By: Sarah Schufreider, LCSW, Menopause Mental Health Certified Therapist
Guide to your mental health and menopause by menopause mental health certified therapist, Sarah Schufreider, LCSW
It’s 2 a.m. and you suddenly get woken up from sleep. Your mind is racing. You suddenly remember every single detail of the things that you forgot to do. You try to fall back to sleep but you can’t. Your brain just won’t slow down. You start to question whether or not you are going insane. Or could there possibly be another reason…maybe it is those hormones that your friends keep talking about.
If this is happening to you, don’t panic. Despite your worry and the disruption to your sleep, and by extension, your life, these symptoms don’t automatically mean that something is wrong with your mind. This guide will help you better understand who is actually happening during the perimenopausal and menopausal phase and how it impacts your mood, emotional health, and brain.
The Short Answer
It is rarely just one thing that is impacting your sleep and your mental health. Rather, you are a complex individual who lives in a wildly complex world. Both of these things have a significant impact on your emotional health. It is true that hormonal shifts, especially the ones that women experience in perimenopause, can affect mood. Hormones such as estrogen and progesterone fluctuate and can cause sleep disruptions. Additionally, all the responsibilities of mid-life are real stressors. Combined, they create a perfect storm of challenges that can greatly affect your mood and daily functioning.
What's Actually Happening in Perimenopause?
Perimenopause is the transition phase that happens before menopause. Many people are confused about the difference between perimenopause and menopause. A simple way to explain it is this:
Perimenopause is the transition stage where a woman’s body starts hormone fluctuations that eventually lead to the end of her fertility. The perimenopause phase lasts approximately 4 years, on average, but can range from 2 to 10 years.
Menopause lasts exactly 1 day. It is the 24 period that is exactly 365 days after a woman experiences her last menstrual period. Often, women have inconsistent periods leading up to menopause, and it is not uncommon for someone to go long periods of time without one. However, if a woman gets her period within that 12 month period before menopause, the clock restarts, and she is not yet in menopause.
Post Menopause is all the time in a woman’s life after menopause.
(Source: Perimenopause | The Menopause Society )
The menopause rage, irritability, overwhelm, and other disruptive symptoms are REAL!
The Emotional Landscape of Perimenopause
The emotional impact of perimenopause is vast and can vary from person to person. The seven main mental health symptoms associated with perimenopause are: anxiety, panic, depression, mood swings, overwhelm, irritability, rage.
Anxiety: Anxiety is the overwhelming feeling that something is going wrong, and/or the overwhelming feeling of doom. It can seemingly pop up out of nowhere and have significant impacts on your capacity to complete daily tasks. While it is still being studied to better understand the correlation between hormone fluctuations and anxiety, many women report increased incidence of anxiety during perimenopause.
Panic: Panic is a more acute version of anxiety. A panic attack is a sudden, brief episode of intense fear and severe physical reactions that usually peak quickly and last between 10 and 30 minutes. A possible correlation exists between panic attacks and the onset of hot flashes. Both anxiety and hot flashes have symptoms that can mirror each other. Therefore, it can be hard to figure out which is the true cause of the discomfort.
Depression: Would you believe that rates of depression in women double during this life transition? There are a number of theories as to why this is. One theory is called the “window of vulnerability” and it purports that women are more sensitive to hormone shifts during perimenopause. The theory suggests that this increased hormone sensitivity contributes to a greater risk of developing depression. Additionally, women who have a history of depression, especially if they had depression connected to hormone-affected times such as puberty and postpartum, have a greater risk of depression during the menopause transition.
Mood Swings: Mood swings can be affected by hormonal changes and by environmental factors. The changing levels of estrogen in the brain during perimenopause may be a contributing factor to some mood swings. Again, calling to mind the “window of vulnerability,” it appears that some women are more sensitive to the hormonal fluctuations which can result in more intense symptoms. Additionally, environmental stressors such as changes in sleep, eating habits, sexuality, and increased health challenges play a role in mood swings.
Overwhelm: Things can often feel like too much to bear during this stage of life. There are multiple factors contributing to this including the immense mental load that women bear, and the constant obstacles to managing their lives such as brain fog, decision fatigue, and poor sleep. Plus, there are the day to day responsibilities of managing kids, aging parents, and careers. Add to this the fact that many women find that they develop a bit of an identity crisis at this crossroads in their lives. It’s no wonder that women describe themselves as constantly overwhelmed.
Irritability: All of us feel irritable from time to time. However, all of the changes that happen during perimenopause put women at increased risk for decreased patience and increased annoyance. Biological factors such as vasomotor symptoms (i.e. hot flashes and night sweats), history of depression and/or anxiety, sleep deprivation, and a history of premenstrual dysphoric disorder (PMDD), combined with societal risk factors such as feeling like an “invisible woman” with aging and/or being a part of the sandwich generation all contribute to increased risk for irritability in this life stage.
Rage: It’s likely that we have all heard someone reference “menopausal RAGE.” It isn’t just an old wives tale. In fact, irritability and rage are some the most commonly reported clinical symptoms for women’s mental health in perimenopause. It becomes even more challenging because anger and rage are not usually emotions that women are taught to embrace, let alone express. The impact of this rage can be devastating and have significant social, work, home, and personal consequences.
