What we don’t Talk about when we talk about perimenopause
Ya’ll, I’ve said it before and I’ll say it again - perimenopause is having a long overdue moment. We can thanks Gen X and Elder Millennial women for shaking things up.
As a result, we’re seeing more traditional media coverage and social media content about the physical changes and bothersome symptoms that come with perimenopause. And it’s about time! For too long, women have been left to navigate the strange, often bumpy terrain of hormonal changes without a map. But even as the conversation grows, there’s still so much we don’t say.
The majority of the conversation is dominated by bothersome physical symptoms—hot flashes, irregular cycles, trouble sleeping. And of course, that’s important, but we rarely talk about the deeper psychological and emotional impact of this life stage. The felt experience.
As a psychotherapist who specializes in working with women in perimenopause and midlife, I know that what we don’t talk about can be just as damaging as what we do. So let’s start naming it.
The Invisible Mental Health Struggle
Perimenopause is not just a physical transition. It’s an emotional reckoning.
Hormonal fluctuations can profoundly impact mood. Estrogen, progesterone, and testosterone all affect neurotransmitters like serotonin and dopamine, which regulate our sense of well-being. Many women in perimenopause experience heightened anxiety, irritability, rage, panic attacks, or depressive episodes that seem to come out of nowhere. This isn’t just stress or aging. It’s biology.
Yet these symptoms are often minimized or misdiagnosed. Women are told they’re “too sensitive,” or “just going through a rough patch.” They’re offered antidepressants without context, or told to wait it out. It’s invalidating—and infuriating.
Understanding the hormonal root of these mental health changes doesn’t negate their intensity. It legitimizes them. And it helps women seek the right kind of care.
The Grief We’re Not Naming
Beyond the hormones, there is often grief. And this grief is typically silent because it’s hard to name what feels like it shouldn’t matter—or isn’t “allowed” to matter. These feelings linger in the shadow and aren’t given the attention they’re due.
Grief for our changing bodies.
Grief for the sense of invincibility we didn’t realize we were clinging to.
Grief for a version of ourselves that felt freer, more desired, more energetic.
Even if we’ve long rejected patriarchal beauty standards, we still live in a culture that worships youth. Our bodies feel less visible, and sometimes less trustworthy. The world no longer reflects back the sense of power we might have once felt.
This isn’t about vanity. It’s about identity. And the loss is real and very, very common. It’s one of the reasons why the support of a knowledgable therapist can be a game change and community is essential.
The Loneliness of a culture Obsessed with youth
And then there’s the impact of toxic youth culture.
Often I hear women in midlife either feel invisible or hyper-scrutinized. Media messages offer either glowing anti-aging fantasies or horror stories of decline—nothing in between. This type of messaging takes it’s toll even for the most confident women.
So where do we go to tell our truths?
Where do we say:
“I don’t recognize myself anymore.”
“I’m exhausted.”
“I feel rage and I don’t know why.”
“I miss my libido.”
“I want something more—but I don’t even know what.”
Perimenopause is not just a hormonal phase—it’s a psychological and spiritual threshold. It asks us to let go of old identities and make space for something new. But without community, without language, and without support, that transition can feel isolating and terrifying.
The search for Perimenopause-Knowledgable Providers
I hear it time and time again from the women I work with in my practice: Finding perimenopause-knowledgable medical providers is one of the most challenging aspects of the perimenopause journey. This is why mental health therapists are often on the frontline of perimenopausal care, and why I feel it’s so important to work with my clients to build our their web of specialized care providers.
Too many women go to their primary care doctor or OB/GYN only to be told their labs are “normal” or that they’re “too young” for perimenopause. Others are offered a birth control pill as their only option, or dismissed altogether. The Menopause Association offers training and certification for menopause-knowledgable providers and provides a directory for patients. That link can be accessed here.
It’s also worth noting that mental health support is often no better. Many therapists are generalists and aren’t trained to recognize the emotional toll of hormonal shifts, or to validate the existential upheaval this time can bring. It’s also why I offer trainings for other therapists in perimenopause so they can recognize early signs of perimenopause, as well as be more aware of what their clients may be experiencing.
Midlife isn’t a crisis. It’s a portal.
Despite the challenges and nonstop changes of this time, let me say this clearly: You are not broken. You are becoming.
Perimenopause can be disorienting, but it’s also a profound opportunity for transformation. It’s a time to revisit your values, reorient toward your desires, and (re)claim your voice.
I truly believe:
In the discomfort, there is wisdom.
In the unraveling, there is truth.
In the mess, there is possibility.
And this is not a journey made for the solo traveler.
We all deserve care and support.
Specialized mental health Care for Perimenopause and Midlife
In my psychotherapy practice, I work with women in California and Louisiana who are navigating the emotional terrain of perimenopause and midlife. Whether you’re dealing with mood swings, identity loss, career burnout, relationship shifts, or a deep sense of “what now?”—you’re not alone.
I offer a holistic approach to supporting women going through perimenopause. This includes tending to matters of the mind, body, and spirit.
Wondering what this looks like? Well, since each person is unique in their physiology, emotions, and experiences, the constellation of symptoms will also be unique. Together, we’ll develop a care plan based on your individual needs and therapy goals.
Often that goal is: I just want to feel better!
And I want that for you too.
We’ll identify self-care practices and coping strategies to help you feel more resourced and resilient as you navigate your day-to-day. And concurrently, discuss what additional providers (OBGYN, reproductive psychiatry, acupuncture, pelvic floor PT, naturopathic medicine etc) may be helpful in adding to your support team.
If you’re ready to feel more like yourself—or even discover a new version of yourself—I’d love to support you.
Till next time, Wishing you peace & ease,
Jessika
Support for women’s healing, growth + Wellness in New Orleans and San Francisco
A little about me …
Hi, my name is Jessika Fruchter LMFT and I’m a feminist psychotherapist, expressive arts therapist, writer and educator. I provide online holistic psychotherapy for women in California and Louisiana who are navigating the perimenopause transition and all things midlife. Together we tend to matters of the mind, body and spirit.
I believe personal healing is a revolutionary act. I say it often. And in these (continued) turbulent times, I believe it now more than ever.
If you think spiritually-integrated therapy might be right for you, and you live in the states of Louisiana or California, I’m here to support. Here are a couple of steps to move forward …
Schedule a free initial consultation here
Of if you have questions … Let's chat.I’m happy to answer any questions you have.
Also please know there are directories where you may seek out other feminist therapists in your area. Inclusive Therapist and Therapy Den are two great places to start.
