When Everything Changes at Once - Perimenopause, Mental Health and the Transitions Nobody Prepares You For

A note before we begin: Not every symptom or mental health difficulty experienced during your forties is related to perimenopause. This is why finding a trusted doctor or gynaecologist to look at your overall health is so important — to understand your unique picture and rule out anything else that might be going on. What follows is an invitation to consider one piece of that picture that is too often overlooked.

The moment you stop recognising yourself

Recently a client — or someone very much like her — stepped into my office. A lovely woman in her early forties, describing tiredness, low motivation, irritability and anxiety. We explored everything that had been happening — the last months, the last year.

Her toddler had just started preschool. For the first time in years she had space — space to focus on her career, herself, her relationship. By every measure, life should have been easing. She should have been feeling the lift.

But she wasn't.

"It's like someone dropped a massive blanket over me," she said. "It darkens everything. I'm so tired. And I don't recognise myself."

We explored the possibility of also seeing a doctor — blood tests, a hormone panel. A few weeks later she came back with her results, and I noticed something on her face before she even spoke. A quiet relief. Not because everything was solved, but because something finally had a name.

What she was experiencing had a name. And like so many women, she had never considered it might be perimenopause.

What perimenopause actually is — and why nobody warned us

Most of us were never told about perimenopause in our twenties or thirties. We watched our mothers go through menopause and perhaps didn't fully understand what we were seeing — partly because the generations of women before us were expected to manage it in silence, with a kind of quiet grace. Something you simply got on with.

Looking back now, I believe so much of what my mother and grandmother struggled with — mentally and physically — was connected to their hormones. And so much of it went unnamed.

Perimenopause is the transitional stage that happens before menopause, initiated by fluctuations in oestrogen and progesterone. As these hormone levels begin to fluctuate and gradually decline, the effects reach far beyond the physical — affecting mood, cognition, sleep and sense of self. It can begin earlier than most women expect — in the mid-thirties or early forties — and it looks different for every woman.

And it goes far beyond hot flushes.

Some of the symptoms that often go unrecognised or dismissed include: increased anxiety, mood shifts and rage, depression, migraines, sleep disturbances, brain fog, fatigue, heart palpitations, night sweats and — perhaps most quietly devastating — a loss of confidence and the feeling of simply not being yourself anymore.

The ability to find something positive, to appreciate the good things in a day, can feel like it's slipping away. And when everything you try doesn't seem to bring you back to yourself, it becomes exhausting and frightening.

Too often these symptoms are dismissed. Women are sent away with the words "we can't find anything" — or handed antidepressants without any exploration of what might actually be happening hormonally. It leaves women feeling like they are losing their minds. Like it's all in their heads.

It isn't.

When postpartum and perimenopause arrive together

More and more women are having children later, and this creates a particular and disorienting experience — moving almost directly from the postpartum period into the early stages of perimenopause.

"It's been two years since I had my baby, but I still don't feel like myself." The tiredness, the mood shifts, the brain fog, the feeling that everything is too much — it persists, long past when it feels like it should have eased. The cup never seems to fill, no matter what you do.

And then there are the women whose children are older — perhaps entering puberty, or leaving home entirely. Another transition layered on top of their own. The house changing shape just as their body and mind are doing the same.

If you are experiencing depression during this time, it may be connected to low progesterone levels. This is why finding a health professional who will look at your unique story — your full history, your hormones, your life — is so important. You deserve more than a one-size-fits-all answer.

Why this is the right time to seek support

Perimenopause is a significant life transition. And transitions — as I see every day in my work — have a way of bringing everything that has been quietly waiting to the surface. Old patterns, unresolved feelings, questions about identity and worth that there was never time to sit with before.

Psychotherapy during perimenopause can offer something essential: a space to find calm in the chaos. To make sense of the feelings that are arriving — the rage, the sadness, the grief, the confusion — with understanding rather than judgement. To rebuild self-compassion at a time when your inner critic may be louder than ever.

And there is something else I want to say. This transition, as hard as it is, can also be a doorway. Not to becoming a new person, but to reclaiming the person you already are. Perimenopause does not have to be something you simply endure. With the right support, it can become a time of real clarity — about what matters, who you are, and how you want to live.

This is not the end. It can be the beginning of something good.

How I work — and how I can help

As a psychotherapist currently undertaking specialist training in menopause-informed therapy, I work with women navigating the emotional and psychological complexity of perimenopause — alongside the other transitions that so often arrive at the same time.

I bring not just professional training but personal experience of navigating change, identity and the particular challenges of building a life far from the place you came from. I understand what it means to feel unlike yourself, and to do so without your closest people nearby.

Sessions are available in English and German, online and in person in Ibiza. You don't need to have it figured out before we speak. We can start exactly where you are.

A gentle invitation

If something in this has resonated — if you have recognised yourself, or someone you love, in these words — I would love to hear from you.

You don't have to keep carrying this alone. And you don't have to wait until it becomes unbearable to reach out.

Feel free to get in touch — I'd love to hear from you.

Denise

Image credit: Diliara Garifullina via Unsplash