Introduction

If you are reading this and feel unheard, dismissed or overwhelmed by emotional and cognitive shifts, you are not alone. Many Australian women experience changes in mood, memory, energy and anxiety during perimenopause yet are often told their symptoms are “just depression”, “just stress” or “normal ageing” without a thorough assessment of hormonal influences. Perimenopause can affect not just your body but your mental and emotional wellbeing, and changes such as anxiety, low mood and brain fog are commonly reported in Australian women living through this transition according to Beyond Blue’s information on perimenopause and mental health (Beyond Blue, n.d.).

Because I have personally lived through perimenopause while juggling work, relationships and clinical practice, I understand how disorienting and destabilising it can feel. Hormonal fluctuations affect brain chemistry, mood regulation and stress response systems, and these shifts often come at a time when women are already balancing high demands in work and family life. This lived experience informs how I assess and care for women, combining clinical expertise with genuine empathy rather than dismissal or minimisation.

What Is Perimenopause and Why Does It Impact Mental Health?

Perimenopause is the transitional phase leading up to menopause when your menstrual cycle becomes irregular and your hormone levels, especially oestrogen, begin to fluctuate unpredictably. These hormonal changes can have a significant impact on mood, thinking processes and emotional regulation. According to Healthdirect Australia, perimenopause usually begins in the 40s and can last several years before menopause is reached — and the hormone fluctuations during this time can influence both physical and emotional symptoms.

Many women report emotional symptoms long before physical signs such as hot flushes or night sweats become obvious. Research and clinical resources show that mood swings, irritability, anxiety, sadness and cognitive issues like brain fog are frequently described during this stage of life (Menopause Alliance Australia, n.d.). Because oestrogen plays a role in regulating mood and neural circuits, fluctuating levels can lead to emotional and cognitive shifts that feel sudden and strange, particularly if you have never experienced these symptoms before.

Why Symptoms Can Be Misdiagnosed

Symptoms such as low mood, anxiety, irritability and cognitive fog can overlap with diagnoses like depression or burnout. These overlapping features often lead clinicians to focus only on surface symptoms rather than exploring underlying perimenopausal influences. The Australian Psychological Society (APS) recognises that hormonal fluctuations and decline during perimenopause can have meaningful effects on emotional wellbeing and that psychologists can play a crucial part in supporting women through this transition.

This situation is made more complex by the fact that mood and thought changes during perimenopause can mimic major depressive disorders and anxiety conditions, yet many women have never experienced significant psychological symptoms before. Life stressors such as work demands, caregiving responsibilities and personal transitions often co‑occur with hormonal changes, making it harder to isolate the root cause without careful and sensitive assessment.

From my combined experience as a clinician and through my own lived perimenopausal journey, I know how frustrating it is to be told you are simply depressed “when all the tests show nothing” or that your emotional changes are just “stress”. Many women say things like “I am not myself anymore” or “this feels unlike any emotional slump I have had before”, and these are important clinical signals that deserve deeper exploration rather than quick labels.

Perimenopause Psychological Symptom Checklist

To help you clarify whether perimenopausal changes are part of your emotional and psychological experience below is a practical symptom checklist you can review. This checklist reflects common emotional and cognitive effects reported by women in clinical literature and community mental health resources:

Psychological and emotional symptoms experienced over the past several months:

☐ Persistent low mood or feelings of sadness
☐ Increased irritability or emotional reactivity
☐ Anxiety or excessive worry without clear triggers
☐ Panic sensations or feelings of tension
☐ Chronic fatigue or low energy not resolved with rest
☐ Cognitive challenges such as brain fog or difficulty concentrating
☐ Memory lapses or forgetfulness
☐ Sleep disturbances such as trouble falling asleep or waking frequently
☐ Decreased interest in activities you used to enjoy
☐ Low motivation or energy
☐ Feeling overwhelmed by everyday stressors
☐ Reduced self‑confidence or sense of self worth
☐ Mood changes that fluctuate frequently
☐ Feeling unlike yourself or out of character

If you have ticked several of these items, especially alongside physical signs such as irregular periods, hot flushes or night sweats, it is reasonable to consider that perimenopause may be part of the explanation for what you are experiencing. It is important to note that the classic symptoms of depression can overlap with perimenopausal emotional changes but may not fully capture hormonal influences on mood and cognition. Research on mood disorders during menopause shows that this transition can heighten the risk of depressive symptoms and mood disturbance.

How a Psychological Intake Assessment Helps

If your symptoms have arisen recently or are causing impairment in relationships, work, self-care or daily life, a psychological intake assessment can make a significant difference in understanding your experience. When you book an intake assessment with me, you can expect:

Detailed clinical interview: We discuss your emotional symptoms, their onset patterns, your reproductive history, stress levels, sleep and life context.

Standardised psychological measures: These assessments help distinguish whether symptoms align more with clinical depression, anxiety conditions, burnout or patterns related to perimenopausal changes.

Holistic case formulation: We explore biological, psychological and social contributors to your experience.

Collaborative goal setting: We work together to identify your priorities and design a therapeutic pathway tailored to your needs.

