The menopause 'meh' - explained

Many of my patients in perimenopause say something like this:

“I don’t feel depressed … I just feel kind of flat.”

I’ve coined this the menopause “meh” and when I say this to patients they often light up because they now have a clear way to describe it AND they realize it’s much more common than they thought.

Not sadness, not despair — just a dulling. A loss of joy. A sense that something is muted and little desire to do much of anything at all.  

If that sounds familiar, you’re not alone — and it’s not your imagination.

MENTAL HEALTH IN PERIMENOPAUSE

When it comes to mood and brain changes in perimenopause, I hear variations of this all the time:

• “I just feel blah. I have no real motivation to do much of anything.”

• “I suddenly feel anxious about things that never used to bother me — or I’ve started having panic around driving or flying.”

• “I can’t focus. My brain feels scattered. I can’t get anything done.”

• “I feel like my brain has gone offline — and I really need it to be sharp again.”

Recently, I worked with a woman in her mid-40s who described brain fog,

fatigue, overwhelm, and crying that seemed to come out of nowhere.

What stood out to me wasn’t that she had a lot going on — because honestly, most women I see do — but how frightening it felt to her.

“I don’t know what’s happening to me. I don’t feel sad, but I can’t stop crying. I can’t think clearly. And the scariest part is that I’m a single mom — I can’t afford to not function, in my life or at work.”

Like many people navigating perimenopause, she wondered if she was the only one feeling this way.  She wondered if she was “losing her mind.”  She wondered if she would ever feel normal again.

These are the stories I hear — in different forms — day after day.  And it’s why the box of tissues is always at the ready on my desk.  

it's not all in your head

What often gets missed in conversations about mental health in midlife is this: during perimenopause, what’s happening isn’t just about stress, mindset, or caregiving load — though those are often a big part of the picture too.

And it certainly isn’t a personal failing.

Perimenopause involves real, predictable physiological changes that affect the entire nervous system, including the brain.

Understanding this context can be deeply relieving.  Not because it makes the symptoms disappear, but because it gives them meaning.  It helps women stop thinking, “This must all be in my head”  even though, yes, it is happening in the brain… just not in the way we’ve been taught to think about it.

What the evidence shows is that:

• Fluctuating estrogen levels affect key brain chemicals involved in mood and emotional regulation

• Changes in progesterone — and its calming metabolites — influence anxiety, irritability, and stress tolerance

• Hormonal shifts often interact with disrupted sleep, amplifying stress, low mood, and emotional reactivity

  
  

From the time we start ovulating, many of us notice that ovarian hormone ups and downs affect how we feel and function — some much more than others. 

In perimenopause, those hormonal patterns often become more erratic and unpredictable, which is why symptoms can feel confusing, frustrating, or completely out of proportion to what’s happening externally.

This is why mental health changes in perimenopause often looks like:

• Increased anxiety or a constant sense of inner agitation

• Low mood, tearfulness, or heightened emotional sensitivity

• Irritability — or feeling less resilient than you once were

• Difficulty concentrating, remembering, or coping under pressure

• Sleep disruption that seems to make everything harder

• And in more severe cases: major depression, panic attacks, increased suicidality, and new diagnoses of previously unrecognized mental health disorders.

Some of us may experience more subtle shifts. Others feel like something truly fundamental has changed.

All experiences are real.

All are valid.

SUPPORT IS NOT JUST A PRESCRIPTION

When I support one’s mental health through perimenopause, I approach it from a few interconnected areas:

Biology: Hormones, sleep quality, nutrition, movement — and when appropriate, evidence-based medical options.

Nervous system: Stress load, recovery, pacing, quality of relationships, and tools that support regulation rather than constant pushing.

Mind & meaning: How we are making sense of these changes, the stories we’re telling ourselves, and the identity shifts that often come with midlife.

Support: Feeling heard and seen, always believed, and not having to navigate this alone — clinically or personally.

There’s no single solution.  But there is a thoughtful, compassionate path forward.

If you’re struggling with your mental health in perimenopause right now, it doesn’t mean you’re failing — and it doesn’t mean this is “just how it is now.”

It means your body and brain are responding to a period of real biological change, and they’re asking for a different kind of support in this season.

There are options.

There is nuance.

And you don’t have to figure this out alone.

A HOPEFUL REMINDER

One of the things I wish I could gently place in everyone’s heart at this stage is this:

What you’re experiencing is not a permanent loss of who you are.

For many, with the right understanding and support

• The fog lifts. 

• The nervous system settles. 

• Sleep becomes more reliable. 

• The emotional swings soften. 

• Confidence returns — sometimes quietly, sometimes all at once.

Often, patients tell me “I finally recognize myself again, even my friends have said, ‘it’s nice to have you back’”.  They say they feel more grounded, more self-aware, and more compassionate with themselves than they ever were before.

That doesn’t mean perimenopause is easy.  And the path certainly is not the same for everyone.

But it does mean that this season can be navigated — thoughtfully, collaboratively, and with care that meets you where you are.

If you’re in the thick of it right now, please know this: feeling better is possible, even if it doesn’t feel that way today.

And you don’t have to walk the path alone.

If this resonates and you’re looking for clarity around your own experience, this is exactly the kind of support I provide — clinically and educationally.

Because perimenopause care is so much more than a prescription, and you deserve care that considers your whole experience — not just a single symptom.