By Lisa Hillman, MSW, LCSW, CP
Why Emotional Well Being Matters
Perimenopause and menopause are often discussed in terms of physical symptoms. Hot flashes. Weight changes. Sleep disruption. Joint pain.
What is talked about far less openly is the emotional and psychological impact of this transition.
Many women describe feeling unlike themselves for the first time in their adult lives. Increased anxiety. Irritability that feels unfamiliar. Lower stress tolerance. Brain fog. Mood shifts that feel unpredictable or disproportionate. A sense of emotional overwhelm that was never there before.
These experiences are real. They are common. And they are not a sign that something is wrong with you.
A growing body of research shows that hormonal fluctuations during perimenopause and menopause directly affect neurotransmitters in the brain, including serotonin, dopamine, and GABA. These systems play a central role in mood regulation, emotional resilience, sleep quality, and cognitive clarity.
Mental health symptoms during this phase are not imagined. They are biologically driven and emotionally compounded.
Why Emotional Regulation Becomes More Challenging
Estrogen and progesterone influence far more than reproductive health. They interact closely with the nervous system and the body’s stress response.
As hormone levels fluctuate and eventually decline, many women notice increased baseline anxiety, heightened emotional reactivity, difficulty managing stress that once felt manageable, changes in sleep that worsen mood and focus, and a sense of disconnection from their previous identity or sense of self.
For women with a history of anxiety, depression, trauma, or high stress roles, these shifts can feel especially destabilizing.
This does not mean you are regressing. It means your nervous system is adapting to a new hormonal environment.
Understanding this reframes the experience from personal failure to physiological transition.
Why Just Pushing Through Often Backfires
Many women entering midlife have spent decades being capable, dependable, and emotionally steady. When that steadiness starts to feel shaky, the instinct is often to push harder.
Work more. Do more. Power through.
Many women I speak with describe this phase as the first time their usual coping strategies stop working. I relate to that. Like many high-functioning women, my instinct was to push through, stay productive, and minimize what I was feeling. Over time, that approach did not create stability. It created emotional exhaustion. What helped was not doing more, but understanding what my nervous system needed and responding differently.
Mental health during perimenopause and menopause often requires a different strategy. One that prioritizes regulation, support, and self awareness rather than endurance.
Ignoring symptoms or minimizing emotional changes does not make them resolve faster. It often increases shame, isolation, and self doubt.
Individualized Mental Health Support Matters
There is no single emotional experience of menopause.
Some women feel primarily anxious. Others feel flat or disconnected. Some notice grief, identity shifts, or heightened sensitivity. Others feel anger or frustration they have never allowed themselves to feel before.
This is why individualized mental health care is essential.
Effective support during this phase involves understanding how hormonal changes interact with mood and cognition, identifying what symptoms are physiological versus situational, supporting emotional regulation and nervous system balance, helping women make sense of identity shifts and life stage transitions, and creating space for emotions without judgment or minimization.
This is not about pathologizing menopause. It is about supporting women through a complex biopsychosocial transition.
Mental Health as Preventative Care
Just as strength training helps preserve muscle and bone, mental health support during perimenopause and menopause helps preserve emotional resilience, self trust, and quality of life.
Early support can prevent symptoms from escalating into more severe anxiety, depression, or burnout.
This stage of life is not a breakdown. It is a recalibration.
When supported appropriately, many women emerge with stronger boundaries, deeper self understanding, and a more grounded sense of purpose.
Continuing the Conversation
These topics will be explored further at the upcoming Women’s Health Seminar, where mental health, hormone health, nutrition, and movement are addressed together rather than in isolation.
If you are navigating emotional or mental health changes during perimenopause or menopause, support is available and can make this transition feel far less overwhelming.
About the Author
Lisa Hillman, LCSW, is the founder of Exceptional Wellness Counseling and a presenter at the Women’s Health Seminar. She has spent her career building and leading a multidisciplinary mental health practice and is committed to expanding conversations about women’s mental and emotional well being across the lifespan.
Email Us: info@exceptionalwellnesscounseling.com
Call Now: (908) 415-2042
Next Steps & Resources
- Are you ready to take your first step? Reach out to us.
- Do you feel you may benefit from counseling during this time? Take the first step.
- Interested in online counseling? Learn more.
- Resources on relaxation techniques https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/relaxation-technique/art-20045368
