Is It Perimenopause, or Is It My Life?

Licensed psychotherapist Lauren Tetenbaum, author of Millennial Menopause, on the emotional side of perimenopause, and why it so often goes unnamed.

Q: One of the hardest things about perimenopause is not knowing what’s “Peri” and what’s just life. Anxiety, irritability, low mood, overwhelm, even feeling unlike yourself can be easy to dismiss as stress. What should women understand about the emotional side of this transition?

A: First, women should know that “perimenopause” is a real thing! I wrote my book Millennial Menopause: Preparing for Perimenopause, Menopause, and Life’s Next Period because I realized that we never got a sexual health education for our 30s and 40s – but we really need this knowledge! If we are proactive, we won’t be like the women who came before us who told me things like, “No one warned me that the menopause transition was more than hot flashes” or “I wish I had known that not feeling like myself or feeling depressed or rageful could be related to hormonal shifts.” Our hormones fluctuate wildly for several years during perimenopause (and then ultimately decline) and those fluctuations usually do lead to symptoms related to mood and emotional health, not to mention physical symptoms that can also impact our mental health. This can feel like a wild ride, especially when midlife is already usually full of stressors related to career, aging parents, kids, and other health issues. The most important thing for women to know about this phase of life is that they do not need to suffer and they are not alone. You may be feeling anxious about an upcoming work assignment, or feeling low about a difficult moment with a friend, or feeling exhausted because you didn’t sleep well this week – and those feelings can also all be exacerbated by perimenopause. Try not to get too caught up in labels or view symptoms in isolation; instead, know that everything is connected and that changes are natural. If hormone therapy is an option for you (it is indeed safe and effective for most women) and trying it alleviates some or many of your symptoms, you are in perimenopause. And all women, perimenopausal or otherwise, using hormone therapy or not can benefit from prioritizing healthy habits like proper nutrition, quality sleep, social connection, strengthening exercises, and stress reduction. 

Q: A lot of women say they become less tolerant of things they used to put up with - at work, at home or in relationships. Is that simply irritability, or can there be something psychologically meaningful happening in this stage of life?

A: I view the menopause transition as an opportunity to reflect on what’s working for you, what’s not, what you enjoy spending time doing, what makes you feel anything less than joy, and what you want your future health to look like. We tend to joke about women’s tolerance of bullshit getting lower due to irritability (which can be true, sometimes) but I view setting boundaries and no longer spending time with people or on things that don’t serve them as a way for women to assert their values and priorities. As women age we (hopefully) get more comfortable in our skin and with our sense of self. And if you’re not feeling this way, please know that support is available to help you do so!

Q: What does meaningful mental and emotional support actually look like during Peri when you can’t simply remove the stressors in your life?

A: Support can come in so many ways, including a compassionate workplace culture or manager, friends you’ve known forever or met recently, or family, including partners and/or children. I know many women whose adult brothers were the ones who noticed changes in them and supported them through accessing healthcare they needed during perimenopause. If your job is adding to your inability to feel good, there are ways that you can advocate for changes in policy (sometimes there already are helpful policies in place but employees aren’t aware of them!). Perimenopause can feel lonely but I think women are always pleasantly surprised by how much they can connect with similarly situated women, even though every experience is different. I encourage women to open themselves up to meeting new people in this chapter of life. At home, it can also feel awkward or overwhelming to discuss symptoms with partners or kids, but I think it’s so important to do so in order to normalize this phase of life and get the support that is needed (which can look different every day: a woman may need to prioritize a cold bedroom for sleeping, or her family may learn that when she’s feeling overwhelmed it’s best to give her some alone time or take on more of the domestic and caregiving tasks). And of course, meaningful mental and emotional support during peri can and should come from healthcare providers, including mental health professionals like myself.

Q: And how do you know when what you’re experiencing deserves additional support? What might a good first conversation with a therapist or healthcare provider sound like?

A: I believe that a woman should not have to be suffering to get support. Any time she is feeling sad or anxious or is going through a major life change, she deserves support. I don’t think women should have to meet the criteria for a mood disorder or a crisis to get care. I feel privileged to counsel women during this phase, to educate them on how their symptoms are not their fault or imagined but rather very real, and most importantly, treatable. A good conversation with a therapist or other provider should always include compassion, curiosity, and an investigation to the extent the woman is comfortable sharing. I ask about sleep, cycle, support system, sex life, any recent stressors, any other health issues, and most importantly, How are you feeling? What is something you’d want to change? How do you want to go about changing it? We start small and work on the progress together.

Q: Finally, some favorite must-haves during perimenopause?

A: Patience, a fitness routine you enjoy, self-awareness, and a sense of humor!

About the author 

Lauren Tetenbaum, LCSW, JD, PMH-C, MSCP is a licensed psychotherapist, women's rights advocate, and writer dedicated to supporting and empowering women through life transitions. With experience as both a lawyer and a clinical social worker, Lauren specializes in counseling women navigating identity shifts related to motherhood, career changes, and reproductive health. Lauren frequently contributes thought leadership to media and professional organizations.

She is the author of the acclaimed 2025 book, Millennial Menopause: Preparing for Perimenopause, Menopause, and Life's Next Period. Lauren is also a mom of two who lives with her family outside of her native New York City. 

Learn more about Lauren at thecounseLaur.com or on Instagram (@thecounselaur).