Why Didn’t My Doctor Tell Me? Opening the Conversation Around Perimenopause and Mental Health

Updated: 5 days ago

The question caught me off guard, not because it was unusual, but because it’s becoming so common:

“Why are you the first person bringing up perimenopause to me?”

We were troubleshooting her low libido, ongoing fatigue, and a general sense that her emotions felt “off.” I had mentioned the possibility of hormonal shifts last session, and today, she returned with a look of surprise, not frustration, just confusion.

She had seen her doctor. Her gynecologist. Not once had anyone mentioned that perimenopause might be at play.

This is the silence we’re living in.

And it’s all too common.

Years ago, I had a patient bring this very thing into our work. It started with hot flashes, but what scared her most was the brain fog and emotional lability. She was suddenly crying at commercials, lashing out in irritation, and couldn’t hold onto thoughts mid-sentence. She also felt detached, unmotivated, and anxious in ways she couldn’t explain.

These are classic symptoms of perimenopause, but instead of hormonal support, she was handed a prescription for an SSRI. She’d also been offered birth control “just in case” and told maybe she needed to manage her stress better.

That’s the pattern:

Mood swings become depression
Irritability becomes a personality flaw
Cognitive fog becomes “overwhelm”
Sleep disturbances become anxiety
Libido shifts become relationship issues

Too often, the body is ignored and the psyche is pathologized. It’s faster and easier to write a prescription than it is to zoom out and look at what’s changing hormonally. But that shortcut leaves women feeling broken, confused, and unprepared for what their bodies are actually navigating.

For neurodivergent women, this is especially tricky.

Autistic and ADHD women are often already accustomed to being misread, misunderstood, or misdiagnosed. When perimenopause enters the picture, the sensory sensitivities, emotional intensity, executive function issues, and identity confusion that already exist can intensify. The hormonal shifts don’t just bring new symptoms, they amplify what’s already there. And if a provider isn’t attuned to neurodivergence, it’s all too easy to dismiss the experience as anxiety, burnout, or just “being too sensitive.”

Opening the Conversation Around Perimenopause and Mental Health

We Normalize What We Don’t Understand

Most of us didn’t grow up learning what perimenopause was, let alone how it might feel. We were taught that menopause happens “later” and involves hot flashes and no more periods. But we weren’t taught that the decade before menopause, often starting in your mid-30s or early 40s can bring a storm of changes to mood, energy, libido, sleep, weight, and mental clarity.

So when the fog creeps in…

When the anxiety ramps up out of nowhere…

When sex feels different and emotions feel closer to the surface…

We blame ourselves. We assume it’s stress. Parenting. Work. Weakness.

We don’t connect the dots..........because no one showed us how.

What Is Perimenopause, Really?

Perimenopause is the transitional phase before menopause, where estrogen and progesterone begin to fluctuate and decline. It can start as early as your mid-30s and last for years. It doesn’t always look like missed periods. For many women, it shows up first in mood and mental health:

Anxiety and irritability
Depression or crying spells
Panic attacks that seem to come out of nowhere
Trouble sleeping, even if you’re exhausted (tired but wired)
Low libido or vaginal dryness
Brain fog, forgetfulness, or decision fatigue
Unexpected weight gain or changes in body composition
Feeling overwhelmed by things that used to be easy

And yet, many doctors still don’t screen for this. Some aren’t trained to recognize the early signs. Others were taught to only bring it up once a woman’s period is completely irregular or gone.

By then, many of us have already felt lost in our own bodies for years.

Why This Matters for Mental Health

Hormones are messengers. When they shift, everything they communicate: mood, memory, energy, and motivation can feel off.

That’s why you might feel like a different version of yourself.

That’s why the usual tools aren’t working.

And that’s why this conversation has to be part of mental health care.

What You Can Say to Your Doctor

If you’re wondering how to bring this up with your provider, you’re not alone. Here’s a starting place:

“I’ve been noticing changes in my mood, sleep, libido, and energy, and I’m wondering if this could be related to perimenopause. Can we talk about checking my hormone levels or exploring treatment options?”

You might be met with openness or with dismissal. Unfortunately, many women still experience gaslighting when bringing up these symptoms. If that happens, you have every right to seek a second opinion or work with someone who does take a holistic view of your health.

Becoming a Student of Yourself

No one knows your body like you do. That’s why the most powerful thing you can do in this season is get curious.

For neurodivergent women, this process may look different. You might already be tracking sensory overwhelm, executive functioning patterns, or shutdown responses and now you’re layering in hormone-driven fluctuations too. That’s not easy. But it is possible.

Track your cycle (even if it’s irregular). I use the app Lively.
Note sensory shifts, energy levels, and emotional reactivity
Write down moments of brain fog, motivation crashes, or unexplained irritability
Reflect on what feels off in your nervous system—this is where the clues are

When you start to connect the dots, you build language. Language brings validation. And validation brings power, because you can finally name what’s happening and take steps forward.

Coming Up in This Series…

This is just the beginning. In the coming posts, we’ll talk about:

Blood sugar balance and hormone support
Why your anxiety might not be just anxiety
Libido and vaginal changes during the transition
How to nourish your body during perimenopause
Tools to regulate your nervous system during hormonal shifts
And most importantly: how to stop blaming yourself for what no one taught you

Want to Go Deeper?

Here are a few podcast episodes and resources that can support your journey:

Sara Gottfried, MD – The Hormone Cure Podcast
Great for understanding perimenopause through a functional medicine lens.
The Doctor’s Farmacy with Dr. Mark Hyman – Episode with Sara Gottfried
A concise and powerful overview of hormones, mood, and metabolism.
Aviva Romm, MD – Hormone Intelligence
A brilliant book that blends medical expertise and women’s intuition.

Reflection Questions:

Have you been experiencing symptoms you can’t explain?
Do you feel like your provider takes your concerns seriously?
What do you wish you had been taught about your body?

Let’s normalize these conversations, because this transition is too important to be ignored. If you’re navigating perimenopause and need support understanding your symptoms, advocating for yourself, or caring for your mental health, I’d be honored to walk with you.

Yvette is a psychotherapist, Licensed Clinical Social Worker (LCSW), and Certified Mental Health and Nutrition Clinical Specialist (CMNCS) who takes a holistic, neuroscience-based approach to mental health. She is also a current Nutritional Therapy Practitioner (NTP) student, deepening her expertise in the connection between food, hormones, and emotional well-being. She believes in empowering women to understand their bodies, emotions, and well-being through a combination of psychology, nutrition, and sustainable health habits. Through her practice, Nourivida Wellness, she provides concierge mental health services for neurodiverse individuals, couples, and those navigating emotional transitions, including the complex realities of perimenopause.

Curious to learn more?