Perimenopause & Menopause
Perimenopause — the years of hormonal transition leading up to menopause — can arrive years earlier than expected and bring psychological changes that feel sudden and disorienting. Anxiety, depression, mood swings, and a profound identity questioning are all part of how this transition can manifest. Therapy helps you navigate it with clarity and intention.
What It Can Look Like
- check_circle New or worsening anxiety, particularly in the late luteal phase
- check_circle Mood swings that feel disproportionate or hard to control
- check_circle Depression or persistent low mood, especially if you've never had it before
- check_circle Rage or irritability that feels unlike your baseline
- check_circle Sleep disruption affecting your mood and cognitive function
- check_circle Brain fog: difficulty concentrating, word-finding, or remembering
- check_circle A quiet or not-so-quiet questioning of identity, purpose, and relationships
- check_circle Grief about aging, fertility, or the version of yourself that's changing
Estrogen and progesterone have direct effects on serotonin, dopamine, and the HPA axis — the system that regulates stress response. As these hormones fluctuate and decline during perimenopause, the neurological effects are real and measurable. If you're feeling destabilized in ways you can't explain, your hormones may be part of the story.
But perimenopause isn't only a hormonal event — it's also a psychological and existential one. Many women describe this period as a reckoning: with how they've been living, what they've sacrificed, what they want the next decades to look like. That's not a crisis. That's wisdom arriving. Therapy can help you meet it.
I want to be clear: if you're in perimenopause and experiencing new psychiatric symptoms, it's worth talking to both a therapist and a provider who understands hormonal health. These are not competing approaches — they work best together.
My Approach
I take an integrative, phase-of-life approach to perimenopause work. We address the psychological symptoms directly — anxiety, depression, mood dysregulation — while also creating space for the deeper identity and relational work this transition often calls for. I collaborate with medical providers when appropriate and approach this phase with the seriousness it deserves.