Therapy in Fort Collins, CO for Perimenopause: You Haven't Lost Yourself, But Something Has Changed
Summary
If you are a woman in your forties or fifties, waking in the middle of the night with a racing heart, snapping at people you love, forgetting words mid-sentence, or feeling like a stranger in your own life, you may be in perimenopause. These are real, physiological changes tied to a significant hormonal transition. This guide explains how perimenopause affects mental health, memory, stress, relationships and identity, what the research says, and how therapy in Fort Collins, CO can help you steady yourself throughout this transition.
Key Points
Perimenopause is a mental health transition, not just a reproductive one. In a study of 711 midlife women, those in perimenopause had a significantly higher risk of elevated depressive symptoms than premenopausal women (Mulhall et al., 2018).
Brain fog is measurable, and it is often temporary. In a four-year study of 2,362 women, learning and memory gains stalled during perimenopause and returned to premenopausal levels afterward (Greendale et al., 2009).
Hormonal swings can make your nervous system more reactive. Early research links greater estradiol fluctuation with more negative mood, anger, sadness, and a faster heart rate under stress (Gordon et al., 2019).
Burnout, strained relationships, and a shaky sense of self are common and understandable. Pushing through the way you used to often makes this season harder, not easier. Strengthening resilience skills such as self-compassion and emotion regulation is linked with better mental health during perimenopause (Piraccini et al., 2023, preprint).
Asking for help early matters. In a 2025 study of 42 women, most did not recognize their symptoms as menopause-related at first, and many had to push to be heard (Hendriks et al., 2025). Medical care and therapy work well together, and you do not have to be "sick enough" to deserve support.
When Nothing Is Wrong, But Nothing Feels Right
You're standing in your kitchen holding a coffee cup, and you can't remember what brought you in here. That small lapse sets off a wave of anxiety you can't quite explain, accompanied by a tightness in your chest with no clear cause. You notice that you're tired, too, and deep down you know it's not the kind of tired that sleep fixes. All of this feels unfamiliar, and it worries you. Underneath everything is a quiet, unsettling thought: this just isn't me.
Maybe this started a year ago. Maybe longer. It crept in so quietly that you’ve almost talked yourself out of noticing it. You're strong. You've handled hard things. You don't fall apart. So you keep pushing, keep performing, keep being everything to everyone, until one afternoon you find yourself sitting in a parking lot, unable to get out of the car. Nothing terrible has happened. Everything just feels like too much.
If you're a woman in your forties or fifties and you're reading this, please hear me: you are not imagining it, and you are not losing your mind. This may be perimenopause, and support is available. As a therapist for women in midlife, I have seen this story again and again.
What Is Perimenopause?
Perimenopause is the transition leading up to menopause, when estrogen and progesterone begin to fluctuate unpredictably. It can begin in your late thirties or early forties and, for many women, lasts several years, with periods often becoming irregular along the way.
This fact is important: estrogen is not only a reproductive hormone. It also influences your mental health. The brain systems that regulate mood, memory, sleep, temperature, and stress are affected by reproductive hormones. When estrogen rises and falls erratically, your nervous system feels it. The shifts are not always dramatic, but the nervous system is not subtle in how it responds.
Perimenopause and Mental Health: What the Research Says
If you've been told your symptoms are "just stress," the research tells a more complete story.
In a longitudinal study of 711 Australian women with an average age of about 50, researchers compared premenopausal, perimenopausal, and postmenopausal women. After accounting for other factors, women in perimenopause had a significantly higher risk of more depressive symptoms than premenopausal women, and this held even for women with no prior history of depression or anxiety (Mulhall et al., 2018). Findings on anxiety vary from study to study, and in this one anxiety symptoms were more elevated after menopause, but many women describe anxiety as one of the first and loudest signs in early perimenopause.
This does not mean every woman will develop depression or anxiety. It means perimenopause is a window of real vulnerability, and that mood changes during this time deserve to be taken seriously.
A 2025 interview study offers a closer look at how serious mood shifts can feel. Researchers spoke with 42 women who had experienced suicidal thoughts or self-harm during perimenopause or menopause. For most of them, depression and anxiety were new, since only a small minority had a history of either before this season (Hendriks et al., 2025). Women described hopelessness, feeling trapped, and being overwhelmed by symptoms layered on top of everyday life.
This was a small group, recruited partly from a private menopause clinic and chosen because of these experiences, so it cannot tell us how common they are. But it is an important reminder that mood changes in this season can be severe, and that they are a reason to reach out for support.
If you are having thoughts of not wanting to be here, please call or text 988 or go to your nearest emergency room right away.
