Hormones and their impact on mental health

With thanks to our member, Lynsey Rous MNCPS (Acc.), for this article.

I sit here at my lap top flushed faced and anxious as I type this. I have had a headache for 4 days and have a stomach full of dread at the thought of leaving the house. No reasoning for any of it but it’s all connected to my fluctuating hormone levels or better known as the joyous phase of perimenopause. That is of course, sarcasm. Sometimes it’s the only way I can cope with the injustice I feel of being forced into a 10-year phase of ‘hormonal transition’ into the menopause. And I class today as one of my better days. And I’ve had the surface level conversations around coping with the menopausal years. They can look like ‘have you considered taking HRT, cutting out caffeine and practicing yoga?’. Though well meaning, none of this advice addresses the real mental health struggles that peri/menopausal women face daily, me included. 

Daily struggles look like forgetting appointments, people’s names and where you are going in the car. Feeling panicked for no apparent reason while socialising seems more challenging and is replaced with involuntary isolation. Normal levels of energy are hijacked by a roller-coaster of debilitating fatigue, nervous internal buzzing and an impending sense of doom. There can be unexplained emotional rage, burn out and sense of overwhelm with the daily routine. The zest for life just disappears and numbness seeps in like fast setting cement. It can create an identity crisis, a deep sense of grief for the person you used to be and a search for a sense of belonging. The mind and body don’t communicate anymore and the rhythm that has carried you effortlessly through life is now tripping you up. The sense of abandonment of self is real and shocking. The impact spreads far and wide into relationships and the workplace while self-esteem and confidence plummet. Not only are the physical symptoms anxiety inducing, but the emotional capacity to cope has nosedived into your own brain fog.

So what’s to blame for this unnecessary chaos? The depletion of Estrogen in the body is the culprit. Who knew this hormone was so vital in the function of a woman’s skeletal, cardiovascular, musculoskeletal, reproductive, immune and nervous systems. 

 

My Story

 

At 43, during lockdown and with no warning, my perimenopausal symptoms savaged my brain and body. Panic attacks, heart palpitations, migraines, tinnitus, brain fog, debilitating joint pain and wording finding became my daily battles. I felt like I was in someone else’s body. I became a shell of my former self within months. Even my relationship with wine had gone sour (it’s a histamine intolerance thing I found out that’s due to estrogen fluctuations causing me migraines, a stuffy nose, hot flushes and anxiety). Just great!

Not understanding that all of these symptoms were related to my depleting hormones, my mental health spiraled. My anxiety was so severe that I thought I had Covid and was convinced I was going to die as no one had answers. It became so severe I called an ambulance. I was convinced that I was having a heart attack because of the heart palpitations, tight chest and hot and cold sweats. I began to dread going to bed and had to endure sleeping upright to prevent my symptoms returning. 

Move forward to 2026 and I now sit in counselling sessions, wondering as a menopausal woman, if I will lose my train of thought and focus while listening to my client. Maybe a hot flush will make an appearance mid-sentence, or I’ll develop heart palpitations so loud that they drown out the conversation. I’ll admit it’s a struggle some days to keep my mind and body in sync to feel grounded enough to stay present. It makes me feel incompetent at my job and I question my ability to deliver a service I know my clients deserve.

However, I decided to reclaim my solution focused attitude (I knew she was in the menopausal fog somewhere). After researching at depth about all things perimenopause and menopause related, going on CPD courses, attending webinars, reading books and listening to endless podcasts I now felt equipped and more confident to hold space for myself as well as my clients.  

The strategies that I have adopted to support my mental health are:

1. I am now honest with myself and use immediacy talk – ‘what’s happening to me right now?’ This has replaced ‘battling through’ and feeling embarrassed at not feeling capable some days to give my all. This has helped reduce my anxiety levels and has increased my capacity for self-compassion in real time.
2. I have increased my awareness of how hormones affect my mental health through educating myself on the parts that estrogen, progesterone and testosterone have on the female body during midlife. The scientific explanation helps me come to terms with the changes. 
3. I practice ‘no guilt’ self-care routines and take care to move my body incorporating somatic techniques in ways that feel right for my nervous system.  Walking in nature wins every time.  
4. I am more mindful and present in my action and acknowledge daily wins
5. I share my experiences with friends who are also menopausal. We send memes that make us giggle and help us not feel alone in our heads
6. I track my symptoms to help figure out my hormonal fluctuations to find patterns that are directly related to low mood and depressive thoughts. I feel more in control when I do this, and I plan my activities around this pattern
7. I now advocate for myself at work and have adopted a more flexible attitude to the counselling modes I use in my practice. This helps accommodate my fluctuating energy levels which in turn supports my emotional resilience. I'm choosing to work from home more often offering phone and online counselling. Reducing my anxiety around driving to a session allows me more time before a session to feel more grounded and attuned to my needs. 
   
    

Supporting clients

Many women come to counselling just flummoxed because their ‘go to’ coping skills don’t work anymore creating a level of anxiety that is unexplainable. As an advocate for women’s health, I approach conversations with clients about hormones and mental health in a direct clear way when it is expressed as a concern by them. In my experience, women in and out of the counselling room welcome a direct invitation to talk about their struggle with their hormones. Midlife hormone fluctuations deeply influence a woman’s frame of mind on a daily basis. Sharing her unique experiences in counselling gives her the opportunity to feel heard and to explore how to find compassion and acceptance for herself again in a time of hormonal turbulence that can last years. 

When working with women, aged around 30 to 50, I have a tab open in my head listening for possible signs of hormonal fluctuations like reduced tolerance levels, previous coping strategies not working anymore, unexplained physical symptoms that are seemingly unconnected and are causing health anxiety while panicking and worrying about things that they didn't before. Having conversations about how hormones can impact the brain and body allows self-awareness and compassion to enter the session. Encouraging access to social media is great for generating awareness of how hormones impact mental health. It supports connection of like-minded women making them feel heard and validated. Counselling sessions add to this sense of feeling heard through creating a dedicated one to one space for women to reclaim their hormones, find connections back to self and to make sense of the changes that are an inevitable part of our biological timeline. Acknowledging that It's a mental and physical transition that can take years to navigate can support a client in coming to terms with the fact that there are no quick fixes.

What women need is connection and compassion. I have found in my work that menopausal women are somehow looking for the permission to put themselves first without feeling guilty. Having the counselling space to say their needs out loud can feel exhilarating, especially when there is no judgment or subjective opinions thrown back. It can somehow give them confidence and self-esteem to put these into practice. This could look like saying to a partner without guilt, ‘I need a night of easy food and a bubble bath’ when feeling overwhelmed. 

As a person centred menopausal counsellor, showing myself, empathy, congruence and unconditional positive regard has ironically saved me from myself. These conditions have created a positive psychological change in me but it’s no easy ride. The rollercoaster still jolts, breaks down, goes too fast or stops suddenly. So, I’m holding on tight and searching for those moments to scream with laughter and cry with exhaustion with the people who get it and with the ones who choose to stay on the ride with me.