Maybe you knew about the hot flashes. Maybe you expected your period to change, your sleep to be disrupted, or your body to feel different. You may already be noticing some of the physical changes many women experience during perimenopause, like joint pain, muscle aches, headaches, fatigue, heart palpitations, brain fog, dizziness, night sweats, or changes in your energy and sleep.
What you may not have expected was how much this stage of life could affect your mental and emotional health. You may feel more anxious than you used to, more irritable, more easily overwhelmed, or simply less able to tolerate everything coming at you.
Your patience may be thinner. Your confidence may feel shakier. You might cry more easily, have trouble concentrating, feel emotionally flat, or find yourself reacting to things in ways that don't quite feel like you.
And maybe that is the hardest part: you don't quite feel like yourself anymore. That can be incredibly unsettling, especially if you have always been the person who handles things, keeps going, takes care of everyone else, and figures out what needs to happen next.
Now the same amount of stress may feel like too much. Things that used to roll off your back linger, and noise, conflict, interruptions, demands, or one more person needing something from you may suddenly feel unbearable.
You may start wondering, Why am I so emotional? Why am I suddenly so anxious? Why can't I handle things the way I used to? What is happening to me?
This is one of the parts of perimenopause and menopause that we need to talk about much more openly.
Perimenopause is about much more than hot flashes
For a long time, the conversation around menopause seemed to focus on a fairly short list of symptoms: hot flashes, night sweats, irregular periods, and eventually your period stopping. Those symptoms matter, but the experience can be much broader.
Perimenopause and menopause can also come with disrupted sleep, fatigue, headaches, brain fog, difficulty concentrating, mood changes, anxiety, irritability, joint and muscle pain, sexual changes, and vaginal or urinary symptoms. Some women also report dizziness or lightheadedness during this time.
Not every symptom that appears in midlife is caused by perimenopause, which is why new, persistent, or significant symptoms deserve appropriate medical attention. What can be especially difficult is the way these symptoms begin to layer on top of one another.
Maybe you're not simply tired. You're tired because you woke up several times during the night, your body aches when you get out of bed, and your brain feels foggy while you're trying to remember everything that needs to happen that day.
Maybe you're not simply more irritable. You've been functioning on less sleep, dealing with physical discomfort, trying to concentrate, and managing another day in which several people need something from you.
Maybe you aren't suddenly bad at coping. Your body and mind are working with a different set of circumstances than they were several years ago.
We don't talk enough about the mental and emotional impact of perimenopause
The physical symptoms of menopause are finally becoming more widely discussed, which is important. But the emotional experience can still catch women completely off guard.
For some women, anxiety suddenly feels louder. You may worry more, feel a greater sense of urgency, wake up with your mind already racing, or have a harder time settling after something stressful happens.
For others, it is irritability. You have less patience for things you used to tolerate, become overstimulated more easily, or find yourself thinking, I just need everyone to leave me alone for five minutes.
You may feel sadder, more vulnerable, or emotionally flat. Brain fog can be unsettling too: losing words, forgetting why you walked into a room, having trouble making decisions, or struggling to concentrate on things that used to feel easy.
Many women describe the whole experience with one sentence: I just don't feel like myself.
That does not mean menopause explains every emotional change in midlife. Previous anxiety or depression, trauma, sleep, relationships, work pressure, caregiving, grief, and health concerns can all contribute.
Often, it isn't one thing. It is the intersection of many things.
Life doesn't slow down because you're in perimenopause
Your body may be going through a significant transition, but your life does not suddenly make room for it.
You still have to work, parent, pay bills, take care of a home, maintain relationships, remember appointments, and show up for friends and family. Maybe you're helping aging parents while still raising children, managing a career or business, or trying to stay connected to your partner while wondering when you are supposed to have a moment for yourself.
Whether you're a provider, homemaker, caregiver, professional, parent, partner, or some combination of all of it, life still needs tending to. For many women, midlife actually brings more responsibility, not less.
Some days, doing everything you normally do can feel close to impossible. Yet you get up and do it anyway.
Your body is changing, your emotional bandwidth may be different, and you may still be carrying an enormous amount.
We learned to push through, until pushing through stops working
There is a generational piece to this too. Many of us grew up with very little meaningful conversation about what perimenopause and menopause could actually feel like.
The women who came before us went through these changes too, often with less information and fewer opportunities to openly say, This is really affecting me. For many women, the message was simply that this was part of life, so you got on with it.
That message fits neatly into so many other things women learn: be capable, don't complain, take care of everybody else, and keep going.
Maybe you became the one who holds everything together. You anticipate what everyone needs, stay busy, pride yourself on being self-sufficient, and push yourself past your own limits.
Maybe being useful, easygoing, successful, responsible, or emotionally contained helped things go more smoothly earlier in your life. Those patterns may have helped you build a career, raise a family, survive difficult experiences, and accomplish things you are genuinely proud of. But they can also be exhausting.
