Navigating the Midlife Transition: What Science Tells Us About Perimenopause, Menopause & Mental Health
- jfoye0
- Oct 30
- 5 min read
By Jessica Lyons MS, LMFT
Co-Founder, Aloft
Co-Founder, Helios Behavioral Health
LinkedIn: www.linkedin.com/in/jessica-lyons
While menopause is viewed as an expected biological transition, many women also
experience profound transitions emotionally and cognitively related to this phase of life.
The stage of life leading up to—and following—menopause can bring shifts in mood,
cognition, stress resilience, and quality of life. At Aloft, we approach this transition not
merely as a “hormonal event,” but as a holistic, systems interplay.
This post aims to highlight current scientific understanding of perimenopause and
menopause, especially as it relates to mental health, into something meaningful and
actionable for women in our community. It also highlights a timely and exciting new study
from Fordham University exploring brain changes during the menopausal transition.
Menopause is having a moment and we want you to know!
Understanding the Terms: Perimenopause, Menopause & Postmenopause
Perimenopause is the transitional phase before menopause, when hormonal
fluctuations (especially in estrogen and progesterone) occur, menstrual cycles become
irregular, and symptoms begin. This phase often lasts 2 to 8 years.
Menopause is officially reached when a woman has had 12 consecutive months without
a menstrual period. The average age is ~51 in the U.S., though individual variation is
common.
Postmenopause refers to the years after menopause has occurred.
It’s during perimenopause—rather than after full menopause—that many women
experience the most volatility in mood, symptoms, and cognition.
Multiple studies show that the greatest risk for depression and anxiety tends to cluster in
perimenopause rather than before or after. Of note, research does not yet explore or
control for lifestyle factors during this period of life; the perimenopausal years, for many women, occur while women are also raising children, caring for aging family members
and perhaps navigating leadership roles in the professional world.
Hormones, Brain Biology & Mental Health: What the Evidence Says
Hormonal fluctuations & neurotransmitters
The connection between gonadal hormones (primarily estrogen and progesterone) and
brain function is well documented. Estrogen modulates neurotransmitter systems like
serotonin, dopamine, and norepinephrine, affects neuroplasticity, and influences
stress‑response circuits. When estrogen levels fluctuate unpredictably during
perimenopause, the stabilization those systems usually enjoy may become
compromised.
That volatility may lower the threshold for mood symptoms when a woman encounters
life stressors. Some researchers describe perimenopause as a “window of vulnerability”
for mood dysregulation.
Brain structure, metabolism, and cellular-level studies
Until recently, investigating how menopause affects the human brain at the cellular level
was nearly impossible—because you can’t biopsy living brain tissue. That’s where
postmortem brain studies and imaging come in. A 2025 paper examining postmortem
tissue biomarkers in the menopausal transition highlights how brain imaging suggests
structural and metabolic changes in midlife women that may underlie shifts in cognition
and mental health risk.
This dovetails with a high-profile new study from Fordham University, led by Dr. Marija
Kundakovic, which is among the first to parse out how the transition to menopause
affects the human brain at the molecular and cellular levels. The Fordham team has
been funded (via NIH) for ~$2.8 million to follow women longitudinally throughout the
transition, with the ultimate goal of informing better treatments for menopause‑related
mental health issues. Their work builds on an earlier paper (in Molecular Psychiatry) that
used postmortem and molecular techniques to map cellular changes associated with the
menopausal transition.
The hope is that, with deeper insight into how neurons change in midlife, clinicians will
one day be able to predict—or prevent—mood disturbances tied to menopause.
Cognitive changes and “brain fog”
It’s common for women to report difficulty concentrating, memory lapses, or “brain fog”
during perimenopause. Recent reviews and studies support the subjective experience:
fluctuations in hormones, sleep disruption, hot flashes, mood symptoms, and stress all
correlate with self‑reported cognitive difficulty and objective cognitive performance
declines.
Though these changes are often subtle and variable across individuals, they can
contribute meaningfully to distress and functional impairment, especially when layered
on top of anxiety, depression, or life stress.
Risk for depression & anxiety
Multiple lines of evidence point to a heightened risk of mood disorders during the
perimenopausal window. Meta‑analyses have found that women in perimenopause are
about 40% more likely to experience depression compared to premenopausal or
postmenopausal women. Anxiety symptoms are also frequently heightened, often
correlating with vasomotor (hot flash) symptoms.
Where do women turn?
Our traditional healthcare system exists in siloes, leaving patients to navigate disjointed
systems and professional opinions largely on their own. For example, if a woman
experiencing anxiety or depression seeks only outpatient psychotherapy during
perimenopause or menopause, there may be a missed opportunity for medical
evaluation and possible treatment, specifically related to hormonal changes. It’s
important to advocate for yourself and seek professionals with holistic approaches to
care who may even be willing to consult with other members of your care team.
Why Do Some Women Suffer More Than Others?
Not every woman going through perimenopause experiences clinically significant mood
or cognitive disturbance. Factors include prior history of mood disorder, psychosocial
stressors, low social support, sleep disturbance, early life trauma, and lifestyle/health
factors. This points to a biopsychosocial model: hormones set the stage, but
psychological, social, and environmental variables influence whether symptoms cross
over into clinical distress.
Practical Strategies: What Women Can Do Now
1. Screening & early recognition: Persistent changes in mood, memory, sleep, or
anxiety—especially in your 40s or early 50s—should prompt evaluation for
perimenopause.
2. Hormone therapy: HT may reduce symptoms but requires individualized evaluation.
3. Psychological / behavioral interventions: CBT, mindfulness-based therapy, stress
management, and sleep‑focused interventions show benefit.
4. Lifestyle optimization: Exercise, nutrition, sleep, and social connection play major
roles in resilience.
How Aloft & Other Local Professionals Can Help
The team of dedicated clinicians at Aloft aim to provide holistic, systems focused
frameworks of care. We are willing to partner with your medical providers to share
information and work together. We also coach you on how to advocate for yourself to
improve your overall healthcare experience. You’re not in this alone!
A Word on Hope & Empowerment
While the menopausal transition is often portrayed in negative terms, it’s also a time of
potential renewal, perspective, and self-redefinition. The “midlife brain” is still plastic,
adaptable, and resilient. With the right navigation tools—biological, psychological,
social—we can often mitigate distress and even emerge stronger.
The new Fordham University research signals an exciting inflection point: we may soon
be able to identify which women are at highest risk and tailor interventions proactively.
But until these advances solidify, the best strategy is to be proactive, informed, and
connected.
References & Suggested Reading
Fordham University Study on Menopause and Mental Health:
menopause-mental-health-connection/
Depression During and After the Perimenopause (PMC):
Menopause and Mental Health (PMC):
Risk of Depression in Menopausal Stages (ScienceDirect):
World Journal of Psychiatry: https://www.wjgnet.com/2220-3206/full/v15/i7/101906.htm
Severe Mental Illness and Perimenopause (Cambridge):
and-the-perimenopause/8D072AACBCD3C7888C173B36635C08C3
Interested in learning more? Follow Seacoast Women's Health Collective Facebook
Group for expert advice and insights from a group of women’s health professionals in the Seacoast, NH.