Therapy for Perimenopause and Menopause
If you are in the potent psychological and physiological state of change that comes with perimenopause and menopause you are likely navigating emotional upheavals, tensions in your relationships, and surprise at how your body is changing.
Often when we are disoriented by perimenopause and menopause we say things like, “I just don’t feel like myself” because the familiar ways we have identified with ourselves are being seriously challenged and we do not know what will take their place. This can feel overwhelming and possibly traumatic because the “me” we have identified with is fundamentally evolving.
“This sort of experience defies all our notions about gradually growing older without a hitch, just doing what we do better and better, giving and taking as we please while becoming wise and beneficent. Instead, it seems that in order to know and exercise real wisdom in forthcoming stages, we must first be taken to some outer reach, some distant shore very far from our perceived identity. This is a journey of the soul, a struggle to keep body and spirit together.” - Davis and Leonard
Often with the shifts that come with perimenopause and menopause we feel a sense of loss and can stay in a state of overwhelm, fear, reactivity, defensiveness, and denial. Many of us harshly judge ourselves and the overwhelm we feel.
You may be experiencing:
Your inner world being rearranged, possibly intensely and potently re-organized
Anger towards loved ones such as your partner and children
Frustrations with dynamics at work and with colleagues
Unhappiness with where you are in your career
Tiredness with giving so much of your energy to others
Fear due to your physicality changing, and feeling less than because of this
Exhaustion due to lack of sleep that makes it hard to get through the day
An emotional rollercoaster ride that creates more tension in your relationships
Burdensome physical symptoms that diminish your energy and sense of pleasure and joy
Many women in perimenopause and menopause also find that old patterns — particularly codependency, people-pleasing, and the suppression of anger — become impossible to sustain. The hormonal shifts of midlife have a way of surfacing what has been buried for decades. Relationships that once felt manageable now feel unbearable. Roles that once gave you purpose now feel suffocating. This is not a sign that something is going wrong. It is a sign that a deeper intelligence within you is demanding change.
There is Another Story About Perimenopause and Menopause
There is another story about perimenopause and menopause that therapy can help you discover. It is a story whose narrative focuses on meeting the intensity of the moment with curiosity, tenderness, vulnerability, spaciousness, compassion, and wisdom that enables you to hold the complexity of who you are with love and care as a way to embody your evolving life purpose.
This way of coming into relationship with all the changes you are going through will help you to be less reactive, less critical, and more compassionate and discerning while you live into the next era of your dynamic life.
“Menopause is a profound initiation into your authority, purpose and leadership skill. Menopause mobilizes the singular genius of you to bring a positive influence to the planet, unleashing your personal agency and potency.” - Pope and Wurlitzer
My Approach to Perimenopause and Menopause Therapy
Most therapy for perimenopause and menopause focuses on symptom management — coping with mood swings, managing anxiety, navigating sleep disruption. While these concerns are real and important, my approach goes deeper. I work with the psychological and spiritual dimensions of this transition, drawing on parts work, contemplative psychology, somatic awareness, and mindfulness to help you meet this powerful passage with the presence and compassion it deserves.
Perimenopause and menopause are not only hormonal events. They are psycho-spiritual transitions that touch every aspect of identity — your relationship to your body, your sense of purpose, your roles as mother or partner or professional, your sexuality, and your connection to your own creative power. In therapy, we create space to grieve what is being released and to discover what is emerging. This requires a different pace and quality of attention than the problem-solving orientation that many of us bring to our lives.
I also bring a somatic lens to this work, because the changes of perimenopause and menopause are profoundly embodied. Hot flashes, insomnia, rage, fatigue — these are not just symptoms to be managed. They are your body speaking, often about things that have been unsaid for years. In therapy, we learn to listen to what the body is communicating and to respond with care rather than frustration.
I help perimenopausal and menopausal clients explore in therapy:
Your relationship to rage/anger/heat; your relationship to sex and sensuality; arising grief; and increased self-empowerment and self-compassion.
Ways to listen into and care for the psycho-spiritual changes that come with perimenopause and menopause so that you can prune what is not serving you and be discerning about what to grow.
Your relationship to change: What were experiences of change that felt overwhelming/not in your control, and how did you react? What were positive experiences of change, and what resources did you bring to those experiences?
Old psychological wounding that might be getting stirred due to feeling vulnerable with the emotional and physical changes you are experiencing.
Ways to shift out of negative thoughts loops about yourself and live into caring for yourself with more compassion, curiosity, joy, pleasure, and self-awareness.
Simple contemplative practices to nourish and care for your inner world as you navigate the changes in your menstruality.
Breathwork practices to balance your nervous system.
Practices to increase self-awareness to reduce mood swings and emotional reactivity.
Frequently Asked Questions About Perimenopause and Menopause Therapy
When should I consider therapy for perimenopause? Many women seek therapy when they notice that they are experiencing emotional changes that feel unfamiliar or unmanageable — unexplained anxiety, sudden rage, weepiness, a loss of interest in things that used to bring joy, or a pervasive sense of disorientation. Others come because the shifts of perimenopause are straining their relationships or disrupting their work. Perimenopause can start in your late thirties or early forties, and the earlier you have support, the more skillfully you can navigate the transition.
Is what I am feeling hormonal or psychological? In perimenopause and menopause, it is almost always both — and that is exactly what makes this transition so disorienting. Hormonal fluctuations amplify emotional responses, and at the same time, the psychological themes that arise during midlife have their own depth and significance. In therapy, we attend to the whole experience, and I may also encourage you to work with a physician or naturopath who specializes in hormonal health so that you are supported on both fronts.
Will therapy help with the physical symptoms of menopause? Therapy is not a medical treatment for physical symptoms, but somatic and contemplative approaches can meaningfully change your relationship to physical discomfort. Mindfulness practices can help you meet physical symptoms with less resistance and frustration. Many clients find that as their stress levels decrease through therapy, their physical symptoms also become more manageable.
Can perimenopause and menopause bring up old trauma? Yes, and this is very common. The vulnerability of midlife transition — the loss of familiar identity, the intensification of emotions, the changes in the body — can reactivate old wounds that you may have thought were resolved. If you are finding that your emotional reactions feel outsized or that memories from the past are surfacing with new intensity, therapy can help you process these experiences with the care and skill they deserve.
Do you work with women who are in early perimenopause versus postmenopause? I work with women at all stages — from those who are just beginning to notice the early shifts of perimenopause to those who are postmenopausal and navigating the next chapter of their lives. The psychological and spiritual themes evolve across these stages, and I tailor our work to wherever you are in the process.
If you are interested in learning more about my approach to working with the psychological changes that come with perimenopause and menopause, I can be reached at 415-721-3355 or by email. I see clients via telehealth throughout California and in my San Francisco office in Noe Valley at 4155 24th Street, San Francisco, CA 94114.
To learn more about my approach to psychotherapy, you can also read the articles on my psychotherapy blog.
I offer day-long retreats for those in perimenopause and menopause. If you are interested to learn when the next one is happening sign up for the waitlist.