For most women, the journey into perimenopause doesn’t start with a missed period; it starts with a sense that the "internal compass" has gone haywire. It begins in the late 30s or early 40s, often arriving as a series of unexplained emotional shifts. One morning, the resilience that once powered you through a high-pressure career or a chaotic household feels replaced by a sudden, sharp irritability or a fog that refuses to lift.
This isn't a "midlife crisis"—it is a biological rewiring.
What is perimenopause?
Perimenopause is the transitional phase before menopause marked by fluctuating estrogen and progesterone levels.
According to Bakul Dua, Clinical psychologist and psychotherapist, this phase often coincides with peak professional responsibility and caregiving demands. Many women are part of the “sandwich generation,” caring for growing children while also supporting ageing parents.
"The cumulative load of work, caregiving, and invisible labour makes women more vulnerable to stress during this transition," said Ms Dua.
Women in this phase may experience unusual levels of fatigue, anxiety, low mood, irritability, tearfulness, sleep disruption, brain fog, and reduced stress tolerance.
Sleep disturbance is a major pathway linking hormonal shifts to mood dysregulation. Cognitive symptoms such as forgetfulness and reduced concentration are common and often misattributed to incompetence or burnout. "These changes impact functioning at work and home, leading to loss of confidence, self-blame, and heightened anxiety. For some women, perimenopause can trigger a first episode of depression or worsen pre-existing mental health conditions," she said.
"Women with histories of trauma, PMS/PMDD, postpartum depression, or chronic stress may experience more intense psychological symptoms. Cultural silence around menopause increases shame, self-doubt, and delayed help-seeking. Many high-functioning women struggle privately, wondering where their energy, resilience, and clarity have gone," Ms Dua added.
Steps to manage perimenopause
*Track cycles, mood, sleep, and symptoms to identify patterns and hormonal links.
*Seek informed medical care. Gynaecologists and psychologists are important, but care is often fragmented and siloed.
*Be aware that even within clinical circles, awareness about perimenopausal mental health varies widely. Some practitioners are informed and take an integrated approach—considering supplements, therapy, strength training, and hormone therapy where indicated. Others may dismiss or minimise symptoms.
*Advocate for coordinated care and appropriate treatment, including hormone therapy when indicated and not contraindicated.
*Prioritise sleep hygiene and proactively manage night sweats and insomnia.
*Engage in regular strength training and aerobic exercise to support mood, cognition, and metabolic health.
*Reduce alcohol and ultra-processed foods, which can worsen anxiety and sleep disruption.
*Consider psychotherapy, particularly approaches that normalise hormonal vulnerability rather than pathologise distress.
*Build peer conversations and community. Shared narratives reduce isolation and self-blame.
What healthcare systems must do
According to Ms Dua, primary care providers should be equipped to screen women for perimenopause when they present with symptoms including depression, cognitive complaints in midlife and anxiety.
"Integrate gynaecology, psychiatry, and primary care instead of relying on fragmented referrals. Include perimenopausal mental health within national reproductive and public health policies, and also fund research on Indian and other LMIC populations rather than relying solely on Western data," said Ms Dua.
Steps to be taken by workplaces and organisations
*Recognise perimenopause as a legitimate health transition, not a performance deficit.
*Offer flexible scheduling, temperature control, and mental health leave options.
*Train managers to respond with empathy and accommodation rather than stigma.
This conversation forms part of the broader dialogue at the upcoming Mpowering Minds 2026 Women’s Mental Health Summit panel discussion, Challenges Impacting Women’s Mental Health, where experts will further examine issues such as perimenopausal mental health and collaborate on practical, evidence-based solutions across life stages.
