Perimenopause and Menopause: A Psychological Perspective on Navigating Change

For many women, perimenopause and menopause mark the beginning of a significant life transition—one that is often misunderstood, misdiagnosed, or minimised. Beyond the well-known physical symptoms like hot flushes and night sweats, these hormonal shifts can bring emotional, cognitive, and psychological challenges that deserve greater attention and compassionate support.

Understanding Perimenopause and Menopause

Perimenopause refers to the years leading up to menopause, where hormonal fluctuations—particularly in oestrogen—can cause a wide variety of symptoms. This stage can begin in a woman’s early to mid-40s and may last several years. Menopause is defined as the point when menstruation has ceased for 12 consecutive months, typically occurring between ages 45 and 55.

While each woman’s experience is unique, common symptoms include:

• Mood swings and irritability

• Anxiety or panic

• Depressive symptoms

• Brain fog or memory lapses

• Fatigue and sleep disturbances

• Changes in libido and body image

• Feelings of loss or identity confusion

These experiences are not “just part of ageing”—they are real, valid, and can significantly affect quality of life, relationships, and workplace wellbeing.

Why Mental Health Support Matters

The hormonal changes associated with (peri)menopause affect brain chemistry, which can impact mood, cognition, and emotional regulation. For some women, unresolved trauma, past mental health challenges, or longstanding patterns of self-neglect may resurface during this time. Others may find themselves overwhelmed by the cumulative pressures of midlife—caring for children or elderly parents, managing careers, and navigating shifting relationships.

Many women report feeling as though they no longer recognise themselves. Counselling can help make sense of these feelings and support the psychological, emotional, and existential changes that often accompany this phase.

How Counselling Can Help

Working with a counsellor who is menopause-informed can be transformative. Therapy offers a safe, confidential space to:

• Explore the emotional impact of hormonal changes

• Understand the interplay between physical symptoms and mental health

• Process changes in identity, purpose, and self-esteem

• Learn coping strategies for mood swings, anxiety, and sleep difficulties

• Navigate relationship dynamics and communication

• Advocate for workplace accommodations and self-care

Evidence-based approaches such as Cognitive Behavioural Therapy (CBT) have been shown to reduce menopause-related symptoms including hot flushes, sleep issues, and low mood. Acceptance and Commitment Therapy (ACT) and mindfulness-based therapies can help women respond to distress with greater flexibility and self-compassion.

Another powerful modality is schema therapy, which explores longstanding patterns of thought, emotion, and behaviour—our ‘personal blueprints’. During perimenopause, women often reflect deeply on who they are and what matters to them. Schema therapy supports this introspection by helping to identify unhelpful patterns and cultivate healthier ways of relating to oneself and others.

Looking at the Bigger Picture

Psychological symptoms don’t occur in isolation. They are influenced by:

• Biological changes – hormonal fluctuations and sleep disruptions

• Social context – roles as caregivers, partners, professionals

• Cultural messages – stigma, ageism, and silence around menopause

• Economic realities – the cost of treatment, lost income due to symptoms

A skilled therapist will consider all these factors, helping clients make meaning of their experiences and empowering them to navigate change with confidence and agency.

The Importance of Menopause-Informed Care

Despite growing awareness, many women still encounter barriers to accessing appropriate mental health care during menopause. Symptoms may be dismissed, misunderstood, or misdiagnosed. For instance, menopausal depression can present as irritability, anger, or a sense of emptiness rather than classic sadness, which may lead to inappropriate treatment.

This highlights the need for better training for health professionals, so they can recognise and respond to menopause-related mental health concerns effectively and empathetically.

Towards a More Supportive Future

The Australian Psychological Society (APS) recently made 11 key recommendations as part of the Federal Government’s inquiry into menopause and perimenopause. These include:

• Investing in research on mental health impacts

• National awareness campaigns to reduce stigma and promote help-seeking

• Training for all health professionals in menopause-informed care

• Ensuring access to affordable hormonal and psychological treatments

• Supporting workplace policies that accommodate menopause-related needs

Therapists have an essential role to play—not just in one-on-one support, but in shaping policies, educating communities, and advocating for change.

Reclaiming This Life Stage

Menopause is not the end—it is a powerful time of transformation. With the ri

ght support, many women find a renewed sense of purpose, clarity, and self-understanding during and after the menopausal transition.

Counselling can help women move beyond just coping to thriving—by recognising what no longer serves them, embracing who they are becoming, and navigating the years ahead with wisdom and authenticity.

If you’re experiencing symptoms of perimenopause or menopause and feel overwhelmed, you’re not alone—and you don’t have to go through it unsupported. Counselling offers a space to be seen, heard, and understood. Together, we can explore what this stage of life means for you, and how to move through it with care, curiosity, and courage.

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