Perimenopause and Menopause
Because mood swings, hot flashes, and WTF moments deserve a therapist too
At 35, I was thrust into sudden menopause following surgery—what’s known as surgical menopause. One day, I was managing life’s usual demands. The next, I was reeling from a complete hormonal shutdown. No gentle tapering. No roadmap. No conversations about grief, brain fog, rage, or the unbearable emotional weight that came with the loss of estrogen.
I was suddenly falling apart. I couldn’t find myself. I couldn’t find language for what was happening in my body, mind, or heart. There was a gaping silence around the emotional, mental, and somatic toll of menopause—especially when it comes early and without warning.
This experience has shaped my work in profound ways. I now hold space for bodies that menstruate and bodies that once did—navigating perimenopause, surgical menopause, early menopause, and natural menopause. I bring the compassion I once needed—paired with trauma-informed, somatic, feminist, and neurodivergence-affirming practices.
Hormonal Shifts in Perimenopause and Menopause: What’s Really Going On?
Hormones impact nearly every aspect of our lives—mood, sleep, focus, energy, libido, appetite, and emotional regulation. During perimenopause and menopause, these hormones don’t quietly exit the stage. Instead, they shift in unpredictable and often disruptive ways. And for people with menstrual cycles, this transition can feel like your body suddenly stopped playing by the rules you’ve always known.
For those of us socialized to care for others before ourselves, the loss of hormonal stability can be devastating—not just physically, but emotionally and existentially. These are not just mood swings. They are neurological and hormonal changes layered on top of lifetimes of over-functioning, caregiving, masking, and being told that your body’s needs were secondary.
Whether you're cis, trans, nonbinary, or gender-diverse, if you have a menstrual history, this transition matters—and you deserve support that’s inclusive, trauma-informed, and non-pathologizing. You're not "too sensitive," broken, or weak. You're moving through a profound physiological transformation—and you don’t have to do it alone.
Estrogen: The Multitasking Messenger
Estrogen is involved in hundreds of physiological processes—from maintaining bone density and skin elasticity to regulating serotonin, dopamine, and our brain’s response to stress. It also supports memory, learning, and sexual health.
What Happens During Perimenopause:
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Estrogen doesn’t just decline—it fluctuates sharply, rising and crashing before eventually settling at lower levels post-menopause.
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These swings can destabilize mood and increase sensitivity to stress.
Low or Fluctuating Estrogen Can Cause:
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Anxiety, irritability, or tearfulness
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Brain fog, forgetfulness, and trouble concentrating
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Low libido or vaginal discomfort
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Increased sensitivity to criticism or stress
Progesterone: The Calming Hormone
Progesterone is a key hormone in the second half of the menstrual cycle. It supports the production of allopregnanolone, a neurosteroid that enhances the calming effects of GABA—the brain's natural brake system. GABA helps regulate anxiety, overwhelm, and overstimulation.
What Happens During Perimenopause:
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Progesterone levels begin to fluctuate and eventually decline, especially when ovulation becomes less regular.
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Without the steady presence of progesterone, GABA’s calming influence weakens.
This Can Feel Like:
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Heightened anxiety, especially before bleeding starts
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Difficulty falling or staying asleep
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Emotional reactivity or sensory overwhelm
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A sense of being “revved up” or unable to rest
Testosterone: Energy, Drive, and Desire
Testosterone isn’t just a “male” hormone—it’s crucial for people with ovaries too. It supports libido, muscle tone, energy levels, and confidence.
What Happens During Perimenopausee:
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Testosterone naturally declines with age
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Some individuals may experience sudden drops due to surgeries, medical transitions, or hormonal contraceptive changes
Symptoms May Include:
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Decreased sexual desire or satisfaction
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Loss of energy, vitality, or motivation
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Muscle loss or physical fatigue
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Lower confidence or assertiveness
Cortisol: The Stress Amplifier
Cortisol is the body’s primary stress hormone, and it's tightly regulated by the brain’s HPA axis. Estrogen helps modulate this system—keeping stress in check.
What happens During Perimenopause:
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Estrogen loss can make the HPA axis more reactive
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Chronic stress becomes harder to buffer
This Can Lead To:
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Feeling overwhelmed by everyday tasks
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Panic, hypervigilance, or burnout
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Trouble winding down or sleeping
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Physical symptoms like headaches, GI issues, or inflammation
Insulin: Blood Sugar and Mood Swings
Insulin helps keep blood sugar balanced. Estrogen supports insulin sensitivity, helping the body metabolize food and keep energy stable.
