Hot flashes and night sweats tend to get most of the attention when people talk about menopause. But for many women, the hardest parts of this transition are the ones no one can see: irritability that seems to come out of nowhere, a low mood that won’t lift, trouble concentrating, or a quiet sense of no longer recognizing oneself. These experiences are common, they are real, and they are treatable. Yet many women struggle to find anyone who takes them seriously.
Recently, the mental health challenges of the menopause transition have finally begun to get the attention they deserve. To understand them, it helps to start with the people who live them.
If you’re navigating perimenopause or menopause, you deserve compassionate, specialized care. Explore Seleni’s clinical services →
Three women, three very different transitions
Pamela is 47 and has a history of anxiety and depression. She was treated by a psychiatrist and a psychologist in her 20s, and her symptoms have been stable for years, until recently. Now she feels constantly irritable and sad, and she’s having trouble concentrating at work. She’s also having hot flashes and night sweats, which she recognizes as classic signs of perimenopause. When she sees her doctor, she leaves without any solutions and feels her emotional symptoms were dismissed out of hand. She is frustrated and angry that she can’t get answers or help.
Rhoda began having perimenopausal symptoms in her late 30s and reached menopause at 41. Her mother and grandmother also went through early menopause, and breast cancer runs in her family. Because of that history, her OB/GYN has advised against hormone therapy and refers her to a mental health professional instead. Rhoda is also devastated: she had hoped to have another child, and that no longer seems possible. She has become very depressed and doesn’t know where to turn.
Kathy was diagnosed with uterine cancer at 35. Her treatment includes a hysterectomy, and her surgeon also recommends removing her ovaries, which will bring on menopause immediately. Kathy is reeling from the diagnosis, recovering from surgery, and bewildered by the sudden onslaught of symptoms. She feels overwhelmed by the decisions she must make about hormone therapy. She is grieving the loss of her fertility and of her sense of youthfulness and attractiveness, and she is growing more depressed and anxious about her health.
Each of these women is moving through the menopause transition, but their experiences look nothing alike. Their bodies, their histories, their relationships, and the losses they are grieving all shape what this stage of life means for them. That is why a purely medical view of menopause so often falls short.
What happens during the menopause transition?
Menopause is the point in time when someone has gone 12 consecutive months without a period. When it happens naturally, the average age is 51, with a typical range of 45 to 55. Menopause can also arrive earlier, as it did for Rhoda, or suddenly, as a result of surgery or cancer treatment, as it did for Kathy.
Two hormones play a central role: estrogen and progesterone. Together they regulate the menstrual cycle and support pregnancy. As the ovaries age, their hormone production doesn’t decline in a smooth, steady line. Instead, levels rise and fall unpredictably as the body works to keep up. These fluctuations are linked to many of the physical and emotional symptoms women experience during this time.
Hot flashes, night sweats, and difficulty sleeping are among the best-known and most difficult symptoms to manage. What many people don’t realize is that these symptoms often begin during perimenopause, the years leading up to the final period, and can continue for years afterward. Less widely known still is the range of mental and emotional symptoms that can accompany the transition, including moodiness, irritability and anger, mental fogginess, anxiety, and sadness.
Shifting estrogen levels are thought to contribute to these mood symptoms, but hormones aren’t the whole story. Emotional symptoms often coincide with other major life changes that happen at midlife, and they can be harder to name, harder to see, and harder to get help for.
Why a biopsychosocial approach matters
Reproductive mental health professionals are often trained in the discipline of health psychology, which views patients through a biopsychosocial framework (Taylor & Stanton, 2021). First introduced by Dr. George Engel in 1977, the biopsychosocial model holds that health, illness, and behavior are shaped by the constant interplay of biological, psychological, and social factors (Engel, 1977). It moves beyond understanding health and disease through a strictly medical lens and takes a holistic view of how our thoughts, emotions, relationships, and circumstances influence our wellbeing.
The physical symptoms of menopause are the most visible, and they are the ones medical providers can readily acknowledge and treat with prescriptions. Having a medical provider with expertise in menopause is essential. But the psychological changes of this stage of life, though less visible, can be just as profound. Mental health professionals who apply a biopsychosocial approach to menopause gain a fuller understanding of the many factors that shape each person’s unique experience, and can offer support that meets her where she is.
If Pamela, Rhoda, or Kathy’s experiences resonate with you, you’re not alone. Support from therapists trained in reproductive mental health can help you navigate the mood changes, grief, and shifts in identity that often accompany the menopause transition.
Midlife, identity, and the meaning of menopause
How women experience and make sense of menopause varies enormously. Because menopause is often associated with aging, it can carry negative connotations. For others, it brings a sense of liberation, including a new sexual freedom once pregnancy is no longer possible.
Menopause also rarely happens in isolation. Midlife is often a period of shifting roles and responsibilities. Children may be leaving home. Careers may be changing. Some women go through a divorce, become caregivers for aging parents, or face financial upheaval. For some, these shifts bring a renewed sense of wellbeing; for others, they bring losses and changes in identity that deeply affect how they feel.
Several psychological themes recur across the reproductive life span, and they can be especially useful for understanding the menopause transition:
Self-identity: our sense of ourselves as unique individuals, formed through our inner emotional life and our interactions with the world.
