavioural Therapy (CBT): Can reduce symptoms of anxiety, depression, and insomnia.
Interpersonal Therapy (IPT): Especially helpful when navigating changing roles, grief, or major life transitions.
Mindfulness-Based Cognitive Therapy (MBCT): Helps manage rumination and improve emotional resilience.
Psychoeducation or Coaching: Understanding what’s happening in your body can be deeply empowering.
Many women also explore Hormone Replacement Therapy (HRT) or antidepressants as part of their care. But accessing HRT safely and appropriately can be difficult without a specialist. Primary care physicians may lack training in menopause care, and those with complex medical or mental health needs often fall through the cracks.
There’s no one-size-fits-all solution—what matters is finding what works for you.
What can you do if you're struggling?
Track your symptoms: Mood changes, sleep disruptions, and cycle irregularities—write it down. Patterns can be powerful.
Don’t minimize your experience: If you feel off, overwhelmed, or not like yourself, that matters.
Ask for help: Whether it’s your doctor, a therapist, or a trusted friend—you don’t need to wait until you’re at a breaking point.
Find a community: Whether it's an online support group, a therapist who understands, or a friend who’s been there—connection makes a difference.
Explore holistic support: Education about menopause, regular exercise, mindfulness techniques, yoga, and nutrition can all support mental health. Reducing alcohol intake is especially important for emotional and physical well-being.
Perimenopause is not “just a phase,” it’s a major life transition
It affects your brain, your emotions, and your sense of self. If you're finding it difficult to cope, you’re not weak, lazy, or broken—you’re responding to very real biological and social stressors. You deserve care, attention, and support.
And while therapy can’t change your hormones, it can give you the tools to navigate the storm—and remind you that you’re not alone. Even when specialist care is out of reach, you still deserve to be believed, supported, and treated with compassion.
Resources
1) Behrman S, Crockett C. Severe mental illness and the perimenopause. BJPsych Bull. 2023. Nov 13;48(6):1-7. doi: 10.1192/bjb.2023.89. Epub ahead of print. PMID: 37955045; PMCID: PMC11669460.
2) Kulkarni J. Perimenopausal depression - an under-recognised entity. Aust Prescr. 2018 Dec;41(6):183-185. doi: 10.18773/austprescr.2018.060. Epub 2018 Dec 3. PMID: 30670885; PMCID: PMC6299176.