As you enter your 40s, you might notice yourself feeling unusually anxious, forgetting everyday things, becoming irritable with loved ones, or feeling exhausted despite getting enough rest. For many women, perimenopause is likely contributing to these experiences in varying degrees, and it also varies person to person.
Nearly one in three women experiences symptoms of depression, anxiety, and/or insomnia around the transition. In Singapore, a survey indicated that close to half the participants experience sleep problems and physical and mental exhaustion.
8 Mental Health and Cognitive Changes Associated with Perimenopause and Menopause
Perimenopause refers to the transitional years leading up to menopause. A woman is deemed to have reached menopause when she has had 12 consecutive months without a menstrual period. Other than physical symptoms, many women experience cognitive and mental health symptoms too.
Cognitive symptoms and brain fog
During perimenopause and menopause, some women experience cognitive changes commonly described as brain fog. Cognitive symptoms that include forgetfulness, difficulty concentrating, trouble finding words, and slower information processing are also complaints women have around the menopause transition. Such changes can feel particularly frustrating for women who previously felt confident in their ability to manage demanding responsibilities. Although these experiences can feel unsettling, cognitive difficulties during the menopause transition do not necessarily indicate a serious cognitive disorder. However, if symptoms are persistent or worsening symptoms, it is encouraged to discuss with a healthcare professional.
Depression and depressive symptoms
Women with a history of depression may be more vulnerable during perimenopause. Some experience persistent sadness, frequent crying, emotional numbness, or loss of interest in activities. When these emotional changes occur with physical symptoms, sleep disruption, or major life changes, it can be difficult to identify the cause. While occasional low moods are normal, depression is not inevitable and should be addressed professionally. Effective treatments are available.
Anxiety
Some women experience anxiety for the first time during perimenopause, while others find existing anxiety harder to manage. You may notice yourself worrying excessively about situations that previously did not concern you. Anxiety can also present as restlessness, a racing heartbeat, difficulty relaxing, and racing thoughts. Hormonal changes, sleep disturbances, and life stressors can all contribute to increased anxiety during this period.
Irritability and mood swings
You may find yourself snapping at loved ones, becoming tearful, or feeling frustrated more easily. Hormonal fluctuations, when combined with poor sleep, fatigue, and life demands, can affect emotional regulation. These changes may strain relationships, particularly if others do not understand what is happening. Recognizing these patterns can help you communicate your needs and respond to emotions more effectively.
Sleep disturbances
Do you struggle to fall asleep, wake frequently throughout the night or experience night sweats that interrupt your sleep? Even when you get enough sleep, you might wake up feeling exhausted. Sleep difficulties are among the most common complaints during perimenopause and menopause. Chronic sleep deprivation can contribute to increased irritability, anxiety and depressive symptoms, creating a difficult cycle. Addressing sleep difficulties and improving sleep hygiene are therefore an important part of supporting mental health during menopause and perimenopause.
Difficulty coping with stress
Hormonal changes, sleep disruption, and physical discomfort can affect your stress response. When multiple stressors occur together, it can be harder to cope emotionally. Perimenopause and menopause may coincide with major life responsibilities such as caring for aging parents, supporting children, and/or managing high-pressure professional environments during midlife. Tasks that once felt manageable may now seem overwhelming. You may find yourself becoming easily stressed by work, family obligations, or minor disruptions.
Exhaustion and low mood
Exhaustion and low mood can stem from fatigue, poor sleep, anxiety, or depressive symptoms. This can cause reduced motivation and a loss of interest in activities you once enjoyed. Note that this is not always directly caused by hormonal changes. If it is accompanied by persistent sadness, loss of pleasure, or hopelessness, it may indicate depression. Understanding the underlying causes can help you seek appropriate support.
Suicidal thoughts
For some women, this period can bring severe psychological distress, including suicidal thoughts, which may range from wishing not to exist to actively considering ending their lives. Research shows an association between the menopause transition and increased suicide risk. Suicidal thoughts should always be taken seriously and never dismissed as a symptom of hormonal changes.
Menopause, Perimenopause and Mental Health
A Singapore study showed that brain fog, anxiety and low mood affect many women in midlife. While not everyone will experience psychological symptoms, fluctuating hormones, sleep disturbances, physical symptoms, and psychological stressors can affect mental health during perimenopause and menopause. Pre-existing mental health conditions and limited social support can further increase vulnerability.
Understanding the relationship between menopause, perimenopause and mental health enables you to make informed decisions about seeking support. If you are experiencing these symptoms, it is important to know that it’s okay to seek help.
Particularly, if symptoms are persistent, disrupt work or relationships, or make daily functioning difficult, seek support. Consult a GP or gynaecologist to explore medical causes. Psychological support can also be beneficial alongside medical care.
How Counselling Can Support You
Counselling offers a safe space to understand emotional changes, manage anxiety and stress, address relationship challenges, and navigate changes in identity and self-esteem. Research shows that psychosocial interventions such as Cognitive Behavioural Therapy and mindfulness can improve non-physiological symptoms during menopause.
The menopause transition is a period when your identity can shift. Feelings of grief around changes in one’s body or sense of self and the pressure to continue functioning normally can be addressed in counselling. Therapy also creates space for genuinely processing an experience instead of just coping.
If emotional changes during perimenopause or menopause are affecting your daily life, our counsellors in Singapore can help you explore your experiences and support your mental wellbeing.
For immediate mental health support in Singapore, contact Samaritans of Singapore at 1767 or 91511767 (WhatsApp), available 24 hours a day. If you are in immediate danger, call 995 or visit the nearest A&E.