Bria Better Health Menopause Mental Health Level 1 Certified
By: Sarah Schufreider, LCSW, Menopause Mental Health Certified Therapist
Katie (not her real name) came to see me and her main complaint was that she couldn’t seem to handle anything anymore. She said that small things that usually didn’t bother her, were now causing her to burst into tears or they were causing her to scream at her family. She said that she usually considered herself a pretty go-with-the-flow person. But, now she was worried because she didn’t feel at all like herself. She said it felt like her emotions were taking over her brain and body, and she didn’t know what to do to get back in control.
Feeling overwhelmed and having changes to a woman’s mood and emotions during perimenopause and menopause is something that I commonly see in my therapy practice when I’m working with women in mid-life. There are so many competing bids for women’s attention at this stage of life. Let’s dig a little deeper to better understand how all of these can impact a woman’s emotional health.
The Heavy Weight Behind Your Feelings
What is actually going on that causes you to feel like you just can't handle anything? In my practice, I encourage clients to imagine that they have an energetic gas tank and that it ideally starts off as full of fuel. Throughout the day, the fuel depletes as we use our energy, but that high-quality sleep replenishes our energy fuel. The product of having enough fuel is having enough reserves to emotionally and energetically deal with the highs and lows of the day.
However, starting the day with a full energy tank isn’t a guarantee. There are factors that can prevent you from getting back to full and/or that deplete your fuel more quickly than it can replenish itself. For women in perimenopause, there are three main categories of “fuel drainers” that contribute to the energy drain: stressors on your brain and mind, mid-life responsibilities, and changes to your identity.
Too Much Stress On Your Brain
Your brain has to do a lot of work just to make it through the day. When the following factors are at play, it makes it harder for your brain to function at its highest level.
Brain Fog: Brain fog during menopause describes memory, concentration, and focus difficulties that many women experience during this time in life. Maybe you can’t remember where you parked your car. Or, you struggle to find a word, but it just won’t come to you. These cognitive functioning blips are very common for women in perimenopause. Yet, despite it being common, it is very upsetting, disruptive, and scary, especially for people who worry about developing dementia. Thankfully, studies do show that this tends to be a temporary condition that improves once a woman transitions out of menopause.
(Source: Menopause and brain fog: What's the link? - Harvard Health )
Poor Sleep: Sleep is a key to having good health. Unfortunately, perimenopause can cause chaos for a woman's sleep. Perimenopause symptoms including hot flashes, night sweats, insomnia, joint pain, and increased anxiety can all negatively affect someone’s sleep. This lack of quality sleep can negatively impact a woman’s ability to properly regulate her emotions, and can increase her likelihood to have increased sadness, anger, irritability, anxiety, and depression.
(Source: Health Risks of Poor Sleep | Johns Hopkins Medicine)
Increased Mental Load & Decision Fatigue: Women have been sold the idea that “you can do it all!” With that belief comes an incredible amount of responsibility and decision making. Women are finding that as they continue to become increasingly competent in all areas of their lives, more and more is asked of them. With this comes endless decisions to make: what to wear to work, what to make for dinner, how to get their kids to baseball practice. All of the nitty gritty decisions wear down the energetic fuel stores.
The Sandwich Generation
Women in Perimenopause are often “sandwiched” between caregiving for their young children and their aging parents.
Have you heard of the term, The Sandwich Generation? It describes people in mid-life who are sandwiched between care-taking roles for their children and for their aging parents. Given that women still tend to take on the majority of caretaking roles and responsibilities in American families, it comes as no surprise that women are greatly impacted by the demands of caring for their loved ones on both ends of the age spectrum.
With the average age of first motherhood in the United States rising to nearly 30 years of age, more mothers are reaching perimenopause when their children are still relatively young and requiring more hands-on attention. Additionally, the average life expectancy of adults in the US remains at around 79 years old. Depending on an elderly person’s health, this could add up to a long time with care needs. Women in mid-life find themselves being pulled between both the needs of the young and the old in their lives.
In addition to caretaking tasks, many women work outside the home and are committed to their careers. And not all employers are the same when it comes to being flexible and accommodating life and family needs. Thankfully, some states are passing legislation like the Illinois Menopause and Care Act, scheduled to go into effect in January 2027, that helps provide some protections for workers experiencing perimenopause. But, there is still a long way to go until all employees are given the protections they all deserve.
