Nichi Morrin is a clinical psychologist and sustainable health consultant. Nichi is also the founder of The Million Seen Movement, author of Girl, Get Out of The Freaking Car! and podcast host of The Sustainable Success Series.
Perimenopause impacts millions of women, yet it remains an invisible struggle shrouded in silence and stigma. With symptoms ranging from anxiety and emotional reactivity to sleep disruptions and worsened ADHD symptoms, the toll on mental health and daily life can be profound. In this article, we break down why perimenopause is misunderstood, explore the signs that often go unnoticed, and share practical strategies to help women navigate this challenging phase with strength and awareness, providing a guiding light for women globally.
Unmasking this natural but challenging transition
Perimenopause is the lead-up to menopause, characterized by hormonal fluctuations, particularly in estrogen, progesterone, and even testosterone. It usually starts in the early 40s but can begin sooner and last anywhere from several months to over a decade. This process isn’t just about irregular periods; it’s an all-encompassing shift that affects mood, cognition, anxiety levels, and even our bodies’ sensitivity to stress.
These hormonal changes can significantly impact the brain, especially estrogen, which is essential for mood regulation, cognition, and neural pathways. Progesterone, another key hormone, plays a role in calming anxiety. But as these hormones decline and fluctuate, women may experience a range of mental health symptoms, including anxiety, depression, and hypersensitivity. In some cases, these symptoms may appear for the first time or become more intense, leading many women to feel as though their mental health is slipping. One of the common things I hear women say is, “I feel like I am losing my mind,” or “I don’t know what is wrong with me!” It can be a very distressing and confusing time for many, with perimenopause often not being a consideration for the struggles.
Why perimenopause remains an invisible struggle
Some of the reasons perimenopause remains less talked about are due to the perceptions in society or discomfort surrounding women’s health and aging, lack of research, and lack of awareness. Despite affecting nearly half of the population at some point, there’s an ongoing stigma tied to aging-related health issues for women, which leaves many feeling isolated, confused, and anxious. Because perimenopausal symptoms often emerge gradually, vary widely, and are invisible, they are frequently misunderstood, dismissed, or not considered at all.
A study in the Australian & New Zealand Journal of Psychiatry highlights that women experiencing perimenopause often report a significant reduction in their quality of life, with symptoms like severe anxiety, hypersensitivity, and even depression affecting their daily activities. For some, it can feel like losing control over their mind and body, feeling out of control, feeling more reactive than usual, and feeling as though their tolerance for things is less. It can be a distressing experience that leaves many women afraid to seek help.
The "invisible" symptoms of perimenopause
Common symptoms such as hot flashes, night sweats, and mood swings are relatively well-known. However, others remain less discussed, including:
Feeling more anxious and hypersensitive. Shifts in hormone levels directly impact brain neurotransmitters, sometimes resulting in heightened anxiety and sensitivity to stressors that can make daily life overwhelming. This heightened sensitivity can feel like everything is intensified, from noises to emotional reactions. Even minor sensitivities, whether from sounds, smells, touch, or others can cause reactions that people would not normally react to.
Insomnia and waking multiple times at night are common during perimenopause. Without quality sleep, women can struggle to regulate emotions, concentrate, and manage stress, often resulting in a cycle of fatigue, mood swings, and diminished focus. This is particularly common when anxiety is also high and the nervous system is overactivated.
Many women describe a heightened emotional reactivity during perimenopause. When already burdened with other symptoms, it becomes even harder to manage emotions effectively, often negatively impacting relationships, energy, and productivity.
What is the connection with ADHD and perimenopause?
One lesser-known impact of perimenopause is its effect on women with ADHD. Studies show that perimenopause can worsen ADHD symptoms due to hormonal changes affecting neurotransmitters like dopamine and serotonin. Commonly reported changes include increased forgetfulness, impulsivity, difficulty concentrating, and mood swings.
These shifts can create confusion for women with ADHD who previously managed their symptoms well. When estrogen levels decrease, they often experience a spike in ADHD-related challenges, leaving them feeling scattered, overwhelmed, and sometimes questioning their coping abilities. Usually, there is little awareness or knowledge around this and people suffer in silence. However, awareness of this connection empowers women to seek support, make lifestyle adjustments, and work with healthcare providers who understand this complex relationship.
Normal mood shifts vs. More serious concerns
Importantly, not all mood changes during perimenopause are solely hormone-driven. Life circumstances, like managing careers, caring for aging parents, raising children, or the huge pressure on finances in the current climate, often add stress during this life phase, amongst other things. When combined with physical symptoms, such as hot flashes, anxiety, and insomnia, these factors can create an emotional storm. If you notice you are experiencing prolonged sadness, hopelessness, or intense anxiousness, or if symptoms begin to interfere with work, relationships, or daily activities, it may be time to seek professional help.
