Navigating Perimenopause and Menopause: How Therapy Can Help

Perimenopause and menopause are often discussed in terms of their physical symptoms: hot flushes, sleep disruption, joint pain, brain fog. While this is great, the conversation about the psychological dimensions of this transition is still catching up. For many women the internal experience is as significant, and as disruptive, as the physical experiences happening in the body.

 

The symptoms that are harder to name

The neurological effects of fluctuating and declining oestrogen are wide-ranging. Oestrogen plays a significant role in regulating mood, in emotional resilience, and in the modulation of the stress response. As Oestrogen levels fluctuate during perimenopause and decline through menopause, many women notice changes and do not feel quite like their usual selves: a shorter fuse, a reduced capacity to tolerate frustration, emotional responses that feel disproportionate or poorly calibrated, tearfulness, overwhelm, poor memory, fatigue and difficulties with word finding. Anxiety that appears for the first time, or worsens significantly. A flatness or absence of pleasure that can resemble depression but does not respond to the usual interventions.

These experiences are physiologically driven and psychologically significant. When a woman does not recognise herself in her own responses, it is unsettling in a way that goes beyond the symptoms themselves.

 

Identity and the midlife transition

Perimenopause rarely arrives in isolation. It tends to coincide with a period of significant life review: children growing up, careers at an inflection point, relationships being reassessed, parents ageing, responsibilities increasing. The physical transition and the psychological one tend to compound each other.

There is also a question of identity that peri/menopause raises directly. For women whose sense of self has been significantly organised around fertility, a particular version of their body, or the roles that midlife is now shifting, the transition can produce an identity disruption.

 

The impact on couple relationships

The effects of perimenopause on intimate relationships are underacknowledged. Changes in libido, shifts in emotional availability, the irritability and exhaustion that accompany hormonal fluctuation. These affect women and their relationships. Partners may feel confused about what has changed and why. You may feel guilty, or defensive, or simply too depleted to manage the relational dimension as well.

 

Menopause, motherhood, and family

For women with children, the timing of perimenopause frequently coincides with adolescence in their children, a period that brings its own relational intensity and increasing demands. The emotional labour required by teenagers navigating their own developmental transitions can be met by a mother whose emotional regulation resources feel depleted by hormonal change. This is a combination that many families understandably find challenging.

For women who do not have children, peri/menopause can bring a different kind of reflection to the surface: about decisions made or not made, grief, relief, or a chapter closing in a way that may or may not require acknowledgement.

 

What therapy can offer

Therapy during perimenopause and menopause is not about managing symptoms; hopefully this can be explored in the context of appropriate medical care, where good hormonal support makes a significant difference for many women. What therapy offers is a space to make sense of the experience, to understand it within the larger context of a woman’s life, and to think about what this transition might mean.

Therapy can also offer a space in which loss, disruption, and identity questions about this period can be given space to emerge. Many women describe this transition as one of the most psychologically significant of their adult lives.

Couples therapy during this transition can be useful, not because a relationship is in crisis, but because both parties can benefit from a safe space to unpack and understand the impact of what is changing. Therapy can provide a space to talk things through without conversations escalating into conflict or misunderstanding.

If you recognise your experiences in any of the examples above, and you (or your loved one) is navigating through perimenopause and menopause, therapy can be a safe space to explore the transition and it's impact.

Dr Erin Reid is a counselling psychologist offering online therapy to individuals, couples, adolescents, and families across the UK and internationally, and 'Walk and Talk' therapy in North West London green spaces. Visit drerinreid.com to find out more.