Perimenopause as a PAUSE: reframing a life transition

Perimenopause is often talked about in terms of symptoms and disruption. But what if it's also an invitation: a pause: to reconnect with yourself?

When women come to see me during perimenopause, they often arrive with a particular kind of confusion. They know something is happening: hormonally, physically, emotionally: but many of them have been given very little language for it, other than the language of decline.

Hot flushes. Brain fog. Mood swings. Disrupted sleep. These are real. They deserve to be taken seriously and treated appropriately. But they are not the whole story of perimenopause: and the narrative we bring to any life transition shapes our experience of it in profound ways.

What is perimenopause, psychologically speaking?

Perimenopause is the transitional phase before menopause: it can last anywhere from two to twelve years, and it typically begins in a woman's mid-to-late forties, though it can start earlier. During this time, oestrogen levels fluctuate and eventually decline, producing a range of physical and psychological symptoms.

But perimenopause is also a developmental transition: a threshold moment in the same way that adolescence, early parenthood, or midlife more broadly can be. These transitions ask something of us. They invite (or sometimes demand) a renegotiation of identity, values, and priorities.

The mental health dimension

Many women are surprised to learn that mood-related symptoms are among the most common features of perimenopause: and among the least talked about. Anxiety, low mood, irritability, emotional reactivity, and a sense of loss of self are all frequently reported, and they're not simply "hormonal." They sit at the intersection of biological change, psychological meaning-making, and social context.

Research suggests that women with a prior history of depression or anxiety are at heightened risk of mood difficulties during perimenopause. But even women with no such history can find themselves experiencing psychological symptoms that feel unfamiliar and bewildering.

Reframing the transition

The word perimenopause comes from the Greek peri: around, or near. It literally means "around menopause." I've started thinking of this peri as a kind of pause.

Not a stopping. A pausing. A moment of standing still long enough to ask: What do I actually want? What have I been carrying that was never really mine? What have I not yet let myself become?

Many women I work with find that perimenopause brings with it a particular clarity about what is no longer working in their lives. Relationships that have been quietly unsatisfying. Work that has felt misaligned with values. A way of relating to themselves that has been marked by self-criticism or self-silencing for decades.

The disruption of perimenopause can crack these things open. And while that's genuinely uncomfortable: sometimes very uncomfortable: it can also be the beginning of something important.

What psychological support can look like

Therapy during perimenopause can serve a number of functions. For some women, it's primarily about managing symptoms: developing strategies for anxiety, improving sleep, processing grief. For others, it becomes a space for deeper reflection about identity, relationships, and what the second half of life might hold.

Approaches that tend to be useful include:

• ACT (Acceptance and Commitment Therapy): particularly helpful for navigating the psychological flexibility that transitions require
• CBT: useful for anxiety, sleep difficulties, and mood management
• Narrative approaches: rewriting the story of what this transition means
• Somatic approaches: working with the body, which is so central to this experience

It's also worth noting that psychological support and medical treatment aren't either/or. Many women benefit from working with both a GP (and potentially a menopause specialist) and a psychologist concurrently.

A final thought

I think about the women who came before us: who navigated this transition without the language, the research, or the professional support that we now have access to. Many of them did so in silence, or with shame, or simply powering through.

We can do something different. We can treat perimenopause as what it is: a real and significant transition, deserving of real and significant care. And within that care: space to pause, to reflect, and to ask what might be possible on the other side.