Menopause is a term that many of us are familiar with; however, what would you say if I told you that what we have come to call menopause, characterized by hot flashes and changes in hormone levels, is called perimenopause. Perimenopause basically means, “around menopause” (Mayo Clinic, 2021). Perimenopause can affect mental health so we want to take a look at what exactly perimenopause is and how it impacts mental health.

The Basics Of Perimenopause

What exactly is perimenopause? According to Harvard Health Publishing (2018), perimenopause begins with “irregular menstrual cycles — courtesy of declining ovarian function — and ends a year after the last menstrual period.” Perimenopause indicates the time your body makes the natural transition to menopause, also known as menopausal transition (Mayo Clinic, 2021). Perimenopause can span a large time frame lasting as little as a few months to several years. Women can start perimenopause at different ages. The cause of perimenopause is the fluctuating levels in estrogen (the main female hormone). After a woman has gone 12 months without a menstrual period, she has reached menopause and the perimenopause period is over (Mayo Clinic, 2021).

Physical Symptoms of Perimenopause

Women who are experiencing perimenopause can include menopause-like symptoms such as:

  • Hot Flashes/Night Sweats – Seen in about 35-50% of women
  • Vaginal Dryness
  • Uterine Bleeding Problems
  • Sleep Disturbances – Experienced by roughly 40% of women
  • Mood Concerns

Perimenopause & Mental Health

The physical symptoms of perimenopause can impact daily living; however, there are also emotional and mental symptoms to be aware of. In many cases, not only are women working through perimenopause but also other life transitions that may be occurring around the same time, such as natural aging and the empty nest as children transition to adult life. This time of life can be challenging, and many face anxiety and depression as they navigate the changes in their body, what this time in their life may mean, and the sudden onset of symptoms. It is not uncommon to experience feelings of anxiousness and irritability.

Does Perimenopause Cause Depression?

Is there a link between menopause transition and the development of depression? That is the question explored by Vivan-Taylor and Hickey in 2014. They did a review to look at the association between depression, menopausal transition, and the complex interaction between the biological, psychological and social factors that inform it. They note that depression is the most common illness known around the world and is twice as common in women than men, with women possibly having increased risk during periods of hormonal change such as puberty, pregnancy and the menopause transition. Vivan-Taylor and Hickey, 2014 mention that although specific hormonal changes and depression has not been linked as of yet it may be deemed a time of risk for women. A time of not only physical changes happening in the body but may be associated with increasing physical health concerns, changing social, work and family roles as well.

Caring For Mental Health During Perimenopause

Now that we have established that perimenopause can be linked to some mental health concerns, we want to offer some practical tips for taking care of your mental health during this transition:

  • Learn Sleep Hygiene: The physical symptoms that come during perimenopause can have a negative effect on sleep quality. Learning to practice sleep hygiene is an important step to protecting your rest and your mental health.
  • Practice Mindfulness Meditation: Engaging in mindfulness meditation can alleviate symptoms of anxiety, depression and sleep disturbances in perimenopausal women (Xiao et al. 2019).
  • Monitor Your Symptoms: Take note of symptoms you are experiencing and how they are impacting your life. Being aware of what you are experiencing will be helpful in making the decision to seek outside support from mental health professionals if needed!
  • Make Lifestyle Changes: During the perimenopause transition, it may be necessary to make lifestyle changes, like reducing stress or adding an exercise routine, to support your mental health.
  • Remember That You Are Not Alone: While perimenopause can be a challenging time, it is essential to know that you are not alone and that resources are available to support you.

Counseling, Perimenopause, & Mental Health

According to Kulkarni (2019), there is a high suicide rate among women in menopause ages. As mentioned above, there are typical life changes that occur alongside these physical changes. If you notice some of the symptoms and are experiencing life transitions, counseling may be beneficial to learn how to manage and cope with these changes. It is notable that there are symptoms in perimenopausal depression that are not typical of regular depression such as paranoid thinking. Other symptoms include weight gain, irritability, low self-esteem, isolation, concentration issues, decreased sexual interest, and hostility. While speaking with your healthcare providers for a course of action is important, adding a counselor to your team may be a smart move in the direction of improving your overall quality of life. Many of the life issues happening as your body changes can be stressful. Counseling can target relationship issues, grief issues, routine issues, and emotional disturbances can all be targeted in counseling to ensure that all areas of life are given attention and causing as little stress as possible. Meyers (2019) says therapy models such as Cognitive Behavioral Therapy (CBT) can assist women in tracking mood, stress, and sleep patterns to serve as protective factors and aid in the recognition of triggers of vasomotor symptoms. It is also noted that changing “self-talk” regarding the lived experience of the signs and incorporating mindfulness acceptance can help women as they undergo the process of perimenopause. Counseling provides a safe space for women to talk freely and process an experience that is often shunned or disregarded and can be the first step in finding relief and understanding.

For women, menopause is an important and normal developmental process, but how many women really look forward to this right of passage? If you or your loved one are experiencing perimenopause related mental health concerns, our team is here to support you. Contact us at (256) 239-5662 or online to schedule an appointment.

This article was written by Maegen Harris, M.Ed, ALC (under the supervision of Leah Simmons, LPC-S #3334), and Salintha Washington, M.A., ALC, NCC (under the supervision of Leah Simmons, LPC-S #3334) – mental health professionals at Garrett Counseling in Boaz and Huntsville.

If you found this article helpful, you might also enjoy reading:
How Therapy Can Help Women Experiencing Menopause
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Kulkarni, J. (2018). Perimenopausal depression–an under-recognised entity. Australian prescriber, 41(6), 183.

“Perimenopause.” (August, 2021) Mayo Clinic, Mayo Foundation for Medical Education and Research, 7 Aug. 2021,

Xiao, C., Mou, C., & Zhou, X. (2019). Effect of mindfulness meditation training on anxiety, depression and sleep quality in perimenopausal women. Nan Fang yi ke da xue xue bao= Journal of Southern Medical University, 39(8), 998-1002.

Zhou, Q., Wang, B., Hua, Q., Jin, Q., Xie, J., Ma, J., & Jin, F. (2021). Investigation of the relationship between hot flashes, sweating and sleep quality in perimenopausal and postmenopausal women: the mediating effect of anxiety and depression. BMC Women’s Health, 21(1), 1-8.

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Harvard Health Publishing. (2021, March 1). Menopause and mental health. Harvard Health; Harvard Health.