Perimenopause and Mind-Body Health: What You Need to Know

The Rollercoaster That is Perimenopause

Perimenopause is often described as a transition, but for many, it feels like a complete upheaval. Mood swings, brain fog, exhaustion, and a sudden shift in how the body functions can leave people wondering what happened to their sense of stability. For those of us who are neurodivergent, this phase of life can feel even more intense.

Hormonal fluctuations affect brain chemistry, nervous system regulation, and emotional well-being. When estrogen and progesterone start fluctuating unpredictably, symptoms like anxiety, depression, sensory sensitivities, and executive dysfunction can all worsen. What often gets overlooked is how these changes intersect with the social pressures of aging, weight stigma, and outdated medical advice that ignores the realities of hormonal health.

If you’ve found yourself struggling more than usual, you’re not alone. Understanding how perimenopause impacts both mental and physical health can help you advocate for better support.

How Perimenopause Impacts Mental Health

Perimenopause isn’t just about hot flashes and irregular periods. The brain is highly sensitive to hormonal changes, and for many, the emotional symptoms can be just as challenging, if not more so, than the physical ones.

Increased Anxiety and Depression

Estrogen and progesterone play a major role in regulating serotonin and dopamine, the neurotransmitters responsible for mood stability and motivation. When these hormone levels start to fluctuate, the brain’s ability to regulate mood becomes unpredictable. Many people experience heightened anxiety, depressive episodes, or feelings of hopelessness.

For ADHDers, this can feel like dopamine withdrawal, making motivation and focus even harder to maintain. Autistic individuals, who may already experience heightened stress responses, might find themselves more easily overwhelmed by daily tasks and social interactions.

Higher Suicide Risk in Perimenopause

One of the most under-discussed aspects of perimenopause is the increased risk of suicide. Research has found that suicide rates are highest in midlife, particularly for women and AFAB individuals between the ages of 45 and 54. The combination of mood instability, increased stress, and a lack of medical support for hormonal changes can contribute to this crisis.

It’s crucial that perimenopausal mental health is taken seriously. If you’ve been experiencing suicidal thoughts, please reach out for support. Therapy, medication, and hormonal interventions can all be life-changing.

Brain Fog and Executive Dysfunction

Many people in perimenopause describe feeling like they’ve suddenly lost their ability to think clearly. Memory lapses, trouble concentrating, and difficulty making decisions are common. For neurodivergent individuals who already struggle with executive function, this decline can feel devastating.

Simple tasks that were once manageable might start feeling impossible. You might find yourself walking into a room and forgetting why you’re there, struggling to remember names, or feeling like conversations require more mental effort than before.

Increased Sensory Sensitivities

For Autistic and ADHD individuals, sensory sensitivities can become even more intense during perimenopause. Estrogen plays a role in pain modulation and sensory processing, so when levels fluctuate, noise, textures, bright lights, and even temperature changes can feel more overwhelming than before.

You might notice that certain fabrics feel unbearable against your skin, crowded spaces become intolerable, or strong scents trigger headaches when they never used to.

Sleep Disruptions and Chronic Fatigue

Hormonal shifts can wreak havoc on sleep, leading to insomnia, night sweats, and early waking. When sleep is disrupted, emotional regulation becomes even harder, contributing to irritability, anxiety, and burnout.

Many neurodivergent people already struggle with sleep disorders, and perimenopause can make it even harder to get restorative rest. Without adequate sleep, everything else, mental health, focus, energy levels, becomes more difficult to manage.

The Impact of Diet Culture and Weight Stigma in Perimenopause

One of the biggest myths about midlife is that weight gain is caused by a lack of willpower or discipline. In reality, hormonal shifts change how the body stores fat, particularly around the abdomen. This isn’t about “eating too much” or “not exercising enough”; it’s a direct result of declining estrogen and its effect on metabolism, insulin sensitivity, and muscle mass.

Despite this, the pressure to “fix” weight gain often leads people down a dangerous path. Studies show that perimenopausal individuals are at increased risk for developing eating disorders, particularly binge eating disorder and disordered restrictive eating patterns. Many also turn to bariatric surgery, not because they truly need it for health reasons, but because of external pressure to conform to weight standards that don’t reflect biological realities.

The outdated “eat less, move more” advice ignores the complexity of perimenopausal health. Over-exercising and under-eating can actually increase stress hormones like cortisol, making symptoms worse. Instead of focusing on weight loss, a more supportive approach includes nutritional support, stress reduction, and movement that feels good rather than punishing.

Holistic Approaches to Perimenopausal Well-Being

Managing perimenopause isn’t about just “pushing through.” There are many ways to support your mental and physical health, including:

1. Therapy and Mental Health Support

Working with a therapist who understands both neurodivergence and hormonal health can be incredibly helpful. A combination of trauma-informed therapy, somatic work, and nervous system regulation techniques can help manage emotional and cognitive symptoms.

2. Hormone Replacement Therapy (HRT)

HRT can help stabilize mood fluctuations, improve sleep, and support brain function. Bioidentical progesterone, in particular, has been shown to help reduce mood swings, anxiety, and sleep disturbances in perimenopausal individuals.

3. Nutritional Support (Without Diet Culture)

A weight-inclusive approach to nutrition prioritizes nourishment over restriction. Some key nutrients that support perimenopausal health and could be tested include:

• Magnesium for relaxation and mood regulation

• B vitamins for energy production and cognitive function

• Omega-3s for brain health and inflammation reduction

• Vitamin D for immune function and mood regulation

• Iron for reduction of chronic fatigue, thyroid function, etc.

4. Gentle Movement

Instead of punishing exercise routines, focusing on movement that supports joint health, strength, and flexibility can be more beneficial. Walking, yoga, and strength training can help manage stress and support muscle mass loss and overall well-being.

5. Nervous System Regulation and Alternative Healing

Practices like Reiki, meditation, acupuncture, and breathwork can help reduce stress and improve emotional resilience. Managing perimenopause isn’t just about hormones; it’s about supporting the entire nervous system.

Final Thoughts

Perimenopause is a massive life transition, and it deserves more attention and support. The mental health struggles that come with it are real, but they are also manageable with the right tools and care.

Understanding the connection between hormones, neurodivergence, and systemic issues like diet culture can help you navigate this stage with more self-compassion.

Please note: this post is for educational purposes only and is not medical advice. Please speak with your medical provider to discuss what might best work for you.