Myths about Perimenopause Series: Post #1

Apr 23

Mental Health Symptoms ARE Common. They’re Just Overlooked.

By Dawn Van Berkel, LPC, CCTP, CST

When most people think of perimenopause, images of hot flashes, night sweats, and irregular periods are the first symptoms that come to mind. These physical signs have long dominated the conversation, often pushed to the forefront by social media and health care professionals (who have not necessarily had training about perimenopause - but that’s a whole other topic of conversation). But what’s missing from this conversation is equally if not more impactful: the mental health symptoms.

Let’s bust a myth:

MYTH: Mental health symptoms are not directly caused by and are less common than physical ones in perimenopause.

FACT: Anxiety, depression, irritability, brain fog, and extreme mood swings are exceptionally common and often show up before a single hot flash ever does.

Why the Myth Persists

Historically, women’s mental health during midlife has been under-researched, misdiagnosed, or chalked up to stress, parenting, or simply “aging.” And because hormones like estrogen and progesterone are more closely associated with reproductive function, their impact on brain chemistry, especially serotonin and dopamine, hasn’t received the attention it deserves.

But research now shows that these hormonal fluctuations play a massive role in:

Mood regulation
Sleep quality
Cognitive function
Stress response

So What are Common Mental Health Symptoms During Perimenopause?

Increased anxiety or panic attacks, even in women with no prior history
Low mood or depression, also in women with no prior history
Brain fog or forgetfulness
Irritability and rage that feels disproportionate to the cause or lack of cause
Insomnia or restless sleep, which worsens mood the next day

These symptoms often precede physical ones, especially in early perimenopause (which can begin as early as your late 30s).

The Emotional Cost of Silence

Too many women suffer in silence, believing they’re "just not handling things well" or are "losing it." Some are prescribed antidepressants without any exploration of hormonal shifts. Others are dismissed entirely.

But here's the truth: if you feel like a different version of yourself, more anxious, reactive, forgetful, or withdrawn, it may not be JUST life stress. It could be your hormones affecting your brain.

What You Can Do:

Track your symptoms, mood, cycle changes, sleep, and stress levels
Talk to a provider who understands perimenopause, including mental health impacts
Seek therapy, not because you’re broken, but because support matters (hit us up at lifedoesntpause.org)
Explore options like HRT or supplements, if appropriate for you
Join a community of women in midlife — shared experience is powerful (join our perimenopause mastermind group)

Bottom Line:

Perimenopause doesn’t just happen to your body, it happens to your mind too. And no, you’re not imagining it. Your brain, mood, and emotional well-being are deeply connected to your hormonal shifts.

It’s time to widen the lens and normalize the mental health side of midlife. Because the more we talk about it, the less any of us has to struggle alone.

Bromberger, J. T., & Kravitz, H. M. (2011). Mood and menopause: findings from the Study of Women’s Health Across the Nation (SWAN) over 10 years. Obstetrics and Gynecology Clinics, 38(3), 609–625. https://doi.org/10.1016/j.ogc.2011.05.011

Freeman, E. W. (2020). Psychiatric disorders associated with the perimenopause: Emerging evidence and clinical implications. Harvard Review of Psychiatry, 28(5), 343–353. https://doi.org/10.1097/HRP.0000000000000252

North American Menopause Society. (2017). The 2017 hormone therapy position statement. Menopause, 24(7), 728–753. https://doi.org/10.1097/GME.0000000000000921

Schmidt, P. J., et al. (2000). Estrogen replacement in perimenopause-related depression: a preliminary report. American Journal of Obstetrics and Gynecology, 183(2), 414–420. https://doi.org/10.1067/mob.2000.106748

Dawn Van Berkel