Mental health symptoms worth paying attention to
Emotional: anxiety that appears from nowhere, irritability, low mood, feeling emotionally raw or easily overwhelmed
Cognitive: brain fog, word-retrieval difficulty, forgetfulness, trouble concentrating on things you used to handle easily
Physical: heart palpitations, night sweats, disrupted sleep, fatigue that doesn't respond to rest, joint aches
Nervous system: a heightened startle response, a persistent sense of dread, feeling "wired but tired," difficulty unwinding
If you're nodding at several of these, you are not falling apart. You are in a transition our culture has almost entirely failed to prepare women for.
Brain Fog in Perimenopause: Why You Can't Find the Word
Brain fog is one of the most frightening symptoms, because it makes many women wonder whether something is seriously wrong with their minds.
The Study of Women's Health Across the Nation (SWAN) followed 2,362 women ages 42 to 52 for four years, testing processing speed, verbal memory, and working memory. Women who were premenopausal or postmenopausal showed the expected improvement from practicing the tests. Women in perimenopause did not learn as well over time, which matches what so many women report about their own memory (Greendale et al., 2009). The reassuring part: the learning difficulty appeared to be temporary, and performance returned to premenopausal levels after the transition.
In plain terms, the forgetfulness, the lost words, and the "why did I walk in here?" moments are real and measurable, and they are not a sign that you are declining. In the 2025 interview study, women also described brain fog as frightening and said it made their overall mental well-being harder to manage (Hendriks et al., 2025). If memory changes feel severe or are worsening, please talk with your medical provider.
Stress, Burnout, and a Nervous System With Less Buffer
Let's talk about overwhelm, because it rarely gets the attention it deserves. It's not simply that you have too much to do. Many of us have often had too much to do. It's that your capacity to absorb the load is smaller. Things that used to roll off your back now feel crushing. You're more sensitive to noise, conflict, and stimulation, and then the guilt about all of it adds its own weight.
There is emerging science behind this. A small pilot study of 15 women in perimenopause tracked estradiol fluctuation over 12 weeks. Women whose estradiol swung more widely reported more negative mood and more anhedonia (loss of pleasure), and during a standardized stress task they showed a higher heart rate and stronger feelings of rejection, anger, and sadness (Gordon et al., 2019). The sample was small and more research is needed, but it supports what many women feel: the hormonal swings of this season may make the stress response more reactive.
There is a second layer. Many women arrive at midlife carrying years, sometimes decades, of unprocessed stress: career pivots, caregiving, relationship strain, quiet losses, and for some, earlier trauma. The body keeps a record. When your hormonal reserves are lower, the buffer that helped you absorb all of that gets thinner. What was managed becomes unmanaged. What was tucked away starts asking to be felt.
The interviews in that same 2025 study capture how this piles up. Women described physical symptoms, mood changes, and major life events, such as relationship strain, children leaving home, and money worries, arriving all at once. For many, the combination left them depleted and feeling that even small tasks had become too much (Hendriks et al., 2025).
That is why pushing through the way you used to often backfires. Burnout in perimenopause is not weakness. It is what happens when a nervous system with less buffer keeps being asked to carry the same load.
Emotion Regulation: When Your Reactions Surprise You
You snap at your kids over nothing. You cry during a commercial and wonder where that came from. A small comment from a coworker lands like a punch. Then comes the shame.
In the Gordon et al. (2019) pilot, greater estradiol fluctuation was linked with stronger feelings of anger, rejection, and sadness in response to stress. You can read that as a plain-language explanation for the question so many women bring to my office: I don’t know why I’m reacting like this. Your reactions are not random, and they are not a moral failing. Your emotional system is working with a changing chemical environment.
The good news is that emotion regulation is a skill, and it can be strengthened. In therapy, we work on calming the body when it's activated, noticing the early signs before a reaction takes over, and responding to yourself with curiosity instead of criticism.
Research on resilience points in the same hopeful direction. In a Swiss Perimenopause Study, 123 women who began the study healthy were followed for about a year. Women who scored higher on a cluster of resilience-related traits (self-compassion, self-esteem, optimism, emotional stability, and emotion regulation) reported fewer depressive symptoms, less stress and distress, milder menopausal symptoms, and greater life satisfaction over time. On average, the women's depressive symptoms and general health even improved slightly over the year, despite increasing menopausal symptoms, a reminder that many women come through this transition well (Piraccini et al., 2023).
The authors are careful to say this shows an association, not proof that resilience causes better outcomes, and the paper is a preprint that has not yet been peer reviewed. Still, self-compassion, self-esteem, and emotion regulation are exactly the kinds of skills we can practice together in therapy.
Marriage, Partnership, and Perimenopause
Perimenopause rarely affects just the woman who is in it. Broken sleep, irritability, shifting desire, and emotional rawness can all spill into your closest relationships. Your partner may feel confused or shut out, and you may feel misunderstood or too exhausted to explain what you barely understand yourself.
Research on married midlife women has found that marital quality and stress are connected to how women experience the menopausal transition, which is a reminder that this season is shaped by relationships as well as hormones. A supportive, informed partnership can make the transition easier, and a strained one can make it feel heavier.
It can help to name what is happening out loud: This is a hormonal transition, and it's affecting my mood and my energy. It isn't about you, and I need support. Therapy can give you the language for that conversation, and a place to sort out which strains come from this season and which have been quietly building for years.
Identity Changes: Who Am I Now?
There is a kind of grief that often goes unrecognized. It's not the grief of losing a person, a relationship, or a job. It's the grief of losing your baseline, the felt sense of who you are when you're simply you.
Many women in perimenopause describe looking in the mirror and recognizing the face while something behind the eyes feels unfamiliar. The old ways of being everything to everyone stop working. The needs you filed under "later" start knocking. You may find yourself questioning your career, your relationships, your role, and the version of yourself you've been performing rather than inhabiting. In the 2025 interview study, women described knowing, even in their hardest moments, that how they felt was not who they were, which made the sense of powerlessness all the more painful (Hendriks et al., 2025).
This season is asking something of you, gently and not as a punishment: slow down, pay attention, and stop ignoring what you've been ignoring. The anxiety, the overwhelm, and the exhaustion are not only symptoms to eliminate. They can also be messengers.
Many women describe the far side of this transition as a kind of homecoming. Not back to who they were at thirty-five, but forward into someone they trust more: someone with less tolerance for what doesn't matter and more capacity for what does.
Asking for Help: Why It's So Hard, and Why It Matters
Before they ever walk into a doctor's office, many women have convinced themselves they aren't sick enough to ask for help. Is something really wrong? Am I making this up? Then, after finding the courage to speak up, they leave with labs marked "normal" and a suggestion to try yoga or reduce stress. So they ask, get dismissed, try another provider, feel the same, and try again. That cycle is exhausting, and it wears down even the most determined women.
I understand this more than I can say. Before I had the right information, I went from doctor to doctor knowing something wasn't right. I was given Adderall, put through several unnecessary tests, and poked and prodded in ways that might have been avoided if someone had considered that an estrogen patch could have been the answer all along.
I'm not a doctor. I'm a therapist, and a woman who did the research herself. My clinical training taught me to read studies and understand data, which is how I learned to advocate for my own care. That experience is why I take this work so seriously. When you come to me, I will take you seriously. I will believe you. And I will help you find the resources you need to keep seeking the care you deserve.
My experience is not unusual. In the 2025 interview study, more than half of the 42 women did not initially connect their symptoms to menopause, and many ended up educating themselves. Many also described resistance or delays when they sought care, and several said they were offered other treatments before anyone asked about hormones. Some felt ashamed of not coping, tied to the expectation that women should always be capable and resilient. At the same time, women described real relief from being heard, from care that fit their situation, and from connecting with other women going through the same thing. Among those who tried hormone therapy, most (32 of 40) found it effective, though it was not a cure-all for everyone and some needed additional support (Hendriks et al., 2025). Whether hormone therapy is right for you is a decision to make with a knowledgeable medical provider.
One woman in the study described feeling out of place in therapy because her life was stable and happy, so she had no obvious problem to point to. If that sounds familiar, please know that a good life and a struggling nervous system can exist side by side, and you don't need a crisis to deserve support.
Here is what I want you to know about asking for help:
You do not need to be in crisis to deserve support. Struggling is reason enough.
Medical care and therapy work best together. A menopause-informed medical provider can talk with you about options, including hormone therapy, while mental health counseling supports your nervous system, your stress load, and the emotional weight of this transition.
Persistence is not complaining. Bring your symptoms, your timeline, and your questions. Keep asking until you are heard.
What Therapy in Fort Collins, CO Can Look Like for Perimenopause
If you're ready to stop white-knuckling your way through this, therapy with someone who understands midlife for women may be exactly the support you've been looking for.
Together, we look at the full picture: sleep, nervous system health, stress load, and the emotional weight of this transition. As a therapist offering counseling for women in midlife, I make room for the fears and questions that never fit into a ten-minute medical appointment: the uncertainty about hormone therapy, the grief of feeling like you're losing yourself, and the exhaustion of holding it all together while quietly falling apart. My specialties include anxiety, complex trauma, and women in midlife and perimenopause, so you will not have to explain why the past is showing up in the present.
Therapy cannot change your hormones, and I won't pretend it can. What it can do is help you regulate your emotions, reduce the burden of burnout, repair how you communicate with the people closest to you, and rebuild a sense of self you can trust.
If you also want support on the physical side of this transition, such as nutrition, strength, and building your body's resilience, Dr. Mary Claire Haver's team at The Pause Life offers a practical, science-backed framework that pairs well with the emotional work we do together.
You Don't Have to Navigate This Alone
You are not broken. You are not too sensitive, too much, or too far gone. You are a woman in the middle of something real and significant, something medicine is only beginning to take seriously, that culture has long ignored, and that most of us were never prepared for.
And here you are, paying attention and searching for answers at whatever hour of the night or morning this found you. That matters. It means something in you is still reaching toward the light.
We're going to figure this out. Not all at once, but one true thing at a time.
Ready to feel like yourself again?
If this resonated, I'd love to connect. I offer therapy in Fort Collins, CO for women in midlife and perimenopause who are ready to be heard, supported, and come home to themselves.
This post is for educational purposes and is not medical advice. If you are experiencing a mental health crisis or thoughts of harming yourself, call or text 988 (the Suicide & Crisis Lifeline) or go to your nearest emergency room.
Frequently Asked Questions
Can perimenopause cause anxiety?
Yes. Fluctuating estrogen and progesterone affect the brain systems that regulate mood and stress, and many women notice anxiety, sometimes with no clear trigger, as an early sign of perimenopause. Research findings on exactly when anxiety peaks vary, but the link between the menopause transition and mood symptoms is well supported.
Can perimenopause cause suicidal thoughts?
Some women do experience hopelessness or thoughts of not wanting to be here during perimenopause and menopause, including women who have never struggled with their mood before (Hendriks et al., 2025). These thoughts are a signal to get support right away, not a sign that you are weak. If you are having them, call or text 988 or go to your nearest emergency room, and tell a trusted person and a healthcare provider.
Is perimenopause brain fog permanent?
For most women, no. Research following women through the transition found that learning difficulties during perimenopause were temporary and returned to premenopausal levels afterward (Greendale et al., 2009). Talk with your medical provider if your memory changes are severe or worsening.
Do I need a diagnosis or hormone testing before starting therapy?
No. You can begin therapy at any point. Because I'm a therapist and not a medical provider, I'll encourage you to work with a menopause-informed doctor on the medical side while we work on stress, emotions, relationships, and identity.
How do I know whether I need therapy or medical care?
Most women benefit from both. Medical care addresses the hormonal and physical side of perimenopause, and therapy addresses the anxiety, overwhelm, relationship strain, and identity changes that come with it.
How can therapy help with perimenopause?
Therapy can't change your hormones, but it can help you build emotion regulation skills, lower your stress load, communicate with your partner, process old stress or trauma that is resurfacing, and feel more like yourself. Research links skills like self-compassion and emotion regulation with better mental health during perimenopause (Piraccini et al., 2023, preprint).
References
Gordon, J. L., Peltier, A., Grummisch, J. A., & Sykes Tottenham, L. (2019). Estradiol fluctuation, sensitivity to stress, and depressive symptoms in the menopause transition: A pilot study. Frontiers in Psychology, 10, 1319. https://doi.org/10.3389/fpsyg.2019.01319
Greendale, G. A., Huang, M. H., Wight, R. G., et al. (2009). Effects of the menopause transition and hormone use on cognitive performance in midlife women. Neurology, 72(21), 1850-1857. Summary: https://www.uclahealth.org/news/release/menopause-transition-may-cause-trouble-learning
Hendriks, O., McIntyre, J. C., Rose, A. K., Crockett, C., Newson, L., & Saini, P. (2025). The mental health challenges, especially suicidality, experienced by women during perimenopause and menopause: A qualitative study. Women's Health, 21, 1-12. https://doi.org/10.1177/17455057251338941
Mulhall, S., Andel, R., & Anstey, K. J. (2018). Variation in symptoms of depression and anxiety in midlife women by menopausal status. Maturitas, 108, 7-12. https://researchportalplus.anu.edu.au/en/publications/variation-in-symptoms-of-depression-and-anxiety-in-midlife-women-/
Piraccini, M., Grub, J., Süss, H., Willi, J., Flach, L., & Ehlert, U. (2023). Longitudinal effects of resilience on well-being and mental health during perimenopause: Results from the Swiss Perimenopause Study. SSRN (preprint, not peer reviewed). https://ssrn.com/abstract=4631301
About the Author
Megan Silberhorn, LPCC is a therapist and owner of Megan Silberhorn Counseling in Fort Collins, Colorado. She specializes in anxiety, complex trauma, and supporting women through the emotional and physical challenges of mid-life and perimenopause. If you're ready to stop white-knuckling it alone, she'd love to hear from you.