What is Perimenopause? Understanding the Mental and Emotional Symptoms in your 40s

Puberty, the reproductive years and menopause. Those were the “stages of womanhood” as I always understood it, well that was until I hit the age of 40. Then, all the sudden I found myself, well, not really feeling like myself. I was feeling anxious for no reason, seemed to have a shorter fuse and was getting “snippy” more easily, and PMS symptoms were so much worse than normal. What was happening to me? I soon learned through my own investigation (aka Google) and talking to my doctor was that there was another “stage of womanhood”, a stage that doesn’t usually get a lot of attention and certainly one that no one warned me about…. Perimenopause. 

So, what is perimenopause, why does it make woman in their 40’s feel crazy and how can we cope with this unavoidable part of our journey in a more effective way? According to the menopause society, Perimenopause is the time leading up to menopause, when the ovaries start producing less estrogen and eventually stop ovulating. For most women, they enter this stage in their early 40’s and it can last anywhere from a few years to a decade.

The first and most common sign of perimenopause is irregular periods. Due to the fluctuation in hormones, woman might notice changes in the length of their cycle, increase in the heaviness of the flow, or even skipping periods altogether. Other physical signs can include hot flashes, night sweats, and more pain associated with PMS.

While these physical symptoms are well-known, the mental health challenges experienced are often overlooked or misunderstood. Here are some common difficulties women face during this time:

1. Mood Swings and Irritability

• Hormonal fluctuations (especially estrogen and progesterone) can disrupt neurotransmitters like serotonin and dopamine.

• Women may find themselves feeling unusually short-tempered, reactive, or overly emotional.

2. Depression

• Risk of major depressive episodes increases, even in women without prior history.

• Women with a personal or family history of depression, PMS, or postpartum depression are especially vulnerable.

3. Anxiety

• Heightened feelings of worry, panic, or nervousness.

• Some women experience new or worsened panic attacks during perimenopause.

4. Sleep Disturbances

• Insomnia is common due to hot flashes, night sweats, or unexplained waking.

• Poor sleep significantly contributes to daytime fatigue, mood instability, and cognitive fog.

5. Cognitive Changes ("Brain Fog")

• Trouble with concentration, memory lapses, or forgetfulness.

6. Body Image and Self-Esteem Issues

• Weight gain, skin changes, and aging signs can trigger loss of confidence or negative self-image.

• Cultural stigma and societal pressure around aging compounds this.

7. Sexual Health and Intimacy Concerns

• Loss of libido, and discomfort during sex can cause frustration and strain on intimate relationships, impacting mental well-being.

8. Lack of Support or Understanding

• Many women feel isolated or dismissed by healthcare providers, family, or peers.

• Misdiagnosis or underdiagnosis of perimenopausal mental health symptoms are common.

So here we are, 40 something with mood swings, anxiety and brain fog… just to name a few. In addition, we have careers, families and children to take care of. But how do we take care of ourselves? Self-care is the most important strategy to help cope with some of these changes. Things like regular exercise, a healthy diet, and prioritizing sleep are important to help balance hormones and boost mood-enhancing endorphins. Additional ways to improve mental health and clarity from a holistic approach include mindfulness and meditation, journaling, acupuncture and massage.

If you feel that coping with these changes on your own is too challenging at times, seeking professional help through therapy or medication management are also great options. Therapeutic approaches such as Cognitive Behavioral Therapy are proven to help manage perimenopause depression and anxiety by rewriting negative thought patterns and improving coping skills. Joining support groups are also a great way to get connected to other women who share in the same experiences. 

Perimenopause can feel like an emotional rollercoaster, and like I learned for myself, you’re not alone! Your feelings are real, and they are treatable. From nourishing your body and practicing mindfulness to accessing medical treatment, managing your mental health during this time is both possible and empowering.