You don't arrive at perimenopause as a blank slate. You arrive with a life.
You bring decades of experiences, relationships, family patterns, expectations, responsibilities, and ways of coping with stress. When perimenopause adds disrupted sleep, physical discomfort, fatigue, brain fog, or irritability, the system you have relied on for years can become much harder to maintain.
Not because you're weaker. The strategy of just pushing harder may no longer be sustainable.
Burnout doesn't always look like falling apart
Burnout can be surprisingly quiet. You may still be answering emails, making dinner, going to work, getting everyone where they need to be, checking in on family, and keeping life moving. From the outside, you look capable. Inside, you feel like you are running on fumes.
You may feel resentful and then guilty for feeling resentful. You want everyone to stop needing you, and then you feel terrible for thinking it.
Maybe you stay up scrolling because late at night is the only time nobody needs anything from you, even though what your body desperately needs is sleep. Maybe you keep telling yourself, I just need to get through this week, and then you say the same thing the next week.
Eventually, burnout can start to feel less like something you're going through and more like the way you live.
Perimenopause may make old patterns more visible
Sometimes this stage of life doesn't create the pattern. It exposes it.
You may notice how difficult it is to say no, how quickly you take responsibility when someone else is upset, or how uncomfortable it feels to disappoint someone. You may recognize how much guilt comes up when you rest or how rarely you ask yourself what you want before considering everybody else.
These patterns usually developed for a reason. Maybe paying close attention to other people's moods helped you navigate your childhood. Maybe being successful earned approval, being helpful created connection, or staying busy helped you avoid feelings that were hard to sit with.
Maybe doing everything yourself felt safer than depending on someone else.
This is where therapy can go deeper than simply helping you "manage stress." We can begin asking where these patterns came from, what they have been doing for you, and whether you still need them in quite the same way.
Why nervous system regulation matters
Stress is not happening only in your thoughts. Your body responds too.
When your brain and body perceive stress, your nervous system helps mobilize you to respond. Your muscles may tense, your breathing and heart rate can change, and stress hormones are part of that larger physiological response.
That response is necessary. But when you spend much of your life rushing, worrying, overfunctioning, staying alert, or overriding your own exhaustion, your system may have fewer opportunities to truly settle.
During perimenopause, that additional layer of stress can matter. If you're already sleeping poorly, dealing with physical symptoms, feeling more emotionally sensitive, or struggling with fatigue, being chronically activated can make an already difficult experience feel even harder. This is one place where therapy can help.
Nervous system regulation doesn't mean being calm all the time. It means becoming more aware of what happens inside you and developing more ways to respond before anxiety, irritation, exhaustion, or overwhelm completely takes over.
You may begin to recognize tension building before you reach your breaking point, notice when everything suddenly feels urgent, or catch yourself pushing through exhaustion because some part of you believes you have no other choice.
Awareness creates space, and space gives us more choice.
Where somatic therapy and IFS fit
This is why I often incorporate somatic therapy into my work with women.
Somatic work gives us a way to notice how stress, emotions, relationships, and old coping patterns show up in the body. Instead of only asking, What are you thinking?, we may notice what happens in your chest when somebody needs something from you, what your body does when someone is disappointed, or how quickly you override your own tiredness.
The goal is not to convince you that physical symptoms are psychological. Your physical symptoms are real. The goal is to have a more connected relationship with your body so you can recognize what it is telling you and have more ways to respond.
I also use Internal Family Systems, or IFS therapy, because many women recognize that different parts of them are reacting to this stage of life.
There may be a part that insists you keep going, another that is angry nobody notices how much you're carrying, and another that feels guilty the second you try to rest. There may also be younger parts carrying beliefs like I have to be useful to be valued or Other people's feelings are my responsibility.
Instead of fighting those parts, we become curious about what they have been trying to protect.
Sometimes the parts of us that seem to be making life harder are actually exhausted from trying to take care of us.
You may not need to get better at handling more
One of the traps of burnout is believing the solution is becoming more efficient at carrying an unsustainable amount.
Sometimes better routines, movement, sleep, organization, and practical support genuinely help. But sometimes the question isn't, How do I become better at handling all of this?
Sometimes the better question is: Why am I carrying all of this in the first place?
Where can you ask for help? Where are you saying yes when you mean no? What matters to you, and what are you doing simply because you feel obligated? Which expectations are actually yours, and which ones did you inherit?
Maybe this stage is not asking you to become more capable. Maybe it is asking you to listen sooner.
There can be grief here too
There can also be grief in this transition: about your body changing, aging, fertility, children growing up, relationships changing, or parents getting older. Sometimes there is grief about how much of your life you have spent caring for everyone else.
You may find yourself asking, Where was I in all of this? What did I need that I never got? What do I want now?
