There has been a surge of women are presenting to therapy during perimenopause. Because there had been no prior warning, many women find themselves overwhelmed, with not just the physical symptoms, but also the psychological impact. One of the most common complaints I hear from women in perimenopause is ‘I just don’t feel like myself anymore’.
While not all mental health symptoms during this stage can be attributed to perimenopause, hormonal fluctuations certainly do interact with other brain functions that may impact on mood, sleep, emotional regulation and cognition.
The most common symptoms that bring perimenopausal women to therapy include:
- Anxiety
Some women experience anxiety for the first time during perimenopause, while those with a history of anxiety often report worsening symptoms. Anxiety often presents as excessive worrying, palpitations, racing thoughts, feeling easily overwhelmed, feelings of dread and feeling ‘tired but wired’.
While not all anxiety symptoms during this time can be attributed to be perimenopause, it is worth exploring further, especially if it starts to hinder some aspects of your life.
- ‘Brain Fog’
While ‘brain fog’ is not an official medical diagnosis, the term is often used to describe cognitive symptoms that affect one’s mental clarity. Brain fog in perimenopause presents as forgetfulness, losing one’s train of thought, slower mental processing, decision fatigue, reduced capacity, increased distractibility and feeling overwhelmed by small demands. This can lead to self-doubt, anxiety about performance, embarrassment, reduced confidence, frustration and irritability.
Our best armour against brain fog is good quality sleep, reducing overstimulation, movement/exercise, mindfulness, using lists, notes and planners, single-tasking, reducing screen time, creating helpful routines and adapting one’s pace. Professional help may be indicated if the symptoms impact on one’s daily functioning, if it gets progressively worse and if it begins to negatively impact on work, mood and relationships.
- Sleep difficulties
Perhaps one of the most common complaints of women in perimenopause is disrupted sleep. The main culprits during perimenopause tend to be hot flushes, night sweats, anxiety and racing thoughts. The sad reality is that poor sleep quality can worsen the other symptoms, such as mood, brain fog, productivity and emotional regulation.
Practice good sleep hygiene by sleeping and waking at consistent times, reducing nighttime screen time, addressing your anxieties during the day, meditation, some physical activity during the day, ensuring that your bedroom is comfortable (e.g. temperature, linen, lighting and noise levels) and not or exercising close to bedtime. Chat to your doctor about supplements that may benefit you.
- Sensory Overload
Many women find themselves more overstimulated during perimenopause. This includes decreased tolerance for noise, crowds, bright lights, certain textures and smells. Another common complaint is misophonia (increased sensitivity and irritability to chewing).
Be patient with yourself. Build quiet moments in your day, avoid stacking stimulating activities close together, have a plan to exit overstimulating environments and include relaxing rituals into your day.
- Mood dysregulation
Women in perimenopause admit feeling varied emotions that are unusual for them and that they don’t quite understand. These include getting tearful easily, feeling increasingly irritable, more emotionally reactive, decreased patience and a lower window of tolerance.
A history of depression may make this more likely, however, it is not unusual for such symptoms to present for the first time during perimenopause
It’s important to note that perimenopause may coincide with other psychosocial life events – empty nest syndrome, marital issues, aging parents, declining health, etc – and these life events may actually explain or contribute to any mental health challenges experienced during this time.
Many people experience anxiety, depression, sleep difficulties, brain fog and sensory overload during their lifetimes, and this is not necessarily clinical or hormonal. What matters is how persistent these symptoms are and how they impact on one’s daily functioning in important aspects of their lives – e.g. work, health and relationships.
Perimenopause requires a holistic understanding and approach. It is most helpful to see a gynaecologist who has a special interest in hormonal changes, get advice on the most effective exercise and nutrition and if needed, see a psychologist who can assist in working through the challenges of this turbulent transition and equip you with the appropriate coping skills.
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