How symptoms of perimenopause and menopause can impact mental health
Symptoms of perimenopause and menopause go way beyond hot flashes and sleep issues. Learn how hormonal shifts impact your mental health and where to find support.
No matter how educated you are on women’s health issues, you may not know much about perimenopause and menopause. It’s not exactly a focus for health classes, and because people hit these stages at different ages and experience a wide range of symptoms, it’s a tough conversation to have with your friends. As a result, you might think that perimenopause and menopause are just about hot flashes and missed periods — but they’re so much more than that.
Due to fluctuating hormones, people in perimenopause and menopause can experience mood swings, sleep issues, and increased anxiety and stress, among many, many other symptoms. These stages can wreak havoc on your physical, mental, and emotional wellbeing.
But support is out there. We’ve partnered with Midi, a virtual healthcare clinic specializing in women’s midlife health with a focus on perimenopause and menopause care, to help anyone experiencing the tricky symptoms that often go hand-in-hand with these hormonal changes. Scroll down for more about the partnership.
What’s the difference between perimenopause and menopause?
Many people just don’t know a lot about perimenopause and menopause, so let’s start at the very beginning. Understanding the stages doesn’t necessarily make the symptoms easier, but it does give you a little clarity. When everything in your body feels unpredictable, this can go a long way.
Perimenopause
Perimenopause is the stage before menopause. It often begins in your 40s, and it can last anywhere from a couple of years to more than a decade. During this phase, your estrogen and progesterone levels fluctuate wildly, causing irregular periods.
“For most women in perimenopause, studies find, cycles become more and more unpredictable," says Dr. Mindy Goldman, MD, Midi’s Chief Clinical Officer and the Director of the Gynecology Center for Cancer Survivors and At-Risk Women at the University of California San Francisco. "The stretch between periods can be longer one month, shorter the next, and flow can be heavier this time around, then suddenly lighter. Your period may go missing entirely for months on end, then come roaring back.”
Other symptoms include mood swings, low libido, hot flashes, and anxiety, to name a few.
Menopause
Next comes menopause, which is marked by 12 consecutive months without a period.
“Think of menopause not as a stage, but rather a moment,” Dr. Goldman says. “That point in time marks the definite end of your fertility. The average age of menopause is 51, but it may come years later or earlier.”
Menopause is also marked by a number of physical symptoms. These can vary, but some are very common: 75% of women experience hot flashes, 75% have night sweats, 82% report memory issues, and 87% gain weight or see changes in their body composition, according to research.
Postmenopause
Finally, there’s postmenopause, when your hormones settle but some symptoms remain. Midi reports that 60% of postmenopausal women experience sleep disruption, and because estrogen levels remain low, there’s also a higher risk for osteoporosis and heart disease.
How do symptoms of perimenopause and menopause affect mood?
During perimenopause and menopause, your estrogen and progesterone levels begin to fluctuate. This is an issue because these hormones are critical players in regulating mood, managing stress, and keeping your emotional responses in check. So when they dip, or rise, it’s like someone’s cut the brakes on your emotional regulation system.
Here’s what that can look like:
Sudden anxiety: Even if you’ve never experienced them before, you may begin having panic attacks. (Meditation and mindfulness can help. Here’s how.)
Irritability: This can sometimes border on rage, especially over small things, like a partner breathing too loudly. Need tips to calm anger quickly? Try these 13 steps.
Low mood or depression: It may feel like a fog that just won’t lift — even on days when things are “fine.”
Feeling emotionally raw: You may feel like your resilience is never going to return.
Apathy: This is especially confusing for people who have always been ambitious.
Brain fog: You might experience memory lapses or feel like your thoughts are hazy.
All of this can lead to frustration, embarrassment, and a sense of disconnection from your usual self — but it doesn’t have to be this way.
“You don’t have to suffer. Relief is possible,” says Midi’s Chief Medical Officer, Dr. Kathleen Jordan, MD, a menopause-certified provider and trained internist. “There are a lot of interventions, from hormones to lifestyle hacks, that can help with these symptoms.”
How do symptoms of perimenopause and menopause affect sleep?
Hormone changes can have a major impact on your sleep — and not in a good way.
Here’s what happens:
Estrogen helps regulate your body temperature and serotonin, both of which impact your ability to fall and stay asleep. When estrogen drops, you might wake up drenched in sweat or just feeling off.
Progesterone has a calming, sleep-promoting effect. But when it dips, falling asleep can feel like trying to meditate in a nightclub. (Here are 10 strategies to manage insomnia.)
When the levels of one of your body’s stress hormones (cortisol) spike, you may experience more wakefulness and less deep sleep.
And it’s not just about feeling tired. Chronic sleep disruption can impact your mood, your immune system, your ability to focus, and your stress tolerance.
