Mental Health Support During Perimenopause and Menopause

Written By Lara Murphy

The Overlooked Side of Midlife Transitions

Perimenopause (the months–years leading up to the final menstrual period) and menopause (12 months after the last period) bring large swings and eventual declines in estrogen and progesterone. Those hormones don’t just govern cycles—they also interact with brain systems that influence attention, memory, sleep, and mood, which is why mental health can feel different in midlife (review, PMC).

Cognitive Symptoms Many Notice

  • Brain fog & forgetfulness (word-finding, short-term memory lapses)

  • Slower processing speed (tasks feel harder/take longer)

  • Attention challenges (harder to sustain or shift focus)

  • Sleep disruption that worsens daytime cognition

Data from the Study of Women’s Health Across the Nation (SWAN) show that about two-thirds of midlife women report memory complaints during the transition, with measurable dips in learning and working memory that track closely with perimenopause (and typically improve afterward) (Taylor & Francis Online).

Why Mental Health Can Feel Harder Now

Hormonal fluctuations, vasomotor symptoms (hot flashes/night sweats), and sleep disruption all interact with life stressors (careers, caregiving, parenting teens/young adults). Reviews and cohort studies link the menopausal transition with more frequent sleep disturbance and downstream effects on mood, cognition, and daytime functioning (PMC).

How Specific Conditions Can Be Exacerbated

ADHD

Estrogen supports dopamine-related brain functions like attention and working memory. A 2025 systematic review examined ADHD symptomatology across the female reproductive lifespan, including perimenopause and menopause. Findings suggest that hormonal fluctuations during midlife may worsen distractibility, memory lapses, and executive functioning difficulties for some women. While more targeted research is needed, this evidence highlights why clinicians and clients alike should pay attention to ADHD symptom changes during the menopausal transition and tailor support accordingly..

PTSD

Hormonal changes during perimenopause can heighten trauma sensitivity. Low estradiol has been linked to impaired fear extinction and stronger trauma responses — processes that are critical for recovery from posttraumatic stress. Clinical and translational studies show that higher estradiol levels support extinction learning, which helps reduce the intensity of trauma memories and emotional reactivity (PMC; PubMed).

This means that during low-estrogen states such as perimenopause and menopause, women with a trauma history may experience more intrusive memories, heightened arousal, or difficulty calming after triggers. Trauma-focused therapies such as EMDR can be especially helpful during this stage, as they target fear networks and strengthen the brain’s ability to regulate distress.

Depression

Longitudinal research by Freeman et al. (2014) followed women for 14 years around their final menstrual period and found that depressive symptoms peak in the years before menopause and decline afterward. Women with a prior history of depression were significantly more vulnerable, showing elevated risk both before and after menopause (JAMA Psychiatry).

Other reviews echo these findings, showing that the menopausal transition increases the risk of depression—even among women without a prior history—though risk typically lessens after menopause (Women’s Midlife Health).

Anxiety

Longitudinal SWAN findings show that women with no prior anxiety are at increased risk of developing high anxiety during and after the transition. Vasomotor symptoms and disrupted sleep further amplify vulnerability (PMC).

Evidence-Based Support Options

1) Therapy & Skills

  • Cognitive Behavioral Therapy (CBT): Cognitive Behavioral Therapy for Insomnia (CBT‑I): A randomized controlled trial demonstrated that telephone-delivered CBT‑I significantly improved sleep quality and reduced hot-flash interference among peri- and post-menopausal women—even up to 24 weeks later—compared to a menopause education control (PubMed).

  • Trauma-focused therapies (including EMDR): Hormonal changes can heighten trauma triggers. EMDR helps reprocess distressing experiences and strengthen adaptive coping, which is especially important when estradiol fluctuations impact emotional regulation (CRMC).

  • Mindfulness-based programs (MBSR/MBIs): In a randomized clinical trial, MBSR led to notable reductions in menopause-related symptoms across emotional, psychological, and somatic domains, when compared with menopause education control (Nature).

2) Everyday Foundations

  • Sleep care: Consistent sleep routines and behavioral strategies (like those used in CBT‑I) help stabilize mood and cognitive function—this is well-supported by the CBT‑I trial mentioned above (The Guardian).

  • Movement & nervous-system regulation: While direct trials in menopausal populations are limited, broader research confirms that regular aerobic and strength training, as well as grounding practices, support emotional regulation—good behavioral strategies that align with neuroscience of stress resilience (PMC).

  • Community & validation: Although systematic trials are rare, a recent Guardian article highlights growing consensus that talking therapies like CBT and mindfulness not only aid mood and cognition during menopause, but also provide vital emotional support through shared experience (The Guardian).

What This Means for ADHD, PTSD, Depression & Anxiety

If you already live with these conditions, symptoms may shift in midlife. Tracking sleep, cycles, vasomotor symptoms, and emotional health can guide adjustments in therapy and coping strategies (Lippincott Journals).

If new “ADHD-like” issues appear (organization, working memory, distractibility), consider both menopause-related cognitive changes and possible ADHD. Formal assessment can clarify the picture, and treatments can be layered thoughtfully (PMC).

Resilience in Transition

Perimenopause and menopause are biological transitions that can reshape cognition and mood. If you’re noticing brain fog, sleep changes, or intensifying ADHD, PTSD, depression, or anxiety, you’re not “doing it wrong”—your nervous system is adapting. With the right combination of therapy, coping tools, and community support, you can feel clearer and more grounded.

✨ If you’d like trauma-informed support through this season, I’d love to help.
👉 Contact me to learn more, schedule a consultation, or join my in-person therapy group for women in midlife starting October 6th at 6:00pm in Henderson, NV. This group offers a safe space to explore cognitive and emotional changes, share experiences, and learn practical strategies for resilience.

Lara Murphy
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