Perimenopause & Menopause
The second great hormonal transition of a life — and almost no one is prepared for it.
Perimenopause can start in the mid-thirties. It can last a decade. It rearranges your sleep, your mood, your body, your sense of self, your sex life, your marriage, your relationship to work, and the cultural conversation around it is, somehow, still almost nothing.
This is therapy that takes it seriously. Not as the end of something. As a real, large, identity-defining chapter that deserves real care, the way we now (finally) treat the perinatal years.
You might recognize
If any of this feels familiar.
"I'm not sleeping and I'm furious about everything."
"My doctor says my labs look fine. I don't feel fine."
"I don't recognize my body and I'm grieving something I can't quite name."
"I'm anxious in ways I never was before, and it's not in my head."
"The marriage is harder than it's ever been and I don't know if it's me or us."
"I keep crying at work and I'm a person who doesn't do that."
What we work on.
- Mood: depression, anxiety, irritability, rage, mood lability tied to the hormonal shifts of perimenopause
- Identity: who am I now, what's mine to keep, what gets to change
- Body: the grief and disorientation of a body changing in ways nobody warned you about
- Sleep, and the cascade of mental health effects when sleep goes
- Sexuality and intimacy, including the impact on long-term partnerships
- Marriage and partnership: both partners are usually in major life transitions at once, and it strains the system
- Returning to ambition: many women describe a second wave of clarity, hunger, and direction in midlife
- Grief over what is or isn't going to happen, including childlessness, late-in-life parenting questions, and the end of fertility
- Caring for aging parents while moving through this yourself
Why a perinatal-trained therapist understands this season too.
Perimenopause and menopause are the bookend to the reproductive arc, and many of the same hormonal, somatic, and relational dynamics apply. The skills that make a strong perinatal therapist (slowing down, taking hormonal shifts seriously, holding identity transitions, working with grief) translate directly. You shouldn't have to start over with a new therapist just because the season changed.
How the work goes
What therapy actually looks like here.
We work psychodynamically and relationally, looking at the layers underneath the mood and the patterns underneath the partnership. We make room for the body's experience to be real (not dismissed as "just stress"). And we collaborate with your medical team. Many clients are working with a menopause-literate physician on HRT or other care, and therapy works alongside that, not in place of it.
Ready to talk?
A 15-minute consultation, by phone, costs nothing and tells you almost everything you need to know.