But despite how frustrated you might feel, your body isn’t betraying you — it’s just adapting. More importantly, the right support is out there.
Other symptoms of perimenopause and menopause
Common symptoms of perimenopause and menopause include mood shifts, insomnia, and brain frog, but there are many other symptoms you may (or may not) know about.
Here are some of the other symptoms you may experience in perimenopause and menopause:
Hot flashes
Irregular periods
Weight gain
Low libido
Vaginal dryness
Heart palpitations
Thinning hair or dry skin
Digestive issues, including bloating and irregularity
Burning tongue or metallic taste
New or worsening allergies or sensitivities
Essentially, this new phase can affect every system in your body. Knowing what’s happening is the first step to getting the support you deserve.
Read more: Here’s what you need to know about menopause and sleep
10 ways to support your mood, sleep, and other symptoms of perimenopause & menopause
There’s no magic fix for perimenopause and menopause, but there are ways to support your body, your brain, and your sanity without overhauling your entire life.
Here are some strategies that might actually help.
1. Talk to professional who is an expert in hormonal health
Find a provider who gets it. You’re not looking for someone who waves off your symptoms with “that’s just getting older,” but rather, a hormone-literate clinician who knows how to support your whole system. Virtual clinics like Midi offer personalized care plans for perimenopause and menopause, created by trained professionals who actually know what you’re going through.
2. Give your nervous system some love
Your hormones may be unpredictable, but your nervous system doesn’t have to go down with them. Grounding, breathwork, and even short, structured mindfulness practices may help stabilize your mood and stress response.
Here are a few easy options:
Try a 4–7–8 breath cycle (inhale for four, hold for seven, exhale for eight) before bed or during a stress spiral.
Use a “pause button” practice like STOP: Stop, Take a breath, Observe, Proceed.
Press your feet into the ground and breathe for 60 seconds during an anxiety spike. It’s low effort, high impact.
3. Focus on sleep hygiene
You can absolutely blame your hormones for your sleep going haywire. Help your body catch some Zzzs by tweaking your sleep environment and habits:
Keep your bedroom cool, as lower estrogen can throw off your internal thermostat.
Use breathable sheets or moisture-wicking sleepwear if you deal with night sweats.
Limit screens an hour before bed. Try blue light glasses or audiobook wind-downs instead.
Try a wind down ritual. Dim lights, make tea, cue a favorite “low-stakes” podcast, or journal a brain dump before bed.
If sleep isn’t happening, get out of bed and do something quiet (no doomscrolling) until you feel drowsy again.
💙 Wind down with gentle movement. Try Mel Mah’s relaxing Sleep Routine practice and ease into rest.
4. Support your body with nourishing food
Your metabolism is shifting, your cravings are wild, and your digestive system isn’t working as well as it used to. Now is not the time to crash diet. Instead, feed your body what it needs:
Prioritize protein and fiber to keep blood sugar steady (which helps mood, energy, and hot flashes).
Limit alcohol and caffeine, especially in the evenings. They’re both sleep disruptors and hormonal agitators.
Eat more omega-3s, leafy greens, and magnesium-rich foods (nuts, seeds, dark chocolate) for mood and brain health.
Stay hydrated.
5. Move, but don’t pressure yourself to “get fit”
Exercise helps mood, sleep, metabolism, and bone density. But it doesn’t have to be a full-body HIIT bootcamp. Actually, pushing too hard can backfire.
Try:
Gentle strength training (two to three times a week) to protect muscle and bones
Walking, dancing, yoga, or swimming — exercises that feel good, not punishing
Stretching in the morning or before bed to ease joint pain and stiffness
Quick five-minute movement breaks if you’re stuck at a desk all day
6. Track your symptoms
You don’t have to journal obsessively, but keeping tabs on how you’re feeling can help you spot patterns. This makes it easier to advocate for yourself — and mentally prepare for the ebbs and flows.
Use a simple tracker, an app, or just a notebook. Jot down:
Mood shifts
Sleep quality
Energy levels
Period changes
Unusual one-off symptoms
7. Nurture your relationships
When you’re in the thick of it, isolation might make everything feel worse. Connect with people who get you, whether that’s a friend, partner, support group, or online community.
Let your loved ones know what’s going on. It’s okay to say, “Hey, I’m not doing well and I need you to be patient with me.”
Seek out conversations with others going through it. It’s a relief to vent to someone who is experiencing the same thing.
If a therapist is accessible, find one who understands hormonal transitions. Mental health care during this phase can be a game-changer.
💙 Connecting with people when you’re feeling low isn’t easy. Tamara Levitt’s Relationship with Others series can give you tools to cultivate stronger connections no matter what’s going on in your life.