Social identity: the roles society assigns to us, which shape both how others perceive us and how we perceive ourselves.
Self-concept: our overall perception of who we are, shaped in part by the roles we hold.
Self-schemas: the specific beliefs that make up our self-concept and provide an internal framework for interpreting our experiences.
Seen through this lens, women in the menopause transition are often doing two difficult things at once. They are reconsidering who they are in relation to the many roles they now hold at this stage of life, while also navigating changes in their bodies and minds that can feel bewildering and hard to manage.
In The Psychology of Menopause, Marie Percival describes the body as the vessel for all of our experiences. It should come as no surprise, then, that when our bodies change, or stop working the way they used to, our overall wellbeing is deeply affected (Percival, 2025).
Who is at higher risk for depression and anxiety?
Much of the research on mental health during perimenopause has focused on depression. Multiple studies have shown that the risk of developing depression and anxiety, or of experiencing a recurrence, is higher during perimenopause. Research has also identified factors that raise a person’s risk of depression during this time (Hutner et al., 2022), including:
A history of premenstrual or perinatal mood symptoms
Adverse childhood experiences or childhood trauma
A lack of social support
A history of a violent or abusive relationship
For someone like Pamela, whose anxiety and depression had been stable for years, understanding these risks can be a relief in itself. What she is experiencing isn’t a personal failing or a sign that she’s “back to square one.” It is a recognized pattern, and there is help for it.
Treatment options: medical, psychological, and everything in between
Hormone therapy. Hormone therapy (often called hormone replacement therapy, or HRT) replaces estrogen and, in many cases, progesterone. It is considered the gold standard and most effective treatment for vasomotor symptoms such as hot flashes and night sweats. Whether it is the right choice is an individual decision made with a medical provider.
Non-hormonal options. For women who can’t take hormone therapy, like Rhoda, or who prefer not to, there are other paths. In its 2023 position statement on non-hormonal treatments, The Menopause Society (formerly the North American Menopause Society) found good evidence for cognitive behavioral therapy (CBT), clinical hypnosis, and several non-hormonal medications, including certain SSRIs and SNRIs that are also used to treat depression and anxiety (The North American Menopause Society, 2023). The statement found that lifestyle changes, mindfulness-based practices, and relaxation techniques were not as effective for hot flashes specifically, though mindfulness-based approaches may still help with menopause symptoms more broadly.
Cognitive behavioral therapy. A growing body of research shows that CBT is effective for a range of menopause symptoms, including hot flashes, sexual concerns, and mood symptoms, as well as for improving sleep and reducing fatigue (Arentson-Lantz et al., 2026; Lam et al., 2022; Rukure & Husted, 2026; Spector et al., 2024). A recent pilot study found that four sessions of CBT that had been adapted for menopause improved insomnia, reduced impact of hot flashes interfered on daily activities, and eased depressive symptoms (Arentson-Lantz et al., 2026).
Caring for the whole person
Establishing care with a qualified medical provider is critical during the menopause transition. But care from a reproductive mental health professional can be just as important for women navigating its physical, mental, and emotional challenges. A biopsychosocial approach, one that gives the psychological and social equal weight alongside the medical, offers women more options for relief and new ways to move through this stage of life.
Pamela, Rhoda, and Kathy each deserve to be seen as whole people, not just a collection of symptoms. So does every woman going through this transition.
If you’re struggling during perimenopause or menopause, you don’t have to navigate it alone. Seleni’s clinicians specialize in reproductive mental health, including perimenopause and the life transitions of midlife. Request an appointment.
Are you a clinician? Learn how to support patients through the menopause transition with Module 1: Mental Health and the Menopause Transition—An Introduction
References:
Arentson-Lantz, E. J., et al. (2026). Cognitive behavioral therapy for menopausal insomnia in perimenopausal and postmenopausal women with insomnia and nocturnal hot flashes: A randomized-controlled pilot trial. Menopause. Advance online publication. https://doi.org/10.1097/GME.0000000000002779
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. https://doi.org/10.1126/science.847460
Hutner, L. A., et al. (Eds.). (2022). Textbook of women’s reproductive mental health. American Psychiatric Association Publishing.
Lam, C., et al. (2022). Behavioral interventions for improving sleep outcomes in menopausal women: A systematic review and meta-analysis. Menopause, 29(10), 1210–1221. https://doi.org/10.1097/GME.0000000000002051
Percival, M. (2025). The psychology of menopause. Routledge.
Rukure, [initial]., & Husted, [initial]. (2026). [Article title]. BMC Women’s Health, 26, 58. https://doi.org/10.1186/s12905-025-04142-y
Spector, A., et al. (2024). The effectiveness of psychosocial interventions on non-physiological symptoms of menopause: A systematic review and meta-analysis. Journal of Affective Disorders, 352, 460–472. https://doi.org/10.1016/j.jad.2024.02.048
Taylor, S. E., & Stanton, A. L. (2021). Health psychology (11th ed.). McGraw-Hill.
The North American Menopause Society. (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause, 30(6), 573–590. https://doi.org/10.1097/GME.0000000000002200
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