Mental Health Support During Perimenopause and Menopause
If you’re in perimenopause or menopause and you have noticed changes in mood, anxiety, sleep, or patience - you’re not imagining it, and you’re not alone. Many people are surprised by how much this transition can affect mental health.
The good news? Therapy can help. Cognitive Behavioral Therapy (CBT) is a practical, evidence-based approach that can reduce the impact of symptoms like anxiety, low mood, irritability, and insomnia - and help you feel more steady and in control again.
Why this life stage can affect mental health
Perimenopause and menopause aren’t just physical transitions. They often arrive alongside major life stressors, such as career pressure, caregiving, relationship changes, and identity shifts.
Common experiences include:
· Sleep disruption (insomnia, night sweats, early waking)
· Increased anxiety or a “revved up” nervous system
· Mood changes (low mood, irritability, tearfulness)
· Brain fog or reduced concentration
· Shifts in confidence, body image, or sense of self
· Feeling less patient, more reactive, or more emotionally sensitive
When sleep is disrupted and your body feels unpredictable, it’s easy for your brain to interpret symptoms as threatening - and that can intensify distress.
The “symptom + meaning” cycle
A big part of suffering during menopause comes from two layers:
· The symptom (hot flashes, night sweats, insomnia, mood changes)
· The meaning we attach to it (“I’m losing control,” “I won’t cope tomorrow,” “This is going to ruin everything”)
CBT targets the second layer - and that often reduces the intensity of the first.
How CBT can help during menopause
CBT helps you identify and change patterns that keep symptoms feeling bigger and more disruptive. Depending on your needs, therapy may focus on:
· Reducing symptom-related worry and catastrophic thinking
· Calming the stress response (so symptoms feel less “alarming”)
· Improving sleep using CBT-insomnia strategies when appropriate
· Rebuilding routines that protect mood, energy, and confidence
· Strengthening communication and boundaries (often crucial in midlife)
CBT doesn’t tell you symptoms are “all in your head.” It helps you reduce the mental and emotional amplification that makes symptoms harder to live with.
When sleep is the main problem
Sleep disruption is one of the most common factors affecting mood and anxiety during perimenopause/menopause. If insomnia is part of the picture, CBT often includes:
· Sleep-supportive habits that actually work (and avoiding common traps)
· Strategies for racing thoughts at night
· Reducing the “pressure to sleep” that fuels insomnia
· Practical plans for nights when sleep is disrupted
Better sleep doesn’t solve everything - but it often makes everything feel more manageable.
What therapy sessions can look like
CBT is collaborative and skills-based. Sessions may include:
· Identifying triggers (night sweats, work stress, social situations, fatigue)
· Mapping your cycle: body sensations → thoughts → emotions → coping behaviours
· Practicing tools like cognitive reframing, problem-solving, and nervous system regulation
· Creating a plan you can keep using long-term
CBT can also complement medical support (for example, working alongside care related to hormones, sleep, or other symptoms).
Final Thought
Perimenopause and menopause can be challenging, especially when mental health shifts appear out of nowhere. You don’t have to push through alone. CBT offers practical, evidence-based tools to reduce anxiety and low mood, improve sleep, and help you feel steadier through this transition.
If you would like to schedule an appointment with a registered psychologist, we can help! Contact Waterloo Psychology Group through our website (www.waterloopsychologygroup.com) or call us at 226-476-0276.
If you are in immediate danger or at risk of harming yourself, call 911 or go to the nearest emergency department.