When Hormones Hijack Your Headspace: A Therapist Breaks Down Perimenopause

Let’s talk about the F-word.

No, not that one. I’m talking about fluctuations—specifically, hormonal fluctuations that come knocking (or kicking down the door) during perimenopause.

As a therapist, I’ve sat across from countless women in their 30s and 40s who come in saying things like, “I think I’m losing my mind,” or “I don’t feel like myself anymore.” Often, these women are high-performing (to a fault), emotionally intelligent, and self-aware. So when anxiety spikes, sleep vanishes, or rage and overwhelm ramp up, they start wondering if they need to make some serious life changes—or make a call for an exorcism.

Spoiler alert: It’s probably perimenopause.

Wait, What Is Perimenopause?

Perimenopause is the hormonal pre-party (read: chaos) before menopause. It can last anywhere from 2 to 10 years (yes, years), and often starts anywhere from your mid 30s to early 40s. The ovaries begin phasing out like a tired barista on a double shift, and estrogen—once the star of the show—starts pulling unpredictable vanishing acts.

What follows? Fun stuff like:

• Random mood swings

  
  

• Anxiety that makes you rethink everything you did last summer

  
  

• Brain fog so thick you almost forget your dog’s name

  
  

• Depression that isn’t always “clinical,” but definitely isn’t fun 

  
  

• Relational strain when others fail to read your mind or stop putting more demands on you

  
  

• Decreased libido - who has time for sexual desire in all this chaos? 

  
  

• Physical changes - differences in body composition, including muscle loss, skin changes, increased aches and pains, fatigue, hot flashes and many more

  
  

• Grief, loss, and a touch of existential dread—like a charcuterie board of midlife surprises

Mental Health in the Hormone Hurricane

Here’s the thing most women don’t hear enough: Perimenopause can absolutely affect your mental health.

Not because of those lines we’ve been fed all our lives about being “too sensitive” or “overreacting,” but because your brain is literally bathing in a different hormonal soup every day. Estrogen and progesterone don’t just handle baby-making—they’re also major players in serotonin production, sleep regulation, and emotional resilience.

So yes, you may suddenly feel like a raccoon in a dumpster fire. But you’re not broken—you’re biologically remodeling. Many women describe brain fog, forgetfulness, and a sense of “losing their edge.” For those already navigating ADHD or anxiety, perimenopause can make symptoms like distractibility and overwhelm even more challenging.

Add to this the fact that it shows up right at the phase of life when many of us are parenting, trying to hold it down in our careers, and caring for aging relatives. Frankly, we’re exhausted to begin with, and now we can’t find that 6th gear, or second and third wind to carry us through the day. 

So What’s a Perimenopausal Woman to Do?

As your friendly neighbourhood therapist, here’s my totally non-exhaustive (but helpful) list of coping strategies:

1. Track Your Experience – Apps like Clue or MyFlo can help you notice patterns. This is also great ammo when your doctor says, “Are you sure it’s not just stress?”

2. Sleep Like It’s Your Job – Easier said than done, I know. But prioritize it like your sanity depends on it—because it does.

3. Move Your Body – Not because you have to, but because movement helps regulate mood and reduce anxiety. Bonus points for dancing like no one’s watching.

4. Therapy – Yes, I’m biased, but having a space to vent, process, develop your inner strength and self-compassion, and not be judged for screaming at the top of your lungs in your car, or crying at insurance commercials is priceless.

5. Talk to Your Doctor (One Who Actually Gets It) – Not all medical professionals are trained in recognizing perimenopausal symptoms, especially the mental health ones. Find one who listens and doesn’t hand-wave you into oblivion with “It’s just stress.”More to come on this in a future blog. 

6. Community – You are not the only one Googling “Why do I hate everyone now?” at 2 a.m., text your sister/Mom, DM a friend. Normalize the conversation.

Final Thoughts: You’re Not Crazy, You’re Changing

Perimenopause isn’t a breakdown—it’s a biological remix. It’s frustrating, yes. It’s unpredictable, absolutely. But it’s also a powerful time to tune in, recalibrate, and tell the patriarchy to take several seats. It’s also a great time to educate yourself on the available options to improve and support your health and well being. There has not been enough research on women’s health and hormones in general (surprise, surprise I know), and it’s up to us to advocate for more and to push back when we are ignored or told to just grin and bear it.  

So next time you find yourself sobbing because you dropped a spoon (been there), or snapping at your partner for breathing too loud (also been there), take a breath and reach out for support, from friends, from your therapist and from your health care professionals.

You’re not alone. You’re not weak. This is really hard and it can get better. 

Stay tuned for our full blog series diving deeper into this topic.