(Source: Average age of moms giving birth in U.S. has climbed to nearly 30 years old, CDC data show - CBS News ) (Source: FastStats - Life Expectancy )
Grief and Identity
“Why are you bringing up grief?” I get this question all the time in my practice when I mention that grief is a part of the menopause experience. This is because grief and identity challenges are the quieter emotional layer of this transition and many women don't expect it. Menopause doesn’t only signify an end to biological fertility. It can represent a change in how women and the world view themselves. Western society is very unkind to aging women. Many women feel like they are invisible and that they are no longer viewed as desirable, competent, or needed. Other women struggle to figure out their identity as their children get older or as their career options change. This ambiguity can create a great deal of stress and anxiety.
What Helps Manage Stress in Perimenopause?
Reducing The Mental and Physical Load: I often ask clients to think about all the things that they are carrying and to try to identify at least one thing that they can figuratively put down. I do this because we are often doing things out of habit or just because that is how it has always been done. It can be helpful to start to meaningfully question why you carry everything that you do. Start to get curious about whether there are other ways to get these things done.
Protecting Your Sleep: Since sleep is the gateway to good health, women can work to prioritize fixing their sleep. You can try to focus on good sleep hygiene by turning off all electronics an hour before bed, going to bed at the same time every night, and creating a regular bedtime routine. Other people may need more assistance and can talk to their doctors about medications or hormone treatments to help manage symptoms that interfere with sleep such as night sweats. Additionally, there are some therapeutic interventions such as Cognitive Behavioral Therapy for Insomnia (CBT-I) that are specifically designed to help manage sleep disorders.
Asking for Support: No one can do everything by themselves. However, the women who I end up seeing in my practice are often trying to do just that. They are often afraid to ask for help because they don’t want to inconvenience anyone else or they are afraid that other people won’t be able to handle the things in the way that they want it done. But, what inevitably happens when they don’t ask for help? They continue to get more and more burned out. Their physical health, their mental health, and their relationships suffer. If asking for help is challenging, try asking for something small from someone you trust. Even doing this once helps to get you more comfortable with asking again in the future.
Make Room for Identity Questions: There isn’t a right or a wrong way to go through the menopause transition. It is fraught with changes and it is ok to feel unsure about what comes next. However, avoiding asking the questions only creates more discomfort and anxiety. If you need more help in figuring out how to start thinking through identity issues, talking to a menopause therapist in Chicago and greater Illinois can be a great first step.
When It's More than Just Overwhelm
If you find that you have persistent low mood, loss of interest in things that usually spark joy, strong social withdrawal, or thoughts of harming yourself or others, you may be experiencing more than just overwhelm and could be experiencing a more serious mental health condition such as major depression. Unfortunately, neither you nor I can diagnose a mental health condition via a blog post. However, you can get connected to a menopause therapist in Chicago and greater Illinois who can help assess you and help make a treatment plan to get you the support that you need.
***If you are in crisis, please go to your local emergency room, call 911, or call 988 to reach a 24/7 mental health crisis line.***
Final thoughts
You deserve to have a full tank of energetic fuel every day. However, menopause creates some very real reasons why that isn’t always possible. Please remember to have some grace with yourself for the times when life gets in the way and work to create meaningful changes in the areas of your life where you do have the capacity to enact change.
If your tank has been running on empty, you don’t have to refill it alone. Online menopause therapy is available across Chicago and Illinois.
Frequently Asked Questions
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Several things pile up at once: brain fog, poor sleep from night sweats and hot flashes, a heavy mental load, caregiving for children and aging parents, and grief about changing identity. Together they drain your emotional reserves faster than they refill.
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Yes, this is common. Poor sleep and built-up stress make it harder to regulate emotions, so small things can feel much bigger. If it’s persistent or affecting your daily life, a doctor and a therapist can both help.
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Yes. Many women have trouble with memory, concentration, and finding words, and studies show it tends to be temporary. If it worries you, talk with your doctor.
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If you have persistent low mood, loss of interest in things you usually enjoy, strong social withdrawal, or thoughts of harming yourself or others, reach out. A menopause therapist in Chicago and across Illinois can assess what you’re experiencing and build a plan. If you are in crisis, call 988 or go to your local emergency room.
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 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.
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Last updated: October 13, 2026