CBT, Mental Health, and Perimenopause: How Therapy Can Support Mood, Anxiety, Brain Fog, and Menopause Symptoms
This article is informed directly by clinical conversations and lived experiences shared by women’s health experts Dr. Michelle Jacobson OBGYN and Dominique Williams RSW at Coven Women’s Health.
Perimenopause and menopause are often framed as purely hormonal transitions—something to be managed with medication alone, or quietly endured. But for many women, the most disruptive symptoms aren’t just physical. They’re emotional, cognitive, and psychological.
Anxiety that feels unfamiliar.
Low mood or loss of confidence.
Irritability, rage, or emotional reactivity.
Brain fog that sparks fear: What’s happening to me?
At Coven Women’s Health, we see this every day. And we know something critical to be true:
Perimenopause care works best when mental health support is treated as essential—not optional.
This article breaks down:
Why mood and mental health symptoms are so common in perimenopause
How Cognitive Behavioural Therapy (CBT) helps across a wide range of menopause symptoms
When therapy can complement (or substitute for) medical treatment
How Coven supports women through evidence-based, perimenopause-informed mental health care
Why Mental Health Symptoms Increase in Perimenopause
Perimenopause is defined by hormonal fluctuation—not decline alone. Estrogen and progesterone rise and fall unpredictably, and these shifts directly affect the brain.
Estrogen interacts with:
Serotonin (mood regulation)
Dopamine (motivation, reward, focus)
The amygdala (emotional reactivity, threat perception)
As hormone levels fluctuate, many women experience:
Anxiety or anxious thought spirals
Low mood or depressive symptoms
Reduced stress tolerance and irritability
Emotional volatility that feels “out of character”
This isn’t a personal weakness or resilience issue. It’s neurobiology.
“I Don’t Feel Like Myself”: Common Mental Health Symptoms in Perimenopause
Women often don’t arrive saying “I’m anxious” or “I’m depressed.” Instead, they say:
I feel overwhelmed by things I used to manage easily
My patience is gone
My confidence feels shaken
My brain doesn’t work the way it used to
The most common mental health patterns we see in perimenopause include:
Anxiety and Racing Thoughts
Often worse at night or during periods of stress, driven by hormonal effects on the nervous system.
Low Mood or Loss of Motivation
Including emotional flatness, sadness, or feeling disconnected from yourself.
Irritability and Rage
Reduced frustration tolerance linked to amygdala sensitivity during hormone shifts.
Brain Fog and Cognitive Changes
Difficulty with word recall, focus, memory, and mental clarity—often frightening, but typically temporary.
Importantly, brain fog during perimenopause is not associated with future dementia risk. Reassurance and education are a crucial part of care.
How CBT Helps in Perimenopause and Menopause
Cognitive Behavioural Therapy (CBT) is one of the most well-studied, evidence-based therapies for mood and anxiety—and it has specific benefits in perimenopause and menopause.
CBT focuses on the relationship between:
Thoughts
Emotions
Physical sensations
Behaviours
Rather than “positive thinking,” CBT teaches skills to:
Identify unhelpful thought patterns (like catastrophizing or all-or-nothing thinking)
Reduce symptom amplification caused by anxiety or stress
Improve emotional regulation and coping capacity
Restore a sense of agency and control
CBT and Menopause Symptoms
Research shows CBT can meaningfully improve:
Anxiety and depressive symptoms
Emotional reactivity and irritability
Distress related to hot flashes
Sleep disruption and fatigue
Overall quality of life in menopause
It is especially valuable for women who:
Cannot or choose not to use hormone therapy
Are using medical treatment but still feel “not themselves”
Want tools that address both mind and body
There are no contraindications to CBT, and it works well alongside medical and lifestyle interventions.
A Key CBT Principle: You Can’t “Stop” Thoughts—But You Can Redirect Them
One of the most common perimenopause complaints is a racing mind, especially at night.
CBT is grounded in a simple but powerful truth:
The brain doesn’t respond to “don’t think about it.”
Trying to suppress thoughts often makes them louder. CBT teaches intentional redirection—giving the brain something neutral and grounding to focus on instead.
Examples include:
Sensory grounding (what you can see, hear, feel)
Simple mental tasks that gently occupy attention
Breath-based regulation techniques
These tools calm the nervous system and reduce the emotional intensity of symptoms—without forcing control.
Therapy Is Not a Replacement for Medical Care—It’s a Partner
At Coven, we don’t position therapy as an “alternative” to medical care. We see it as a core pillar of comprehensive perimenopause and menopause support.
Hormones matter.
Lifestyle matters.
Mental health support matters just as much.
When these work together, outcomes improve—both symptom relief and long-term wellbeing.
Mental Health Support at Coven Women’s Health
For women navigating perimenopause or menopause-related mood and mental health changes, Coven offers several evidence-based pathways of care:
1. Entry Assessment & Consultation 👉
A starting point to explore your symptoms, mental health concerns, and goals—helping determine the most appropriate next step in your care.
2. Mind & Mood Program 👉
Structured, perimenopause-informed mental health support focused on:
Anxiety and low mood
Emotional regulation
Cognitive symptoms and stress resilience
Practical CBT-based tools you can apply immediately
3. Feel Powerful Program 👉
Our most comprehensive, multidisciplinary offering—integrating medical care, mental health support, and lifestyle guidance for women who want a deeply personalized, whole-person approach to midlife health.
Each option is designed to meet women where they are—without assuming a one-size-fits-all solution.
When to Seek Additional Support
If you’re experiencing:
Persistent anxiety or low mood
Emotional volatility that’s impacting relationships or work
Cognitive changes that feel distressing
A sense that “something isn’t right,” even if labs look normal
You deserve support—and options.
Perimenopause is not something to simply push through. With the right care, many women feel more grounded, more confident, and more themselves than they have in years.
If this topic resonates, you may also want to explore our related educational resources or listen to our conversations on the Hysterical Women podcast, where we unpack the realities of midlife health—honestly, clinically, and without minimizing women’s experiences.
Because feeling powerful in midlife starts with being seen, heard, and properly supported.
