The One Thing I’d Like Women to Know During Perimenopause

Sonya Curran, Clinical Psychology Registrar at Amherst Psychology

If there’s one thing I could tell every woman in perimenopause, it’s this: 

You are not going crazy. 

The emotional rollercoaster, the sudden anxiety, the c

reeping fear about your health and aging; These are all real, and you are not alone in experiencing them. 

Mental Health and the Silent Side of Perimenopause 

When we talk about perimenopause, most people think of hot flashes and night sweats, what are known in the medical world as the hallmark “vasomotor” symptoms. But what’s often overlooked are the mental health challenges that can arrive years before the first hot flash ever shows up. 

In fact, a 2022 study published in JAMA Psychiatry found that up to 60% of women experience significant mental health symptoms such as anxiety, depression, and mood instability, during the perimenopausal transition.  

Even more striking, research shows that more than one-third of women experience depression or anxiety long before they notice vasomotor symptoms like hot flashes or night sweats. That means for many women, the first signal that something is shifting hormonally isn’t physical, it’s emotional. And because these mental health symptoms often appear before the more recognisable perimenopausal signs, they’re frequently misdiagnosed or dismissed - by doctors, by partners, and even by women themselves.  

The Health Anxiety Nobody Talks About 

One of the most common emotional experiences in perimenopause is an increased fear about health. Women often describe an unshakable feeling that something is wrong with their bodies, even when tests come back normal. 

You might find yourself hyper-aware of every ache and twinge, Googling symptoms late at night, or feeling a rising panic about aging, illness, and mortality. This kind of health anxiety isn’t just psychological, it has a biological root in hormone fluctuations, particularly the drop in estrogen, which directly affects serotonin and other mood-regulating neurotransmitters. 

It’s incredibly disorienting to feel like your own mind is turning against you. 

And yet, millions of women are going through this exact experience, often in silence. 

The Midlife Mental Load 

Perimenopause typically begins in a woman’s 40s, but can sometimes begin earlier. It often overlaps with a time of intense life pressure: raising children, navigating career shifts, dealing with relationship changes, and becoming more generally aware of own ageing. Some women also experience mourning relating to loss of fertility, or the missed opportunity for having children. 

Add to that the body’s unpredictable changes (e.g., brain fog, insomnia, and fatigue) and it’s no wonder that mental health takes a hit. 

Though precise Australian figures are sparse, broader findings from a national survey show that while 75% of Australian women with perimenopausal symptoms experience mental health issues or brain fog, many reported a lack of recognition or explanation from their doctors. 

Why This Matters 

Because if women don’t realise that what they’re feeling is part of perimenopause, they’re less likely to seek help. They may blame themselves. Or think they’re just not coping well. Or worse, they may be told by medical professionals that it’s “just stress,” or “normal ageing,” or that they should simply ride it out. These kind of responses, intentional or not, can have a real impact on a woman’s well-being, delaying treatment and leaving her to suffer in silence. 

What You Can Do 

First, know that what you’re feeling is valid, and it is far more common than most people realise. Here are a few ways to support your mental health during perimenopause: 

1. Track Your Symptoms 

Keep a journal or use a tracking app to monitor mood changes, anxiety levels, sleep, and physical symptoms. This can help you identify patterns and provide you with useful data that you can share with your healthcare provider. 

2. Talk to a Provider Who Gets It 

Not all doctors are trained in recognising perimenopausal mental health symptoms. Seek out a provider who specialises in midlife women’s health or menopause care. Ask directly whether they’re familiar with treating mental health issues during perimenopause.

3. Consider Therapy 

There are many evidence-based therapies that psychologists utilise, which can be very effective in managing anxiety and depression during this time. Psychologists will individually tailor their therapy approach to you, depending on your needs.  

4. Explore Treatment Options 

There are many tools available, including hormone therapy, antidepressants, lifestyle changes, supplements. The right choice will depend on your unique health profile and symptoms. 

5. Talk About It 

Share your experience. The more we speak openly about the mental health side of perimenopause, the less alone other women will feel and the more pressure we place on the healthcare system to take it seriously. 

You Deserve Support 

Perimenopause is not “just” a hormonal blip, it’s a major life transition that affects your body, mind, and sense of identity. It’s a time of vulnerability, yes, but also a time of profound potential. When we acknowledge the reality of mental health challenges during perimenopause, we create space for healing and growth, not just symptom management, but deep transformation. 

So, if you’re feeling anxious, low, overwhelmed, or not like yourself, know this: 

You are not broken. You are not alone. And you are absolutely not imagining it. 

If you'd like to work with a menopause informed psychologist, Sonya Curran is available to see new clients at our Mount Pleasant practice. Contact our friendly reception team on 9456 0411 or click here to get in touch via email using our online form.