(Source:Specialized Women's Mental Health & Reproductive Psychiatry Training | BRIA Academy)
(Sources: Specialized Women's Mental Health & Reproductive Psychiatry Training | BRIA Academy , Menopause and mental health - Harvard Health , Mental Health | The Menopause Society )
The Answer Isn’t Simply: My Hormones or My Life?
If only it was as easy as being able to list one cause for the challenges that women experience in perimenopause. But, trying to pinpoint only one cause is a fallacy. This is because biological changes such as hormone fluctuations, joint pain, hot flashes, and sleep disturbances, aren’t the only things going on in this phase in life. Women in mid-life are engaged in caregiving for their children, managing their career, maintaining romantic relationships, supporting their aging parents, exploring identity shifts, and dealing with unexpected grief. All of these things show up in the same years that our hormones begin to change.
How to Start Sorting All of This Out
While I acknowledge that all of these symptoms can feel insurmountable, there are ways to find relief. In my practice, I have found that taking a few meaningful steps can have significant positive impacts on my client’s moods. Examples of things to try:
Get connected to menopause-informed providers. Providers who are familiar with the hormone changes you are experiencing and can give you targeted interventions for what you are experiencing are vital. Whether the provider is an OB/GYN, a nutritionist, a personal trainer, a psychiatrist, or a sexual health specialist, having someone who understands women’s health and perimenopause makes a huge difference. You can search for providers who are certified in menopause by searching online or going to directories such as Bria Academy or the Menopause Society.
See a doctor to rule out any other medical reasons for your mood changes, sleep disturbances, and other health changes. Doctors can be the gateway to getting hormonal help and other medications to help you. When you see your doctor, bring a list of questions with you so that you feel prepared and are able to get answers to the things that are most important to you.
Explore seeing a menopause therapist. They can help you better understand what you are going through with your hormones, your brain, and your current lived experiences. They can also help you develop coping skills to deal with all the changes you are experiencing.
Start tracking your mood, sleep, and menstrual cycles for about 4 weeks. This will allow you to get real data about what is actually happening with you. Humans are not always the best historians and can have trouble accurately remembering information about how they felt, which days they slept well, etc. Tracking is a good place to start in order to give you and your providers some baseline information about what you are dealing with.
Know When to Get Help Now
Red flags that should not be ignored and require more immediate attention include:
Persistent low mood…if you are not having any moments of joy or if you have completely lost the capacity to experience pleasure in things that you usually find enjoyable.
Panic attacks. Even having one panic attack is powerful enough to land someone in the emergency room because the symptoms can mimic a heart attack. This level of anxiety needs to be addressed quickly in order to prevent further life disruptions
Thoughts of self-harm. If at any time you are having thoughts to harm yourself or harm someone else, you need to seek help immediately. You can have someone bring you to your local emergency room or call 911. Or you can call the Crisis and Suicide Hotline at 988.
What Therapy for This Life Stage Looks Like
Therapy for this stage of life can look similar in many ways to therapy that someone experienced in different phases of their life. However, menopause therapy includes psychoeducation to teach clients about what they are experiencing, includes targeted interventions and coping skills to deal with menopause related symptoms, and looks at the client as a product of their whole environment. You can get more information about menopause therapy here and view more details about what to expect in your first menopause therapy session in this blog post.
Finding Support in Chicago and Across Illinois
Thankfully, getting support for perimenopause doesn’t have to be completely location dependent. With telehealth options, there is greater access to services. However, depending on a provider’s licensure, they may be only able to see people in a certain location, such as in Illinois versus anywhere in the United States. But, that varies from provider to provider. A good place to start finding support is to review this blog post on "Questions to Ask a Menopause Therapist".
No matter where you choose to get support, please know that there is help out there. Your body and mind are going through a transition that half of the world will go through. You aren’t alone in this and don’t need to suffer through mood changes and mental health challenges without a team of supporters behind you.
You don't have to sort this out alone — support is available across Chicago and Illinois.
FAQS about Menopause Therapy, Mood, Mental Health, and the Brain
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Yes. Hormonal fluctuations during perimenopause can affect mood, anxiety, and emotional regulation, though sleep disruption and life stressors often play a role too.
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It's often both. Track your symptoms alongside your cycle for a few weeks, and talk to both a doctor and a therapist. They can help sort out what's driving what.
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Yes, this is common, but "normal" doesn't mean you have to just live with it. Support is available if these changes are affecting your daily life or relationships.
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If low mood, anxiety, or irritability lasts more than two weeks, feels unmanageable, or is affecting your relationships or daily functioning, it's a good time to reach out for support.
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Sarah Schufreider, LCSW, at Six Hearts Counseling offers online therapy for mood and anxiety concerns related to perimenopause and menopause throughout Chicago and Illinois.
Sarah Schufreider, LCSW, is a Licensed Clinical Social Worker (Illinois license # 149016639) based in Chicago, IL and the founder of Six Hearts Counseling PLLC. She is has a Menopause Mental Health certification from Bria Better Health. She focuses on mid-life transitions including menopause, parenting special needs and medically complex children, SPACE (Supportive Parenting for Anxious Childhood Emotions), grief, and postpartum depression. Sarah’s goal is to help her clients feel like they can take control of their life again through identifying their values, learning concrete skills to manage and regulate their emotions, and work to challenge mental obstacles that are creating stuck points to change. Learn more about her work at About Sarah.