You used to be the one who held everything together. Now you’re lying awake at 3 a.m. with your heart racing, snapping at people you love over small things, forgetting words mid-sentence, and wondering where the version of yourself you recognized went.

If you’re in your late 30s, 40s, or early 50s and this sounds familiar, perimenopause may be part of the picture. And while it’s often talked about as a physical transition (hot flashes, irregular periods), its impact on mental health is just as real and far less discussed.

At The Healing Collective, our therapists support people across Ontario through the emotional side of perimenopause, and we offer appointments with no waitlist.

What Is Perimenopause?

Perimenopause is the transition leading up to menopause, which is officially reached after 12 months without a period. It usually begins in a person’s 40s, though it can start in the late 30s, and it can last several years.

During this time, estrogen and progesterone don’t simply decline in a smooth line. They rise and fall unpredictably. Because these hormones interact with brain chemicals that regulate mood, sleep, and stress (including serotonin), those fluctuations can affect how you think and feel, sometimes dramatically.

How Perimenopause Can Affect Mental Health

Many people are surprised to learn that emotional symptoms can appear before any obvious physical changes. Common experiences include:

Anxiety and panic. New or worsening anxiety is one of the most frequently reported symptoms. Some people experience panic attacks for the first time in their lives, often with racing thoughts at night.

Depression and low mood. Research shows perimenopause is a window of increased vulnerability to depression, even for people with no prior history. Those who have experienced postpartum depression, PMS, or PMDD may be especially sensitive to hormonal shifts.

Irritability and rage. Many clients describe a short fuse that feels out of character, and then guilt or shame afterward.

Brain fog. Difficulty concentrating, losing your train of thought, or forgetting names can be frightening, particularly for people with demanding careers.

Sleep disruption. Night sweats and early waking chip away at rest, and poor sleep makes anxiety, low mood, and overwhelm much harder to manage.

Changes in ADHD symptoms. Women with ADHD, diagnosed or not, often notice their symptoms become harder to manage during perimenopause, as coping strategies that once worked stop working.

Why It Often Goes Unrecognized

Perimenopause tends to arrive during one of the busiest seasons of life. Many people are raising children or teens, caring for aging parents, managing careers, and navigating shifts in their relationships, all at once.

It’s easy to blame stress alone, or to feel like you “should” be coping better. Many women also report feeling dismissed when they raise these concerns. Naming what’s happening is often the first step toward feeling like yourself again.

How Therapy Can Help During Perimenopause

Therapy doesn’t replace medical care. Hormone therapy and other treatments can be very helpful, and we encourage clients to speak with their doctor or nurse practitioner. But hormones are only one part of the experience. Therapy helps with how perimenopause affects your mind, your relationships, and your sense of identity.

Our therapists draw on several evidence-based approaches:

Cognitive Behavioural Therapy (CBT) helps you notice and shift anxious or self-critical thought patterns. CBT has also been studied specifically for menopause, with research supporting its use for sleep problems and for coping with hot flashes and night sweats.

Acceptance and Commitment Therapy (ACT) helps you make room for difficult feelings and bodily changes while staying connected to what matters most to you.

Dialectical Behaviour Therapy (DBT) offers practical skills for emotional regulation, which can be especially useful when irritability or overwhelm feels hard to control.

EMDR can help when perimenopause stirs up older experiences, such as past trauma, medical experiences, or pregnancy loss, that are resurfacing with new intensity.

Emotionally Focused Therapy (EFT) supports couples when mood changes, low libido, or disconnection are putting strain on the relationship. Partners often want to help but don’t know how.

Narrative Therapy creates space to explore the bigger questions this stage can raise about aging, identity, and what comes next, and to rewrite the story that you’re “falling apart.”

Meet Our Clinician Supporting Clients Through Perimenopause

Dr. Sylvi Martin, Naturopathic Doctor and Registered Nurse Psychotherapist

Perimenopause affects both the mind and the body, which is why Dr. Sylvi Martin’s integrative, evidence-based approach is such a good fit for this stage of life. Sylvi is a registered nurse psychotherapist and naturopathic doctor who supports clients experiencing anxiety, depression, irritability, and mood changes, some of the most common and distressing emotional symptoms of perimenopause.

Many people in perimenopause also notice changes in their body, appetite, digestion, and relationship with food, and these changes can bring up feelings of guilt, frustration, or shame. Sylvi is a certified intuitive eating counsellor who takes a non-diet, Health at Every Size (HAES) approach, so her care focuses on helping you feel well and supported in the body you have now, rather than chasing restrictive rules.

Sylvi is regulated with both the College of Nurses of Ontario and the College of Naturopaths of Ontario, and she keeps up closely with current research on mental wellness. She offers one-to-one and group-based care, and a free discovery call so you can find out whether she’s the right fit for you.

Learn more about Dr. Sylvi Martin

Support for the Whole Family

Perimenopause doesn’t happen in isolation. It can ripple through a marriage, a household with teenagers, or a family already under stress. Because our therapists work with adults, couples, children, and families, we can support not just you but the relationships around you.

When to Reach Out

Consider speaking with a therapist if you’re noticing:

• Anxiety, low mood, or irritability that feels different from your usual self
• Trouble sleeping that’s affecting your daily life
• Strain in your relationship or at home
• Feeling like you’ve lost your confidence or sense of identity
• Thoughts that you’re “going crazy” or failing

If you’re having thoughts of harming yourself, please contact 9-8-8 (call or text), the Suicide Crisis Helpline, or go to your nearest emergency department.

You Don’t Have to Wait for Support

Perimenopause can feel isolating, but you are not alone, and you are not failing. With the right support, many people come through this transition with more self-understanding and clarity than before.

The Healing Collective offers therapy with no waitlist for residents across Ontario. Book a free consultation to find a therapist who understands what you’re going through.