For a lot of women, the first sign that something has changed isn’t a hot flush. It is feeling unexpectedly anxious in situations that never used to bother you, losing words mid-sentence in a meeting, or snapping at the people you love and not quite recognising yourself afterwards.
World Menopause Day falls on 18 October, and it is a good moment to talk about the side of perimenopause and menopause that often gets the least attention: the effect on mood, confidence and relationships. This post is for women going through it, and for the partners who are trying to understand what is happening and how to help.
The NHS lists mood swings, low mood or depression, anxiety, and problems with memory or concentration, sometimes described as “brain fog”, among the common symptoms of perimenopause and menopause. Disrupted sleep from night sweats can add irritability and stress on top.
Because these changes often begin in your 40s, sometimes years before periods stop, they can easily be put down to something else: a demanding job, teenage children, ageing parents, or simply “not coping”. Many women describe spending a long time assuming the problem was them, rather than recognising a significant life transition that deserves proper attention.
Perimenopause rarely arrives at a quiet time of life. It frequently overlaps with the peak of a career, caring responsibilities in both directions, and questions about identity and what comes next. The hormonal changes don’t create those pressures, but they can reduce the reserves you would normally draw on to handle them. That combination can be what tips someone from managing into struggling.
It is also worth knowing that workplaces are slowly catching up. The House of Commons Library briefing on World Menopause Day sets out government plans for large employers to produce Menopause Action Plans, and guidance on things like flexible working and temperature. If work is part of what’s making this harder, you may have more room to ask for adjustments than you think.
If any of this sounds like you, or like the two of you, it isn’t something you have to push through alone. I offer online sessions for individuals and couples across the UK and internationally, and a free initial consultation is a relaxed first step. Book a free consultation →
Talk to your GP. The first step is often a GP appointment to talk about your symptoms, including the emotional ones. The NHS treatment guidance covers options such as hormone replacement therapy (HRT), and notes that if you have low mood, depression or anxiety caused by perimenopause or menopause, you may be offered antidepressants. It is worth going in with a short list of what you’ve noticed, and how long it’s been going on.
Consider talking therapy. The House of Commons Library briefing describes cognitive behavioural therapy (CBT) as a type of talking therapy that can help with low mood, anxiety and sleep problems. Therapy works alongside medical treatment rather than instead of it.
Name it with the people around you. A lot of friction at home comes from partners and families not knowing what is going on. Simply saying “this is part of what’s happening to me right now” can shift the conversation from blame to teamwork.
So much of the strain in a relationship during menopause comes from two people struggling with the same thing separately. Once you’re facing it together, it usually becomes far more manageable.
Watching someone you love go through this can be confusing. You may notice changes in mood, patience, sleep or intimacy, and not know whether to say something or keep quiet. A few things tend to help: learning a little about perimenopause so she doesn’t have to explain everything, asking what would actually be useful rather than guessing, not taking every sharp moment personally, and looking after your own wellbeing too. This is a transition for the relationship as well as for her.
Individual therapy can give you space to make sense of the changes you’re experiencing, work with anxiety and low mood, and rebuild confidence that may have been shaken. It can also help with the bigger questions that often come up at midlife about identity, work and what you want the next chapter to look like.
Couples therapy offers something different: a place for both of you to talk honestly about what has changed, including things like irritability, distance or intimacy, without it becoming another argument. I work with both individuals and couples, and a shared understanding of what is going on can bring real relief to both partners.
If you recognise yourself, or your relationship, in this post, you don’t have to wait until things reach breaking point. I offer sessions online via Google Meet to clients across the UK and internationally, for individuals and for couples.
A free initial consultation is a relaxed, no-pressure conversation about what you’re going through, on your own or together as a couple. I work with adults across the UK and internationally via online sessions on Google Meet.