During Hormonal Transitions:
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Lower estrogen can contribute to insulin resistance
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Blood sugar spikes and crashes become more common
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Signs of Blood Sugar Imbalance:
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Sugar and carb cravings
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Irritability, brain fog, or shakiness between meals
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Mood swings tied to hunger
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Fat storage around the abdomen
Thyroid Hormones: The Metabolic Thermostat
Thyroid hormones help regulate metabolism, energy, mood, and temperature. Estrogen plays a key role in thyroid sensitivity and conversion of thyroid hormones.
During Perimenopause:
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Perimenopause can unmask underlying thyroid conditions
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Many symptoms of thyroid imbalance overlap with hormonal changes
Potential Signs:
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Fatigue, low energy, or depression
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Sensitivity to cold
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Slowed metabolism or weight gain
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Hair thinning or brittle nails
Sleep…
The hidden casualty.
leep disruption is one of the most common—and least acknowledged—symptoms of perimenopause. For many people with menstrual cycles, changes in sleep begin years before the final period and are often blamed on stress, parenting, or aging. But the truth is: hormones play a major role in sleep regulation, and when they fluctuate, sleep often unravels.
Estrogen regulates REM sleep, body temperature, and neurotransmitters like serotonin and acetylcholine that help you fall and stay asleep.
Progesterone has sedative effects and boosts GABA, the brain’s calming system.
You Might Notice:
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Trouble falling asleep, anxiety at bedtime
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Waking at 2–4 a.m. with a racing heart or mind
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Night sweats or hot flashes
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Increased sensitivity to light, sound, or movement
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A “wired but tired” state—restless body, foggy brain
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Morning fatigue that lingers, even after a full night in bed
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Or waking with a surge of adrenaline or cortisol
How I Support Clients in Perimenopause and Menopause
Perimenopause is not just a biological transition—it’s a whole life transition. It can stir up long-buried grief, rage, exhaustion, identity shifts, and questions about who you are now and what your body needs. This stage of life is often dismissed, misunderstood, or pathologized—especially for those who’ve been taught to put their own needs last.
I offer a space that honors the full truth of what you’re carrying—physically, emotionally, and historically. My approach is trauma-informed, somatically grounded, and anti-oppressive, acknowledging that your experience of this transition is shaped not just by hormones, but by a lifetime of caregiving, systemic pressures, and internalized survival strategies.
In our work, we may:
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Explore how hormonal shifts are affecting your nervous system, mood, sleep, relationships, and sense of self—with education that validates rather than blames.
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Work with parts of you that are exhausted, angry, grieving, or craving something new through Internal Family Systems (IFS) and compassionate inquiry.
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Use somatic practices to support grounding, body trust, emotional release, and re-regulation when things feel chaotic or overwhelming.
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Make space for the existential and identity shifts that often arise during this stage—questions about worth, visibility, sexuality, and aging.
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Name and deconstruct the impact of patriarchy, white supremacy, capitalism, and ableism on how we experience and interpret this transition.
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Reclaim connection to your own wisdom, needs, limits, and power.
Common themes I support during this time:
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Emotional volatility, anxiety, or burnout
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Sleep issues and nervous system dysregulation
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Shame around aging, changing bodies, or sexual identity
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Relationship challenges and shifting roles in family or work
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Chronic pain or fatigue, and the medical gaslighting that often accompanies it
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The urge to shed old roles and reconnect with your truest self
You do not have to navigate this alone. Together, we can create a space for integration, recalibration, and reconnection—to your body, your story, and your becoming.
Menopause Resources
Here are a number of resources to support your menopause journey.
Educational & Clinical Guidelines:
Menopause Foundation of Canada: Pocket Guidelines for Canadian Clinicians
Excellent for both healthcare providers and clients wanting evidence-based, accessible information.
Society of Obstetricians and Gynaecologists of Canada: Menopause & You
(Comprehensive resource hub on hormonal and non-hormonal care.)
Menopause Clinics (Toronto/Ontario):
Women's College Hospital Menopause Clinic (Toronto)A specialized clinic providing evidence-based care with referrals from family doctors.
Mount Sinai Hospital Menopause Clinic (Toronto)Focused on complex menopausal transitions including surgical menopause.
The Menopause Society (formerly NAMS) - Find a Certified Provider in Canada. Searchable database of certified menopause practitioners.
Online Communities:
Dr Mary Clare
https://www.instagram.com/drmaryclaire/
Menopause Doctor
https://www.instagram.com/menopause_doctor/
Dr Helen Well
https://www.instagram.com/doctorhelenwall?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw==