Why Perimenopause Can Feel Like Losing Your Mind And What Actually Helps

If you've been feeling like a different version of yourself lately — more anxious, more irritable, forgetful in a way that scares you, crying more easily, or just not quite yourself — and you're somewhere in your late 30s, 40s, or early 50s, I want you to know something first: you are not imagining this, and you are not losing your mind.

You may be in perimenopause.

The symptom that gets missed

Perimenopause is the transition leading up to menopause, and it can start years before your period actually stops — sometimes so early that neither you nor your doctor thinks to connect the dots. The hormonal shifts involved, particularly in estrogen, don't just affect your body. They affect your brain: your mood, your anxiety level, your sleep, your memory, your ability to concentrate, even your sense of who you are.

Here's the problem. Most of the time, when a woman in her 40s comes in describing new anxiety, rage she doesn't recognize in herself, panic attacks out of nowhere, or a fog so thick she can't find words mid-sentence, she's told it's stress. Or she's handed an antidepressant without anyone asking about her cycle, her sleep, or her hormones. Sometimes that medication helps. Often it only partially helps, because it's treating one piece of a bigger picture.

I think that's a real gap in how women's mental health gets treated during this transition, and I want to do better than that.

Two lenses, not one

When someone comes to see me during this stage of life, I'm holding two questions at once: what's happening in your body, and what's happening in your life.

Both matter, and neither one on its own tells the whole story. The hormonal shifts of perimenopause are real and can absolutely drive mood symptoms directly — this isn't "in your head," and it isn't something you should have to push through by sheer will. At the same time, this stage of life often coincides with an enormous amount else: aging parents, teenagers or young adult children, career pressures, marriages under strain, a changing relationship with your own body and identity. Untangling how much of what you're feeling is hormonal, how much is situational, and how much is both intertwined is exactly the kind of work that benefits from someone trained to look at both.

Sometimes that means talking with your gynecologist or primary care doctor about hormone-related treatment options. Sometimes it means medication for anxiety or depression makes sense. Sometimes therapy is what actually helps you make sense of a life stage that can feel disorienting even when your hormones aren't the main driver. Very often, it's some combination — and figuring out which combination fits you means actually asking the question, rather than assuming it's "just" one thing or the other.

You don't have to prove it's serious enough

One thing I hear often from women in this stage of life is a kind of self-doubt: maybe I'm overreacting, maybe this is just normal aging, maybe I should be able to handle this.

I want to say clearly: feeling like you don't recognize your own moods, your own memory, or your own reactions is not something you need to just tolerate. You don't need to wait until it's unbearable, and you don't need to have a clear theory about what's causing it before you reach out. That's part of what we can figure out together.

What this can look like in practice

If you come to see me during this transition, we'll talk about more than your mood in the room that day. I'll want to know about your cycle and where you are in this transition, your sleep, your family history, what's changed recently in your body and in your life, and what you've already tried. From there, we can think together about what combination of approaches — medical, hormonal, therapeutic — actually fits what's happening for you, rather than reaching for the first available answer.

You deserve to feel like yourself again, and you deserve a provider who takes the time to figure out why you don't, rather than assuming they already know.

Dr. Christine M. Crawford is a Harvard-trained, board-certified adult and child and adolescent psychiatrist in Boston. She provides psychotherapy and medication management for adolescents, young adults, and adults, as well as consultation and guidance for parents and families.