I’m Dr Esthefanea F. Santos, a Counselling Psychologist based in Medway, supporting adults across Kent and online throughout the UK. This article opens my Menopause Series for Menopause Awareness Month, where I explore the emotional side of this transition and grounded, evidence-based ways to manage it.
Many women come to therapy saying something like, “I don’t recognise myself anymore.” They feel anxious for no clear reason, snap at people they love, or lose confidence at work. Often, nobody has mentioned perimenopause. If this sounds familiar, you are not imagining it, and you are not alone.
Quick note: Nothing here is a substitute for tailored medical or psychological advice, but it may help you understand your experience and identify what kind of support might be helpful.
What is perimenopause?
Perimenopause is the stage before menopause, when hormone levels begin to change. In the UK, it often begins in the mid-40s, though it can start earlier, and it can last several years. Menopause itself is reached when periods have stopped for 12 months.
Most people know about hot flushes. Fewer know that the psychological symptoms can arrive first, sometimes before periods have changed much at all.
Can perimenopause cause anxiety?
Yes. Changing hormone levels can affect mood, stress and sleep. Women commonly describe:
- Anxiety that seems to come from nowhere, or worry that feels louder than before
- Low mood, tearfulness or feeling flat
- Irritability or sudden anger
- Brain fog, forgetting words or losing focus
- Loss of confidence, especially at work
- Poor sleep, which makes everything else harder
These experiences rarely happen in isolation. Midlife often brings caring for children and ageing parents, work pressure and relationship changes all at once. Hormones, sleep and life circumstances feed into each other.
Why it often goes unrecognised
When anxiety or low mood appear in your 40s, it is easy to assume it is “just stress” or a personal failing. Some women are treated for anxiety or depression without anyone asking about their cycle. Others blame themselves for not coping as well as they used to.
Understanding that perimenopause may be playing a part can bring real relief. It doesn’t make the difficulties less real, but it changes the story from “something is wrong with me” to “something is changing, and I can respond to it.”
What can help
There is no single answer, and what helps will be personal to you. You might consider:
- Speaking to your GP. Ask whether perimenopause could be contributing. HRT and other treatments may help, and your GP can talk through the options.
- Tracking your symptoms. Noting mood, sleep and your cycle for a few weeks can reveal patterns and make that GP conversation easier.
- Noticing your inner voice. When you feel less capable, self-criticism often gets louder. Try asking, “What would I say to a friend going through this?”
- Talking therapy. Therapy offers space to make sense of these changes. Menopause-specific CBT can also help with low mood, anxiety and sleep, which I explore later in this series.
When to seek support
If low mood is persistent, you are struggling to function, or you have thoughts of harming yourself, please speak to your GP or call NHS 111. You can contact Samaritans any time on 116 123.
FAQs
Can perimenopause anxiety start suddenly? Yes. Many women describe anxiety appearing quite suddenly, sometimes without an obvious trigger.
How do I know if it’s perimenopause or anxiety? It can be both. A GP can help explore hormonal factors, and a psychologist can help with the anxiety itself, whatever its cause.
Does therapy help with menopause symptoms? Talking therapies can help with the emotional impact, and NICE recommends that CBT be considered for some physical symptoms of menopause.
Reflection corner
What has changed for you over the past year or two, and what story have you been telling yourself about it?
Support in Medway and online
If you’d like to explore what you’re going through, we offer therapy in person in Rainham, Medway, and online across the UK.
When you’re ready to take the next step, visit our website or book a free 15-minute consultation to find out how therapy can help.
