Perimenopause — Losing the Plot or Just Your Hormones?

Written by Dr. Gracie, Clinical Psychologist, Director of Brain Body Wealth, and Founder of The Female Mental Health Collective.

The thing about perimenopause, though, is that it often sneaks up on women when they’re already juggling a million different demands. I often say it can feel like your body is gaslighting you. Suddenly, you start questioning yourself, your mind, and whether something is seriously wrong. But really, it’s just a natural part of the privilege of ageing.

As a therapist, I strive to create a compassionate space where women can explore what they’re going through, validate their feelings, and equip themselves with tools to navigate this transition confidently. By addressing the mental health aspects of perimenopause, we can reduce some of the distress and, more importantly, empower women to embrace this new chapter and feel like the best versions of themselves.

First off, let’s clear something up: you haven’t lost the plot, and you’re definitely not “mad.” Your body is changing, and with the fluctuating levels of oestrogen and progesterone, you’re probably noticing both physical and mental health shifts. What makes things tricky is that many perimenopausal symptoms overlap with symptoms of anxiety and depression, so it can be hard to figure out what’s actually going on. The women I see in the clinic who are going through perimenopause often share that they’re dealing with fatigue, brain fog, irritability, sleep issues, low libido, muscle tension, and more.

Anxiety

A lot of women report feeling more anxious during perimenopause, which can manifest as higher stress levels, panic attacks, or more generalised anxiety. It doesn’t help that hot flushes and muscle tension are classic symptoms of both perimenopause and anxiety. When we experience these physical symptoms, our brain often interprets them as signs of anxiety, which then worsens the other anxiety symptoms. And, of course, hot flushes always seem to hit at the most inconvenient times, leaving us feeling embarrassed and even more anxious. In short, perimenopause can really exacerbate those feelings of anxiety.

Depression

Perimenopause and depression also share several symptoms, like irritability, changes in appetite, and sleep disturbances, which makes it tough to figure out if it’s perimenopause or a sign of deteriorating mental health. Data shows that women going through perimenopause are at a higher risk of developing depression, or if they already have it, their symptoms can worsen.

Mood Swings and Irritability

One conversation that comes up a lot in therapy is how hard it is to deal with huge mood swings. Women often say they don’t even recognise themselves and feel bad about how their irritability impacts the people around them.

Sleep Disturbances

Sleep issues are super common during perimenopause, thanks to night sweats, hot flushes, and insomnia. Poor sleep and poor mental health are tightly linked, often leading to more irritability, trouble concentrating, and an overall drop in well-being. Plus, poor sleep quality can make depression and anxiety symptoms worse.

Cognitive Changes

Many women report cognitive changes during perimenopause, like memory lapses, trouble concentrating, and “brain fog.” These cognitive challenges can be distressing, impacting self-esteem and work performance, and can lead to even more stress and anxiety. These are often the symptoms that make women say, “I’ve either lost the plot, or I’m perimenopausal.” Trust me, it’s the latter!

Stress and Overwhelm

Perimenopause often coincides with other big life transitions and stressors. Many women are deep into their careers, raising children, and possibly caring for ageing parents, too. And then, of course, hormonal changes get thrown into the mix. Perfect timing, right?

Loss of Identity and Self-Esteem

Navigating the physical and emotional changes of perimenopause, it’s not unusual to experience a shift in your sense of identity and self-worth. Society’s attitudes toward ageing and menopause can make you feel invisible, which can impact your self-esteem and lead to feelings of loss and isolation.

Wow, that’s a long list of symptoms. It’s easy to look at all this and think that perimenopause is nothing but awful. But for many, it can be a really positive and transformative time, especially if you get the right support and prioritise your own health and well-being. I know a lot of the women I work with have spent years putting everyone else first—their families, their careers—and find it incredibly hard to prioritise themselves. Let’s challenge that. You deserve to prioritise yourself and here’s how to begin.

You don’t have to go through this alone. I know many women feel unheard by medical professionals, especially when it comes to women’s health. But please, don’t let that stop you from getting the support you need and deserve. When you meet with professionals, write down what you want to share: your symptoms, how long you’ve been experiencing them, and be clear that you want support, whether it’s medical intervention or therapy.

Perhaps the most obvious and thought of solution. There are various medical treatments available, including hormone replacement therapy (HRT) and other medications, that can help manage both the physical and psychological symptoms.

As with anything new, education and awareness are key. Organisations like Valerie are doing incredible work to support this! Remember, anxiety feeds off uncertainty and the unknown. Empowering yourself with knowledge is a great way to tackle anxiety and hold your own when talking with GPs and other professionals.

Think about moving your body in ways you enjoy, tweaking your diet to support perimenopause, and practising good sleep hygiene. I’ve heard there’s a new daily all-in-one adaptogenic, botanical, vitamin, and mineral elixir shot by Valerie that can help, too! These things might seem small, but often it’s the little steps that make the biggest difference.

I hear almost daily how alone women feel with their perimenopause symptoms. They feel judged or misunderstood, which makes them avoid talking about what they’re going through. But finding a community that gets it can be so validating and normalising. 

If you’d like to learn more about perimenopause and women’s mental health in general and be part of a supportive community, you can join the waitlist for The Female Mental Health Collective. Our doors will be opening soon.

A special thanks to Dr. Gracie for her valuable contribution to this article.

Connect with Dr. Gracie on Instagram @brain.body.wealth, LinkedIn Dr. Gracie McLaven, and via the website brainbodywealth.co.uk.

We’d love to hear from you! Has our advice helped, or do you have tips to share? Let’s keep the conversation going—drop us a DM!

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