Written report for your GP: You receive a comprehensive report you can take to your GP summarising your findings, formulation and recommendations for further investigation, including medical tests to consider.

This approach ensures your care is personalised and considers both psychological and biological factors rather than relying on broad labels that may miss important contextual nuances.

What Is Included in the Report for Your GP

Your report typically includes:

• A summary of assessment findings
• Observed symptom patterns
• A clinical formulation explaining likely contributors to your experience
• Recommendations for further medical evaluation
• Suggested tests to support coordinated care

This report strengthens communication with your GP or specialist and supports a more accurate and collaborative care plan.

Recommended Medical Tests to Discuss With Your GP

Discussing specific investigations with your GP can help rule out other contributors and give a clearer picture of your overall health. Tests you might consider include:

• Hormone panel: Assessing estradiol and follicle stimulating hormone to estimate your perimenopausal stage.
• Thyroid function tests: TSH, free T4 and free T3 to check for thyroid dysfunction that can influence mood and energy.
• Vitamin D levels: Low levels have been associated with mood changes and fatigue.
• Iron studies: Including ferritin to rule out iron deficiency which can contribute to fatigue and cognitive symptoms.
• Blood glucose / HbA1c: To assess metabolic factors that influence energy, mood and overall wellbeing.

These medical investigations complement your psychological assessment and help your GP form a full picture of your health.

How Therapy Supports You

Therapy focuses on emotional regulation, stress management and coping strategies that are tailored to your experience and goals. Evidence-based approaches such as Cognitive Behavioural Therapy (CBT) help you understand and reframe unhelpful thoughts and behaviours while building skills to manage mood and stress responses. CBT supports emotional well-being and helps reduce distress by teaching adaptive thinking and behavioural patterns, as outlined on Beyond Blue’s mental health resources.

Mindfulness and behavioural activation strategies can also support resilience, emotional balance and improved functioning during this transition. Importantly, therapy provides a space to explore your experience with someone who understands both the clinical research and the lived experience of perimenopause, offering validation and practical strategies that reflect the complexity of this life stage.

You Are Not Alone

Many Australian women feel blindsided by the emotional intensity of symptoms during perimenopause. Research, clinical evidence and women’s personal stories show that emotional and cognitive changes can be distressing and are often under-recognised by healthcare systems and wider society. Knowing that others share similar experiences can itself be affirming and reassuring.

Taking the Next Step

If this article resonates with you, consider booking a Comprehensive Psychological Intake Assessment with me, Kristie Clarke, Clinical Psychologist in Brisbane or online across Australia. An intake assessment supports clarity, validation of your experience and the development of a tailored care plan.  Contact me today to book or enquire and begin your journey towards emotional wellbeing with support that truly understands perimenopausal experiences.

Conclusion

Perimenopause is a transitional stage with hormonal, emotional and cognitive effects that go beyond physical symptoms alone. Emotional and psychological changes often overlap with depression and anxiety, yet are influenced by shifting hormone levels that require context-sensitive assessment. A comprehensive psychological assessment ensures your needs are understood and met with care that honours both clinical evidence and your lived experience. You deserve to feel heard, supported and validated through this stage of life.

References

Brown, L., Rother, V., Connors Center for Women’s Health and Gender Biology, & Joffe, H. (2024). Promoting good mental health over the menopause transition. The Lancet. https://doi.org/10.1016/S0140-6736(23)02801-5

Garg, R., et al. (2024). Menopause and mental health. Frontiers in Psychiatry. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.1323743/full

Healthdirect Australia. (2025). Perimenopause. https://www.healthdirect.gov.au/perimenopause

Jeanhailes for Women’s Health. (2023). Top five GP questions on menopause and mental health. https://www.jeanhailes.org.au/news/top-five-gp-questions-on-menopause-and-mental-health

Jeanhailes for Women’s Health. (n.d.). Top five GP questions on perimenopause and mental health. https://www.jeanhailes.org.au/news/top-five-gp-questions-on-menopause-and-mental-health

Kulkarni, J. (2018). Perimenopausal depression – an under recognised entity. Australian Prescriber. https://australianprescriber.tg.org.au/articles/perimenopausal-depression-an-under-recognised-entity.html

McElhany, K., et al. (2024). Protective and harmful social and psychological factors in perimenopause. Journal of Affective Disorders, 330, 45–54. https://doi.org/10.1016/j.jad.2024.03.123

Menopause Alliance Australia. (2025). Menopause and mental health fact sheet. https://www.menopause.org.au/health-info/fact-sheets/menopause-and-mental-health

Monash University. (2025). First of its kind study explores symptom prevalence across the menopause transition. https://www.monash.edu/news/articles/first-of-its-kind-study-explores-symptom-prevalence-across-the-menopause-transition

Musial, N., et al. (2021). Perimenopause and first onset mood disorders: A closer look. National Library of Medicine. https://www.ncbi.nlm.nih.gov/articles/PMC8475932/

Notes from Perimenopause, menopause and mental health. (n.d.). Beyond Blue. https://www.beyondblue.org.au/mental-health/womens-mental-health/perimenopause-menopause-mental-health