The impact on work and relationships
In some cases, the mental health challenges of perimenopause can push some women to reduce their work hours or even leave the workforce, leading to financial strain and feelings of loss. When these struggles go unrecognized, they compound the emotional toll, impact finances, disrupt relationships, make parenting more difficult, and leave women feeling misunderstood by family, friends, and colleagues.
What can be done?
A significant issue in the healthcare system is the lack of attention to how hormonal changes can impact mental health during perimenopause. Women experiencing severe symptoms are often given a standard treatment plan, which may include antidepressants or anxiety medications, without consideration of hormonal imbalances that may drive these issues. In severe cases, women are even admitted to psychiatric wards, with hormonal health often overlooked as a potential cause.
To better support women, healthcare providers need education on the interplay between hormones and mental health, encouraging a more integrated approach that considers both physical and emotional well-being. Addressing hormonal health alongside mental health can lead to better outcomes, faster recovery, and a reduced risk of social and professional withdrawal. A holistic approach is always key!
Ways to support women through perimenopause
Here are a few approaches that can help ease the perimenopausal transition:
Exercise, a nutrient-rich diet, and reducing caffeine and alcohol can support mental and physical health.
Practices such as meditation, yoga, and deep breathing can reduce stress and anxiety, help women tune in to their bodies, and manage symptoms more effectively.
For some, hormone replacement therapy (HRT) can relieve symptoms, though it’s essential to discuss options with a knowledgeable provider to understand the risks and benefits.
Therapy and counselling can offer a safe space to navigate perimenopausal changes. Being part of a supportive community helps reduce isolation and provides a platform for sharing strategies and coping mechanisms.
In cases of severe symptoms, medications such as antidepressants may be necessary. Working with a provider who understands the link between hormones and mental health is essential for optimal treatment.
Speaking up and seeking support is important as there will be others feeling similar too!
Let’s remove the stigma surrounding perimenopause
Perimenopause is a natural phase that doesn’t need to be shrouded in silence. Women deserve support, awareness, and understanding during this period. By bringing perimenopause out of the shadows, we can encourage open dialogue, provide resources, and empower women to advocate for their well-being. For those experiencing perimenopause, remember that you’re not alone; there is support available, and reaching out is a sign of strength, not weakness. We can all be a guiding beacon for someone else. You can listen to more about this topic on my podcast, The Sustainable Success Series, episode 9: Perimenopause – The Invisible Struggle Often Ignored.
Read more from Nichi Morrin
Nichi Morrin, Clinical Psychologist & Sustainable Health Coach
Nichi Morrin is a clinical psychologist, sustainable health consultant and entrepreneur. She is the founder of a clinic focusing on complex and persistent health conditions, neurodivergence, trauma, eating issues and assessments. In addition to her clinical work Nichi also launched The Million Seen Movement, a book, and her podcast, The Sustainable Success Series, Nichi's vision is for a world that meets invisible conditions are met with understanding, acceptance and sustainable solutions to get back living.
References:
Australian & New Zealand Journal of Psychiatry. (2024). The impact of perimenopause on women’s mental health. Australian & New Zealand Journal of Psychiatry, 58(3), 245-259.
Freeman, E. W. (2015). Perimenopause and depression: An overview. Obstetrics & Gynecology Clinics of North America, 42(4), 489-500.
Green, S. M., Key, B. L., & Rutherford, T. (2020). Hormonal changes and mental health: The effects of perimenopause. Women's Health Journal, 15(3), 219-230.
Shifren, J. L., & Gass, M. L. (2014). The North American Menopause Society recommendations on hormone therapy. Menopause, 21(10), 1038-1061.
Salim, R., & Alabi, S. (2023). ADHD and hormonal fluctuations: The perimenopause connection. Journal of Women's Health Care, 32(2), 187-195.
MacGregor, E. A. (2017). Migraine, perimenopause, and the role of hormone therapy. The Journal of Headache and Pain, 18(1), 1-8.
National Institute for Health and Care Excellence (NICE). (2019). Menopause: Diagnosis and management.
Brinton, R. D., Thompson, R. F., & Foy, M. R. (2019). Neurobiology of menopause and perimenopause. Annual Review of Neuroscience, 42, 497-521.
Office on Women's Health, U.S. Department of Health and Human Services. (2020). Menopause and mental health.
The Conversation. (2018). Menopausal mood swings can signal more serious mental illness.