8. Consider hormone therapy or supplements with guidance from a healthcare professional
Hormone replacement therapy (HRT) can be life-changing for some, and there are also supplements that support sleep, anxiety, libido, and more. Work with someone who can help you make a safe and effective plan.
9. Rest as much as you can
Hormonal shifts are exhausting, physically and emotionally. You don’t need to earn your rest with productivity. Cancel the non-essentials. Take a nap. Do whatever you can to support your energy levels by prioritizing rest and sleep.
10. Release the pressure to “bounce back”
It’s okay to grieve the version of yourself that had more energy, patience, or a reliable memory. Try to resist the urge to add additional pressure to your changing mental and physical health by telling yourself you need to fix yourself or “bounce back.” You’re still you. You’re just evolving.
Support for symptoms of perimenopause & menopause with Midi and Calm
Navigating perimenopause and menopause shouldn’t feel like solving a medical mystery alone in your bathroom at 2am, but for so many people, that’s what it looks like.
That’s why we’ve partnered with Midi — a virtual healthcare clinic specializing in women’s midlife health with a focus on perimenopause and menopause care. Midi is evidence-based and science-backed, with more than 300 clinicians supporting those navigating the symptoms associated with menopause and perimenopause including anxiety, depression, hot flashes, and eating challenges. Midi’s personalized care plans include hormonal and non-hormonal treatment options with everything from HRT to supplements to lifestyle coaching.
For additional mental health support, we’ve partnered with Midi to provide:
The care women deserve
Click here to learn more about the support and treatments from Midi.
50% off a year of Calm
We’re offering 50% off Calm annual subscriptions in partnership with Midi. That’s 365 days of less stress, more sleep, and mindful living at half the price. Access our new Midi Mindful Moments in-app collection (see below) or check out our entire library featuring guided meditations, Sleep Stories, expert-led wisdom sessions, soothing soundscapes and more.
A new in-app collection: Midi Mindful Moments
Our new Midi Mindful Moments collection is packed full of sessions to help you support your mental health as you navigate the symptoms of perimenopause and menopause. From sleep meditations to help you fall and stay asleep and mindfulness sessions to help you cultivate more presence and equanimity, the Midi Mindful Moments collection has got the tools you need whenever you need them.
Symptoms of perimenopause FAQs
Are the mental health changes during perimenopause permanent?
The mental health symptoms tied to perimenopause and menopause—anxiety, mood swings, depression, and brain fog—can be intense, but they’re not permanent. They’re tied to fluctuating hormone levels, particularly estrogen and progesterone, which play a huge role in how your brain regulates mood and stress. For many people, once hormone levels stabilize (either naturally post-menopause or with support like HRT), symptoms ease significantly.
That said, just because it’s temporary doesn’t mean it’s not disruptive. Medical, emotional, and lifestyle support can help you feel like yourself again.
Where can I get support for symptoms of perimenopause and menopause?
Start with a provider who actually understands hormonal health — ideally someone who specializes in perimenopause and menopause. General practitioners aren’t always able to connect the dots between things like insomnia, rage, or brain fog and your shifting hormones. That’s why platforms like Midi exist: to give you access to experts who get it, who won’t dismiss your symptoms, and who can offer personalized support.
You can also find help through licensed therapists (especially those familiar with life transitions and hormonal mental health), online communities, and even group chats with friends who are also in the trenches. You don’t have to go through this by yourself, and you shouldn’t have to.
What are the symptoms of perimenopause?
While some people breeze through perimenopause, others feel like they’ve totally lost control of their body. Common symptoms include hot flashes, night sweats, irregular periods, mood changes, anxiety, sleep disturbances, weight gain, low libido, brain fog, fatigue, and joint pain. But it can also show up in more unexpected ways: itchy skin, heart palpitations, burning tongue, even new or worsening allergies.
If you notice changes in your body or mind that feel unfamiliar and you’re in your late 30s to 50s, it’s worth considering perimenopause as a potential root cause — especially if doctors haven’t given you satisfying answers.
What are the phases of the menopause journey?
Perimenopause has two phases: early perimenopause, when hormone levels start to shift and periods begin to change, and late perimenopause, when periods become more irregular and symptoms may intensify. But in the broader menopause journey, there are four distinct stages:
Premenopause: When your cycle is still regular and hormones are stable
Perimenopause: The lead-up to menopause, with fluctuating hormones and often a variety of symptoms.
Menopause: Defined as 12 months without a period and the official end of your fertile period
Knowing which stage you’re in can help you make sense of your symptoms and get the right kind of support.
What are some odd signs of perimenopause?
Some of the more unexpected signs include electric shock sensations, burning mouth or tongue, dry eyes, tinnitus (ringing in the ears), and even changes in your sense of smell or taste. Some people also experience gum problems, hair loss, or body odor.
If you’re experiencing these issues, there’s nothing wrong with you — and you’re not alone.
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