Menopause and Perimenopause

You wake at 3 a.m. drenched in sweat and can’t fall back asleep. You snap at the people you love and don’t recognize yourself doing it. Words vanish mid-sentence, and anxiety shows up out of nowhere, in a life that hasn’t otherwise changed. And when you finally bring it up, you’re told your labs look normal, or that every woman goes through this and you should just wait it out.

You shouldn’t have to struggle your way through a transition that can last years. Therapy for perimenopause and menopause gives you a place where your experience is taken seriously, and where you can build real strategies for the mood changes, anxiety, sleep disruption, and identity shifts this stage can bring.

Perimenopause can start earlier than you think

Perimenopause (the hormonal transition leading up to menopause) can begin in your late thirties or early forties and last for many years. Because the early signs are often emotional rather than physical, many women are treated for anxiety or depression for years before anyone connects the moods to hormones. Irritability, rage, tearfulness, brain fog, low motivation, and a sudden loss of confidence are all common, and all real. Understanding what’s happening in your body is often the first relief my clients feel.

More than hormones: grief, identity, and change

The menopause transition is usually only part of the story. It can coincide with children leaving home, caring for aging parents, career crossroads, changes in intimacy and desire, and the definitive end of fertility, which can stir unexpected grief, especially if your reproductive story included infertility or pregnancy loss. Therapy makes room for all of it: mourning what’s ending, and figuring out who you want to be next. There is often a lot more opening up in this stage than pop culture stereotypes may lead you to believe.

How therapy helps

Narrative Therapy is the foundation of my approach, and I add evidence-based tools from Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT). In 2026 I completed specialized training in menopause-related mental health. Research supports CBT in particular for menopausal mood changes, sleep difficulties, and even the distress associated with hot flashes. Therapy can’t stop the hormonal transition, but it can change your relationship to it, so the symptoms stop running your life.

Therapy in Berkeley, Sacramento, and online across California

I offer individual therapy online for adults anywhere in California. If severe premenstrual symptoms, chronic pain, or another health condition are part of what you’re dealing with, you may also want to read about my work with PMDD, chronic pain, and coping with health issues. Use the scheduling link below to book a free 15-minute consultation and see if we are a good fit.

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