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The Devastating Mental Health Impact of Perimenopause

Tips on how to cope with the psychological symptoms of perimenopause

Perimenopause symptoms
Image by pikisuperstar on Freepik

Perimenopause is the stage before menopause and is a natural process in which a woman starts to notice changes in her menstrual cycles, her body, her mind, her mood and her behaviour. Often, the symptoms are very gradual and usually occur between the ages of 42 and 52 (Kulkarni, 2018), although they can start earlier than this. Typical psychological symptoms in perimenopause include low mood, anxiety, feelings of paranoia, anhedonia (difficulty or inability to experience pleasure), irritability, dissociation, insomnia and feelings of low self-worth (Behrman & Crockett, 2023). Because of the myriad of symptoms, a common experience for perimenopausal women is to not feel like themselves anymore – which, of course, alongside all of the other symptoms, can be deeply distressing.

Women can often suffer for many years before getting treatment. An online survey of over 1500 women revealed that 39% were told by their General Practitioner (GP) they would just have to learn to live with perimenopausal symptoms (Mumsnet, 2021). Other research has shown that 44% of women wait one year or more for adequate treatment from their GP, with 12% waiting more than five years (Newson & Lewis, 2021).


The findings above paint a rather gloomy picture of the care of peri/menopausal women. Despite this, there are things you can do that won’t necessarily get rid of the psychological symptoms of perimenopause, but they will help you manage them. This article describes four key ways you can do this from a psychological perspective.

#1 Learn about perimenopause

We exist in a society that does not talk about perimenopause in schools, workplaces, or homes. Although this is slowly starting to change the generation of women who are now experiencing perimenopause is very much in the dark, which can add to the anxiety and confusion that a woman can feel.

To counteract this - read up on perimenopause – get to know the signs and symptoms to look out for, and educate yourself on what is happening in your body. Knowledge is power where perimenopause is concerned, and this can help reduce the worry and anxiety about the array of symptoms you may be experiencing, and help equip you when you see your GP.

#2 Deal with self criticism, judgement and shame

A common experience for women in perimenopause is memory difficulties and brain fog, which can significantly impact a woman’s day-to-day functioning at home and work - which in turn can lead to intense shame and guilt. In a survey of over 4000 perimenopausal and menopausal women, 44% of women reported that their symptoms affected their ability to work (The Fawcett Society, 2022). Similarly, 99% of survey respondents described that their perimenopausal or menopausal symptoms had led to a negative impact on their careers, with more than a third calling the impact ‘significant’ (Newson Health Research & Education, 2022).

If this resonates with you, try and keep in mind that perimenopause is not something you choose; it is a natural change that happens as we age. Being self critical is futile and unhelpful as it keeps you in a threat state of mind, which only fuels anxiety and stress. You are not to blame for what you are experiencing, and you are dealing with some challenging symptoms that can be debilitating. A gentle shift in can help – rather than self criticism, try and shift to - I am doing what I can with the resources I have. To help deal with shame and embarrassment, talk to trusted friends about what you are experiencing because at least one person is likely going through it, too.

#3 Adopt a self compassionate mindset

Fatigue is particularly problematic in perimenopause, and women often find they have days where, for example, even just messaging a friend can seem like climbing a mountain. In this phase of life, women tend to have multiple competing demands and pressures on their time and emotional resources: children, work, household, ageing parents and so on. When you add in perimenopause, keeping all of the plates spinning becomes incredibly difficult, so it is vital to cut yourself some slack. Try to take on a self-compassionate mindset that recognises how difficult this is. Acknowledge that you are not the only person going through this and that people are finding the same things just as hard as you. Being self compassionate also involves identifying what support you need – can you delegate some tasks? How can other people help you, and how can you communicate those needs?

#4 Develop a toolkit for perimenopause mood swings

Mood swings are commonplace in perimenopause. In the space of one hour, you can cycle from feeling ok, to full-blown anger, to crying uncontrollably, and back again. You can adopt numerous strategies to cope with this, and having a toolkit of a few that you can pick and choose depending on the circumstances can be helpful. For example:

  • Grounding yourself through breathing mindfully or doing a breathing exercise

  • Self soothe using your five senses (link to article)

  • Accepting the emotions as they are and letting them come and go without judgment or struggle

  • Remind yourself that the difficult emotions are not permanent and will pass

  • Using calming statements that you say to yourself in a soothing tone of voice

  • Getting outside in the fresh air/nature

  • Incorporating mindfulness into your day

  • Defusing or stepping back from negative or anxious thoughts


  1. Perimenopause comes with a host of different physical and psychological symptoms that can be very difficult to cope with.

  2. There are things you can do to help cope with these symptoms, but a good starting point is to learn about perimenopause and what you can expect.

  3. Increase your skills in self compassion to counteract shame and self criticism that can be part of the perimenopause experience.

  4. Through trial and error, you can develop your bespoke toolkit to manage perimenopause mood swings.


If mood swings in perimenopause are impacting on your life and your relationships, try our FREE 16 page guide, which contains lots of tips to help you manage your emotions in perimenopause.

Click on the image below:


If you find self-compassion difficult, our FREE Self-Compassion Break worksheet can help. The Self-compassion Break is a tried and tested strategy to help you be self-compassionate in emotionally difficult moments.

Self-Compassion Break FREE worksheet download now



Behrman, S., & Crockett, C. (2023). Severe mental illness and the perimenopause. BJPsych Bulletin, 1-7. doi:10.1192/bjb.2023.89.

Kulkarni J. (2018). Perimenopausal depression - an under-recognised entity. Aust Prescr. Dec;41(6):183-185. doi: 10.18773/austprescr.2018.060.

Newson, L & Lewis, R. (2021) Delayed diagnosis and treatment of menopause is wasting NHS appointments and resources [Paper Presentation], Royal College of GP Annual Conference, London, UK.

Newson Health Research and Education (2022). Impact of Perimenopause and Menopause on Work.

The Fawcett Society (2022). Menopause and the workplace.



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