It can start subtly. You wake at 3 a.m. with your heart racing and a list of worries that felt manageable the afternoon before. You snap at someone you love over something small, then lie awake replaying it. You walk into a room and lose the word you came in for, and a flicker of fear rises up about what that might mean. For many women in their forties and early fifties, and sometimes they get filed under stress, or aging, or a private sense that you are handling life less well than you used to.
If any of this sounds familiar, I want you to know that you are in very good company, and that there is a lot of support available for this stage of life.
What happens during perimenopause
Perimenopause is the transition leading up to menopause, and it can last several years. As estrogen and progesterone rise and fall unevenly, many women notice changes in sleep, mood, focus, and how much they can carry before they feel overwhelmed. Anxiety can show up for the first time, or an old familiar anxiety can return a lot louder than before. Some women describe a new irritability, even a rage, that surprises them. Others feel a flatness or sadness they can't trace to anything in particular.
These experiences have a physical basis, and they also land inside a life. Midlife tends to be crowded with older kids, teenagers, aging parents, work that asks a lot, a long partnership that has settled into its patterns, and friendships that are shifting. When your body changes in the middle of all that, it makes sense that the strategies that used to hold everything together start to feel thin.
The people-pleasing reckoning
Many of the women I work with have spent decades being the capable one, the one who smooths things over, remembers the birthdays, and says yes before checking in with herself. Hormonal shifts can lower the threshold for that way of living. The patience that used to stretch to cover everyone else's needs runs out sooner, and the anger and resentment underneath, which may have been waiting a long time, starts finding its way to the surface.
I have come to see this as an opening.
When it gets harder to override yourself, you get a chance to ask questions that were easy to set aside in your thirties. What do I want? Where have I been abandoning myself to keep the peace? What would it feel like to speak up and trust that the relationship can hold it? Women who sit with these questions often describe a freedom on the other side, along with a steadier kind of peace and a sense of their own power that they wish they had found sooner.
How therapy can help
In my practice I draw on several approaches, depending on what you're facing and what feels right to you.
Internal Family Systems (IFS) helps you get to know the different parts of you, such as the part that keeps saying yes, the part that's furious about it, and the part that's simply tired, and to meet each of them with curiosity. Mindfulness-based CBT offers practical tools for the 3 a.m. thought spirals and the self-critical voice that gets louder when you're depleted. Somatic therapy works with what's happening in your body, which matters a great deal during a transition this physical. Boundaries work gives you a place to find words for what you need and to practice saying them out loud.
I have a phrase I come back to often with clients, which is keep it tiny. Lasting change in midlife tends to come from small steps repeated over time, like one honest sentence to your partner, one evening protected for yourself, or one moment of noticing your breath before you answer an email. Those small steps add up.
Therapy can also sit alongside the medical side of this transition. If you're exploring hormone therapy or other options with your doctor, our sessions can be a place to sort through how you feel about your choices and what's coming up emotionally along the way.
About working with me
I'm a licensed marriage and family therapist with more than 20 years of clinical experience. I'm also an art therapist and the author of The Self-Compassion Journal and Essential Strategies for Social Anxiety. I see clients by Zoom throughout California, and for women in Sonoma County I also offer walk-and-talk sessions on a trail in Santa Rosa, close to Sebastopol. Some people find it easier to open up side by side, with their feet moving and trees overhead.
If this sounds like you
If you've been wondering whether it might help to have someone in your corner as you move through all of this, I'm happy to talk. I offer a free 15-minute consultation by phone or Zoom, where you can ask questions and get a feel for whether we'd be a good fit. Or you can book a first session right away here.
