Why Is Perimenopause Making Me Feel Like I Need Therapy for the First Time?

If you’re in your late 30s or 40s and suddenly feel like your emotions are running the show in a way they never have before, you’re not imagining it. Perimenopause—the lovely transitional phase before menopause—can bring on mood swings, anxiety, depression, and an unsettling feeling that you’re just not yourself.

For a lot of women, this is the first time they seriously consider therapy, wondering, What is happening to me? You might have always been the person who could push through, handle stress, and keep things in perspective. But now? The smallest things can feel like too much. And while society tends to frame menopause as just hot flashes and the eventual end of periods, the truth is that perimenopause can feel like an emotional and psychological storm long before those physical changes fully set in.

The Hormonal Free-Fall

Estrogen and progesterone, the hormones that have been quietly (or not-so-quietly) running the show for years, start fluctuating wildly in perimenopause. Unlike puberty or pregnancy, where hormone levels increase, perimenopause is all about unpredictability—spikes and drops that impact your mood, energy, and overall sense of well-being. These shifts mess with serotonin and dopamine, the neurotransmitters that help regulate mood, which means perimenopause can make you feel like you’re dealing with anxiety or depression for the first time in your life.

So, if you’re crying over a cute dog video one minute and raging at your partner for breathing too loudly the next, hormones are definitely in the mix. But because these emotional changes don’t always show up alongside obvious physical symptoms, it can take a while to connect the dots.

Anxiety, Depression, and Feeling Off

Even if you’ve never struggled with anxiety or depression before, perimenopause can bring them to the surface. And if you have? Buckle up, because this phase can intensify symptoms. Many women describe an underlying sense of dread, racing thoughts, or feeling easily overwhelmed by things that never used to faze them.

You might also find yourself experiencing irritability that feels almost foreign—like you have zero patience for things you used to tolerate. One moment, you’re handling everything just fine; the next, you’re snapping at a loved one or feeling completely emotionally drained by a situation that wouldn’t have bothered you before.

Sleep issues make it all worse—either you can’t fall asleep, you wake up at 3 a.m. with your mind spinning, or night sweats leave you peeling off layers like a human volcano. And we all know that bad sleep makes everything feel 10 times harder.

The Emotional Weight of This Life Stage

Perimenopause isn’t just about hormones—it’s about everything happening in your life at the same time.

Maybe your kids are getting older and need you in new ways, or your parents are aging, adding another layer of emotional responsibility. Maybe your relationships are shifting—whether it’s your marriage, your friendships, or even how you feel about yourself. Work might feel different. Your body might feel unfamiliar. You might be realizing how much you’ve been holding everything together for everyone else, and now, suddenly, you feel like you’re unraveling.

It’s no wonder this season can feel overwhelming.

Why Therapy Can Help—And No, You’re Not Losing It

If perimenopause has you questioning everything, feeling emotionally raw, or just wondering when you’ll feel like you again—know that you’re not crazy, and you’re definitely not alone.

Therapy can be a game-changer, not because something is wrong with you, but because having a space to process everything—without having to hold it together—can be incredibly freeing. Therapy gives you permission to say, This is hard. I don’t feel like myself. I need support. And that support can make all the difference.

Working with a therapist who understands the hormonal, emotional, and psychological layers of perimenopause can help you navigate this transition with more clarity and self-compassion. It’s not about “fixing” you—because you’re not broken. It’s about helping you understand what’s happening, manage the shifts with more ease, and reconnect with yourself in the process.

You Deserve Support

Perimenopause is a major life transition, yet so many women go through it feeling isolated, confused, and unsure of what’s happening to them. But you don’t have to white-knuckle your way through it. Therapy, self-care, and even just giving yourself permission to say, This is a lot right now can be powerful steps toward feeling more grounded.

So, if you’re sitting there wondering why everything suddenly feels different, why your emotions seem bigger than before, or why things that never used to bother you now feel like too much—it’s not just you. And you don’t have to navigate it alone.

If this resonates with you, reaching out for support—whether through therapy, community, or even just talking with someone who gets it—can make all the difference.