Midlife does not have to become an existential crisis, but it can make quieter questions harder to ignore. Sometimes sadness, anger, longing, and uncertainty need room too.
I encourage women to look at the medical side too
When women come to me with significant physical, cognitive, or emotional symptoms, I encourage them to connect with a healthcare provider who has specific training and experience in perimenopause, menopause, and hormone-related health.
I recommend this even when the symptoms aren't new. Sometimes women have lived with fatigue, anxiety, disrupted sleep, brain fog, joint pain, mood changes, or other symptoms for years without realizing that hormonal or other physical factors might be part of the picture.
A thorough evaluation may look beyond reproductive hormones alone. Depending on your age, symptoms, cycle changes, medications, and medical history, a knowledgeable clinician may also consider thyroid function, anemia or iron status, vitamin deficiencies, sleep concerns, and other health issues that can overlap with menopause symptoms.
The goal isn't to reduce everything to hormones, but it is also not to overlook the very real ways physical and hormonal changes can affect how you feel.
This is why I see support during perimenopause as a bigger picture. Medical care can help identify and address physical contributors, while therapy can support stress, anxiety, emotional regulation, relationships, grief, boundaries, nervous-system patterns, and the ways you've learned to cope.
We don't have to choose between taking the body seriously and taking the emotional experience seriously. Both matter.
Maybe you don't need to go back to the old you
A phrase I hear often from women is, I just want to feel like myself again.
Of course you do. When your body or emotions suddenly feel unfamiliar, wanting the old version of yourself back makes sense. But sometimes I wonder whether the work is entirely about going backward.
Maybe you don't actually want to go back to being available to everyone all the time. Maybe you don't want to keep saying yes when you mean no or measuring your value by how productive, accommodating, or capable you can be.
Maybe you want to know what you need before you are completely exhausted. Maybe you want relationships with a little more room for you in them.
Maybe this stage of life, as uncomfortable as it can be, is an opportunity to begin listening to yourself differently.
Therapy for stress, burnout, and perimenopause
If you're navigating perimenopause or menopause while also feeling anxious, depleted, burned out, disconnected, or unlike yourself, therapy can be a place to understand the emotional side of what you're going through.
In my work with women, I use somatic therapy, Internal Family Systems (IFS), and other trauma-informed approaches to help you better understand your nervous system, your emotional responses, and the parts of you that have learned to keep pushing through.
Psychological support has a legitimate place in menopause care. Current clinical guidance includes psychological approaches such as cognitive behavioral therapy and mindfulness-based interventions for some menopause-related concerns, including mood, anxiety, sleep, and symptom distress.
The goal isn't to make you better at tolerating an impossible amount. It's to help you feel more connected to yourself and have more choice in how you move through this stage of your life.
Learn more about therapy for burnout →
Learn more about somatic therapy →
Or, if you'd like to see whether working together feels like a fit, you can schedule a free consultation.
Frequently Asked Questions About Stress, Burnout, and Perimenopause
Can perimenopause make anxiety worse?
Some women experience new anxiety or find that existing anxiety feels more intense during the menopausal transition. Hormonal changes may be part of the picture, while disrupted sleep, physical symptoms, previous anxiety, stressful life events, relationships, caregiving, and work pressures can contribute too.
Why do I feel so overwhelmed during perimenopause?
Several things may be happening at once. Changes in sleep, energy, mood, concentration, and physical comfort can affect your capacity for stress while all of your normal responsibilities continue.
Longstanding patterns such as overfunctioning, perfectionism, people pleasing, or consistently putting your own needs last can also become harder to sustain.
Is burnout a symptom of perimenopause?
Burnout itself isn't a defining menopause symptom. But fatigue, poor sleep, brain fog, mood changes, anxiety, physical discomfort, and significant life stress can overlap with and contribute to what women experience as burnout.
Why don't I feel like myself during perimenopause?
Many women describe this experience. Fatigue, pain, anxiety, irritability, brain fog, poor sleep, stress, physical changes, and the emotional transitions of midlife can all contribute to feeling unfamiliar to yourself.
Can therapy help during perimenopause?
Yes. Therapy does not stop the hormonal transition, but it can support anxiety, mood, stress, sleep, coping, relationships, burnout, and the emotional impact of menopausal symptoms.
Somatic therapy can also help you recognize your body's stress signals earlier, understand your nervous-system patterns, and develop more ways to respond when you feel overwhelmed, activated, depleted, or disconnected.
About Gina Watkins, LICSW
Gina Watkins, LICSW, is a somatic trauma therapist with 20 years of experience helping women understand how patterns shaped by their families, relationships, and life experiences affect how they feel, parent, connect, and care for themselves.
Gina is a mom of two teens, one in college and one at home. She loves animals and hiking in the Pacific Northwest. Her own journey fuels her mission: helping women and moms break old patterns and trust their own voice so they can feel present with the people they love and experience joy beyond just holding it all together.