Mental Health During Perimenopause: Beyond Anxiety & Depression

Mental Health During Perimenopause

I help women struggling with mental health during perimenopause/menopause. Mental health during perimenopause is an often neglected part of the story of women in midlife. We're all familiar with the physical symptoms of menopause: hot flashes, sleep changes, dryness, difficulty maintaining muscle, and more. What is less well known are the ways the menopause impacts mental health and how mental health during perimenopause is a vital part of navigating the initiation inherit in this season of life.

Women in menopause (perimenopause and postmenopause) are also more likely to experience anxiety, depression, and even a highly risk of psychosis (for those already at high risk). Hormone changes interfere with mood, impacting neurotransmitters and mood regulating hormones. In other words: your volatile emotions, mental distress, and new struggles aren't "in your head," they are very real [1].

How is working with me different? First, because I do not view menopause as a problem to solve, but as a natural transition to support. We do not pathologize menopause mental health at Holdfast, and we honor your choices, needs, and support those fully. I cultivate a list of other caring professionals with similar views. If you have ever suggested to your doctor that "maybe this is perimenopause?" and been dismissed you know how valuable that can be. I work intentionally with doctors, naturopaths, acupuncturists and more who take the passage of menopause seriously and have educated themselves well on the newest research.

Menopause is sometimes called "the middle passage," I call it a mythic portal through midlife into the power and wisdom (if we do the work to cultivate it) of the second half of life. Menopause is not just something to "fix" it is something to walk through with intention, it is initiation into the ancient and mysterious rites of the crone...

Menopause Mental Health Support & Awareness

  • Depression is often a silent menace in menopause. Women in menopause do not tend to present with classic depression symptoms and often go undiagnosed or misdiagnosed by those unfamiliar with menopausal women's experience.
  • Hormonal changes compound identity changes and life stressors such as: the shift to empty nest or the return of adult children, care-giving for elderly parents, increases in disease, experiences of new or deepening disability, shifts in career opportunities or goals.
  • The mental health impacts of increased disease and disability in midlife is often underestimated, especially for women who may have less ability or energy but no reduction in responsibilities for others.
  • Perimenopause is also likely to trigger new or worsening anxiety, panic attack, and somatic awareness issues often made worse by the sleep disruption that is common in menopause.
  • Sleep disruption impacts 60% of women in perimenopause and is tied to heightened mood disruption.
Mental health during perimenopause: Candle and oracle cards
an initiation, a portal...

A mythic portal,

  • Menopause is an initiatory portal our culture has forgotten or suppressed. 
  • Only a handful of mammals experience menopause, and in those who do it is those wise elders who guide, guard, and care for the rest.
  • At Holdfast we honor menopause as a time of transformation, change, and reckoning that invites women into new choices, new power, new opportunities. (And yeah, sometimes it sucks.)

the invisible revealed

  • Beginning (on average) in a woman's late 30s to early 40s, perimenopause has been poorly studied, rarely talked about, and mostly ignored by the medical system.
  • Women's health has been systematically understudied, misunderstood, and silenced. (Most medical studies until just a few decades ago were based almost entirely on male subjects, that includes mental health research.)
  • Today: we're changing that. Perimenopause and menopause are powerful seasons in women's lives & together we approach them with curiosity and community.
  • No shame, and definitely no silence, at Holdfast we talk openly about the ways our bodies, minds, and spirits are changing.
  • There is space to mourn what we might not be ready to let go of, and to welcome a new powerful and normal season in our lives.
Mental health during perimenopause a journal
you are worth the investment
Mental Health During Perimenopause Goddess altar
intentional, supported, affirmed

with intention, power

  • You didn't get this far without learning a few things (more than a few). You have survived suffering, hardship, and struggle as well as collecting memories filled with joy and wonder.
  • When we approach mental health during perimenopause with intention we can disarm the monster: when we bring taboo subjects out into the open we strip them of their power and regain our own.
  • Befriend the crone. Explore the rich world of myth and story outside of Western colonial culture that reveres, honors, and learns from the crone in all her mischievous, confident, trickster power. (And maybe notice why our society is so afraid of her!)

everything changes

  • Perimenopause has been compared to a second puberty. For women in the midst of hot flashes, night sweats, insomnia, brain fog, and sudden unwillingness to take shit from anyone it can feel that way, but it is so much more.
  • It isn't just your body that is changing. Perimenopause is an invitation to understand who you have been, rethink who you are, and dream of who you would like to be.
  • For many women, especially those who are neurodiverse, peri and post-menopause is a time of throwing away masks and living into their authentic self for the first time.
  • Whatever your menopause portal holds, there is space here to navigate it with intention, support, and care.
Mental health during perimenopause smooth stones
you write the next chapter
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Reflections on Menopause

August 12, 2026

Awaking the Crone: Reclaiming Menopause

Awaking the Crone: Reclaiming Menopause

Ready to take charge?

Sleep Changes

There are proven ways to address sleep disruption in menopause which have been shown to reduce incidence of depression & anxiety by 30% [click here for reference]

Lifestyle

Simple lifestyle changes can help support mood and combat symptoms of depression & anxiety. These include light exercise (walking) & other tools.

New Stories

Making meaning, claiming your expertise and power, and creating new narratives are powerful tools: we're telling a new mental health during perimenopause story!

Outcomes & Tools

I help women in perimenopause make sense of their symptoms.
I support women building a holistic care team to address all their symptoms.
I help women in perimenopause learn to heal their nervous system using breathwork & EMDR.
I help women in perimenopause heal trauma, and break generational patterns through depth work.

Reclaiming Crone

together, we're queering the story of aging

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I help women answer the menopause invitation to invest in themselves. A chance to address trauma, to face injustice, to dream of new possibilities and new ways of being. Women in menopause often describe it as running out of softness and rediscovering their rage. That rage can burn you up, or fuel you for what you want in your next chapter. Are you ready? It's OK, you don't have to do it alone. For care in Shoreline, Seattle, and the rest of Washington state, click below to get started.
I'm ready to invest in myself
"Dear brave souls, I warmly invite you to come be at the fireside with me and the Dangerous Old Woman and the Power of the Crone. Who is the crone? She is the most dangerous, the most radical, the most revolutionary woman in existence. Whether in fairy tales or in consensual reality, the old one goes where she wants to and she acts as she wishes; she lives as she chooses. And this is all as it should be. And no one can stop her. Nor ought they try."

–Clarissa Pinkola Estés, PhD