Perimenopausal Mental Health
This might seem a bit out of place at first. Why this topic?
First of all, let me just say that when I started working as a therapist I had NO idea about these things. This is all from research I’ve done on the subject, learning from clients who have struggled to find the root causes of their sudden anxiety or depression, and from listening to the women in my life.
The reason I wanted to put together this summary on perimenopause and mental health is because 100% of women will go through menopause if they live long enough. And since most of my clients are women aged 35-55, these are topics that I discuss. A lot. Not many women feel well-educated about menopause, and not all doctors are knowledgeable on the subject.
The other reason I want to offer this as a resource is so you know what’s possibly going on with your body. The way we treat mental health issues that are caused by natural perimenopausal changes is NOT the same way we’d treat mental health issues caused by trauma or a harmful self-relationship.
Some quick definitions:
Menopause: the point where you haven’t had a period for a full year. Technically it’s just that one point in time. Usually around age 51 for most women, but you’re personally more likely to be close to the age when your mom hit full menopause.
Post-menopause: the part of your life after you hit the one year mark
Perimenopause: the first stage of your body’s transition into menopause. It can last from 4-8 years on average. Since menopause can start as early as 40, this means you could start perimenopause in your early 30s.
Medically Induced Menopause: menopause that started because of treatments or surgeries that create similar hormone changes to “natural” menopause. Most commonly due to chemo, radiation, and oophorectomy.
I am not a medical professional. I am a therapist speaking from personal and professional experience. This is general information and does not replace a conversation with your doctor.
Physical root causes mimic psychological issues
I fully believe in holistic therapy. Often that means integrating mind and body therapy methods. It also means we look for physical and medical explanations for your mental health symptoms.
Anxiety and depression in particular. I’m convinced now that anxiety and depression are almost like a check engine light for your mind and body.
Here’s just a brief list of physical root causes that my clients have discovered through our work together (and referrals to get medical tests):
Thyroid disorders
Vitamin deficiencies
Sleep disorders
Heart issues
Perimenopause
I want to highlight perimenopause in particular because it’s harder to fully diagnose.
All the rest of these issues can be discovered through fairly common medical testing, but most women don’t even know about perimenopause, let alone how it affects your mental health.
And because your hormones are still fluctuating and you’re probably still having periods, testing may not reveal anything off. These changes are still considered “normal” and doctors often write them off even though there are treatments that can help.
Could you be in perimenopause?
Anger and irritability
Anxious and easily stressed
Forgetfulness and brain fog
Sudden loss of confidence or self-esteem
Low mood, sadness, or depression
Poor concentration, difficulty finding words
Difficulty sleeping or insomnia
For some extra fun, perimenopause is the time in your life that you’re most likely to have panic attacks, whether or not you’ve had them before. And since women often have thyroid issues around the same time they can potentially start perimenopause (mid 30s-early 40s), there’s possibly a link between the two. (Though not everyone who goes through perimenopause will get a thyroid disorder)
Unlike the mood shifts associated with PMS (premenstrual syndrome), perimenopausal mood swings can happen at any time during your cycle, not just the days leading up to your period.
How do you tell thyroid issues apart from perimenopause?
Thyroid symptoms can look very similar to the list of perimenopause symptoms, but there is a key difference.
The difference? Thyroid issues will show up on a TSH test that will tell you if your levels of TSH (thyroid stimulating hormone) are high or low. Perimenopause may have the same or similar symptoms, but it’s caused by changes in your body as your ovarian function gradually decreases. You may or may not have measurable hormone changes during perimenopause since you’re still experiencing cyclical changes that may vary significantly from day to day.
Managing mental health symptoms of perimenopause
When you’re struggling with hormone-related mental health issues, it can feel like there’s nothing you can do to fix the situation.
Looking ahead at 4-8 years of perimenopause with these symptoms feels daunting and overwhelming. Fortunately, there are several things you can do for your mental health and physical health to help ease the transition.
Make lifestyle changes
Many women benefit from improving their sleep. Creating a good sleep environment should include regulating your temperature, getting enough darkness, possibly using light therapy in the morning, and sticking to a sleep routine. You might experiment with reducing or limiting your caffeine and alcohol consumption to see if that helps.
Manage your stress
Perimenopause seems to hit exactly at the most stressful time. If you have kids, they’re often older and navigating their own life transitions. Your parents are likely aging and facing their own issues.
If you work, these are the years where you’re more likely to be in a higher position where you’re managing more people, dealing with higher stakes, or strategically moving to jobs that better support your retirement goals.
It’s a high stress time of life, so if you don’t already have good strategies to manage your stress, perimenopause will hit you harder.
Check up on your relationships and hobbies
The physical changes of perimenopause often affect your sex life which can lead to feeling disconnected from your partner. Feeling connected to a supportive partner is an important resilience factor that can help you through high-stress times in life.
Similarly, friend relationships can fall by the wayside when you’ve got a lot going on. But it’s great to feel like you’re not alone and that you’re supported by people who care about you.
Making time for your hobbies might not feel like the top priority when you’re busy at work and with family. Hobbies can help you relax, decompress, and disconnect. Plus, many hobbies encourage you to be mindful which is great for your mental health.
Notice your self talk around aging
We live in a very youth-focused culture. The transition into menopause is a signal that you’re no longer young. If you’ve built up a lot of your identity in being young or youthful, perimenopause can feel like a threat to that core part of who you are. If you’ve been hoping to have children, it can feel like time is running out before that’s no longer a possibility. Even if you have positive feelings toward aging, it also brings up issues of mortality, purpose, and legacy.
Mindfulness can be helpful. Notice the way you think about aging, and notice the emotions that come up as you think about yourself getting older. Take time to think about whether or not your current life is moving you toward your values or if it feels like you’ve been on autopilot.
Consider medication
For perimenopause, some doctors prefer to use HRT (hormone replacement therapy) to manage your mental health issues. HRT can address some physical symptoms like hot flashes, but it may not be recommended for all women, particularly if you have a history of hormone-related cancers or if you smoke.
Other doctors will recommend psychiatric medications that target depression or anxiety without using HRT.
Unfortunately, perimenopause is not widely studied so there are not specific medications that fully address the needs of women in this stage.
Therapy can help
Therapy for perimenopausal mental health helps you deal with the different parts of this major life transition. You can get practical tools to help you sleep better, time and space to process your feelings around aging, skills to manage mood changes and lower your stress, and a place to talk through the changes you’re experiencing.
To learn more about how therapy can help your unique situation, contact me for a free consultation.