Why Perimenopause and Menopause Sometimes Come Up in Therapy

Many women are surprised when perimenopause or menopause comes up in therapy. They often come in seeking help for anxiety, irritability, burnout, relationship stress, or feeling unlike themselves, not expecting a conversation about hormones. But as a systemic therapist, I do not separate emotional health from physical health, life stage, or nervous system functioning. Everything matters.

Perimenopause and menopause are major life transitions, yet they are rarely framed that way. Hormonal changes can begin much earlier than most people expect, sometimes in the mid-30s, and those shifts affect far more than reproduction. Estrogen plays a role in sleep, mood regulation, cognition, joint health, energy, and stress tolerance. When those systems are strained, emotional resilience often follows. What looks like anxiety or emotional reactivity is often a nervous system that is working much harder than it used to.

In my Frisco and Plano therapy practice, I regularly see women who feel frustrated with themselves for not functioning the way they once did. Many have been told they are simply stressed, anxious, or depressed, without anyone helping them understand the broader context of what their body is navigating. Over time, this creates unnecessary shame and self-criticism, which therapy then has to undo.

Therapy is not about diagnosing medical conditions. But it is about helping you make sense of your experience so you can respond to yourself with clarity rather than judgment. When we understand the full system you are living in - your body, relationships, stressors, and history - we can work more effectively on emotional regulation, boundaries, communication, and self-trust.

This is also why I often encourage clients to seek informed medical care alongside therapy. Having a trusted OB-GYN is important, and some women benefit from clinicians trained specifically in menopause care, such as those certified by the North American Menopause Society. Therapy works best when your body is supported rather than ignored.

If you are in a season where you feel depleted, reactive, foggy, or disconnected from yourself, it may not be a personal failure. It may be your system asking for a more comprehensive kind of care. My role as a therapist is to help you understand yourself with context and compassion, not to push you to power through something that deserves attention.